Dietary agents in the prevention of radiation-induced nausea and vomiting (RINV): review addressing the scientific observations, benefits, lacunae and future direction.

PURPOSE: Radiation-induced Nausea and Vomiting (RINV) is an important side effect and conservative estimates are that 50-80% of the patients undergoing curative radiotherapy (RT) will experience some sought of retching, nausea, and/or vomiting during the course of their treatment. Conventionally, antiemetic drugs like the 5-hydroxytryptamine receptor antagonists and steroids are the mainstay of treatment. However, the use of these agents, especially steroids, can cause side effects and thereby negate the proposed benefits. The antiemetic effects of Centella asiatica (Indian pennywort), Hippophae rhamnoides (Sea buckthorn), oil of Mentha spicata (Spearmint) and the rhizomes of Zingiber officinale (ginger) have been addressed. CONCLUSIONS: Results indicate that Indian pennywort, Sea buckthorn, Spearmint oil and ginger are beneficial in mitigating RINV. Also, of the four plants investigated in preclinical models of study, mint oil and ginger seem to be more useful and merit structured systematic translational studies to ascertain the benefit of these two agents.

Pharmacoeconomic Appraisal of Treating Head and Neck Cancer with Various Chemotherapy and Chemoirradiation Regimens Using Branded and Jan-aushadhi Drugs in India.

According to recent studies, head and neck cancers (HNC) make up a substantial proportion of all cancers in India and are proportionately high in the lower socioeconomic people practising tobacco and alcohol. Chemotherapy is a crucial component of treating HNC, and this study was carried out to determine the Cost Minimization Analysis (CMA) by comparing the price of the high and least expensive branded drugs marketed in India. This study was performed to understand the cost difference (CD), Cost ratio (CR) and percentage of cost variation (PCV) of both individual drugs and the standard anticancer regimens. The Current Index of Medical Stores was used to determine the costs of the most and least expensive branded medications and analysed. The results indicated that Paclitaxel-Cisplatin-5 Fluoruracil chemotherapy regimen exhibited the greatest variance in cost, with the Jan Aushadhi brand of medicine costing 8.1 times and 4.3 times less than the most expensive and cheapest branded drugs, respectively. The cost of the concurrent cisplatin regimen with Jan Aushadi Medicine was Rs 1764, Rs 3489.64 with the lowest branded drug, and Rs 8477 with the most expensive branded drug. Also when compared to Jan Aushadhi medication, the cost of Ciplatin was 4.8 times higher with the most expensive branded drug and 2 times higher with the least expensive branded drug. As far as the authors are aware of this is the first study that addresses the pharmacoeconomic appraisal of treating HNC with various chemotherapy and chemoirradiation regimens. This study will help oncologists, pharmacists, and healthcare workers comprehend the financial advantages of treating breast cancer with less expensive chemotherapeutic agents instead of brand-name medications.

Social, Ethical and Treatment Related Problems Faced by Healthcare Workers in the Care of Head and Neck Cancer Patients: A Narrative Review from the Bioethics Consortium from India.

Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties.

Adverse reaction profile of sulfasalazine and its persistence in chronic therapy of rheumatoid arthritis and spondyloarthritis: A multicentric observational study.

OBJECTIVES: Sulfasalazine has been widely used in treatment of rheumatoid arthritis and spondyloarthritis. This study aims to assess persistence with sulfasalazine and also frequency and severity of adverse drug reactions (ADRs) encountered with this very well-established disease-modifying anti-rheumatoid drug. MATERIALS AND METHODS: This retrospective study was done in 1,114 patients from medicine and rheumatology outpatient departments of six centers across India. The inclusion criteria was patients taking sulfasalazine. Patients receiving sulfasalazine for rheumatoid arthritis or spondyloarthritis were selected and details on drugs used, duration of taking sulfasalazine, ADRs to sulfasalazine and whether sulfasalazine had to be stopped due to ADRs were analyzed. RESULTS: Of the total of patients included in the study, 10.1% had ADRs with sulfasalazine, and stopped the drug. Gastritis, deranged liver enzymes, hepatitis, skin rashes were the most commonly encountered ADRs. Of the total number of patients recruited for the study, 11% were lost to follow-up, as most of the centers were army hospitals and the officers and staff were posted to other places. Sulfasalazine was taken for less than 1 month by 3.8% patients while 12.5% had taken the drug for less than 6 months. Of the study patients, 28.6% had taken the drug for 24 - 60 months and 4.6% (51 patients) had taken it for more than 5 years. It was found that ADRs were most commonly encountered within the first year of using the drug, and persistence was seen in patients on long-term therapy. CONCLUSION: Sulfasalazine is a safe option in chronic therapy of rheumatoid arthritis and spondyloarthritis. Although frequency of ADRs with patients taking sulfasalazine is minimal, it did necessitate the stoppage of drug. If not well tolerated, sulfasalazine would not have been continued for more than 12 months as evidenced from this study.

Evaluation of the anti-hyperlipidemic effects of Triphala in high fat diet fed rats: Studies with two combinations.

Background: Hyperlipidemia is one of the major risk factors for coronary heart disease and stroke. Triphala, a polyherbal Ayurvedic formulation made from dried fruits of Haritaki (Terminalia chebula Retz.), Bibhitaki (Terminalia bellirica Roxb.), and Amalaki (Phyllanthus emblica Gaertn.) has been suggested to be useful in mitigating hyperlipidemia. In the Ayurveda texts, depending on the patient's condition and body type, Triphala is formulated and used in one of the two combination (1:1:1 and 1:2:4 of individual constituents) forms. Aims: The present study aimed at evaluating the efficacy of two combinations (1:1:1 and 1:2:4 of individual constituents) of Triphala against high fat diet induced-hyperlipidemia in rats. Materials and method: Hyperlipidemia was induced in Spraque-Dawley albino rats by feeding them with high fat diet. The animals were concomitantly administered with graded dose of one of the two combination (combination of Haritaki, Bibhitaki, and Amalaki in ratio of 1:1:1 or 1:2:4, respectively) of Triphala (250, 500, or 1000 mg/kg body wt.) or atorvastatin. The animals were sacrificed on day 22 and serum was processed for lipid profile and the liver for lipid peroxidation. The statistical analysis was performed by the mean analysis of variance followed by Dunnet's test. Results: The results indicated that when compared to placebo group, levels of serum total cholesterol, and triglyceride were significantly lower, while high-density lipoprotein cholesterol increased in both the Triphala combination and atorvastatin groups. Of the two groups of Triphala, the formulation having 1:2:4 ratio was better than the 1:1:1. The group having highest drug dose (1000 mg/kg body wt.) of 1:2:4 formulation was better than atorvastatin in rectifying high fat diet-induced dyslipidemia and the atherogenic index was equal to that of atorvastatin. Conclusions: The results of the study indicate that of the two Triphala formulations, the 1:2:4 ratio was better than the 1:1:1 ratio for anti-hyper-lipidemic effects.

Financial audit of wastage of anticancer drugs: Pilot study from a tertiary care center in India.

PURPOSE: Drug wastage is a major concern in oncology where costs of antineoplastic drugs are exorbitant, and the disposal of toxic drugs increases the chances of occupational hazards to healthcare and sanitary workers and environmental pollution at the site of disposal. The principal objective of this study was to ascertain the extent of drug wastage and calculate its financial costs. MATERIALS AND METHODS: This was a prospective pilot study conducted to ascertain the quantity of drug wastage in a tertiary care hospital. This pilot study was conducted in day care and inpatient facilities in February 2016. The prescription of cytotoxic drugs, recommended dose, the quantity used, and remainder (waste) left were recorded from the nurses and pharmacy files of the hospital. Cost evaluation of the actual use and the waste was undertaken and an audit was conducted to understand in which anticancer drug the maximum wastage was generated. RESULTS: The results of this study indicated that 6.1% of the total amount of reconstituted drugs was wasted. The highest drug wastage was observed in trastuzumab (29.55%), followed by etoposide (20.4%), dacarbazine (17.14%), daunorubicin (16.67%), and carboplatin (11.29%). Cost analysis showed that the total cost of the drug issued during the study period was Rs. 1,294,975 and the cost of drug wastage amounted to Rs. 143,820 (11.1%). CONCLUSION: To the best of authors' knowledge, this is the first study from India and the results indicate that the financial impact of anticancer drug wastage was substantial. Attempts should be directed at minimizing the wastage and cost savings without risking patients' treatment regimen and administering effective dose schedule.

An Aloe Vera-Based Cosmeceutical Cream Delays and Mitigates Ionizing Radiation-Induced Dermatitis in Head and Neck Cancer Patients Undergoing Curative Radiotherapy: A Clinical Study.

Background: This study was planned to evaluate the efficacy of topical application of an Aloe vera-based cream (AVC) for the prevention of ionizing radiation (X ray)-induced dermatitis in head and neck cancer patients requiring therapeutic radiation treatment (>62 Gy). Methods: From July 2012 to December 2012, a total of 60 head and neck cancer patients requiring curative radiotherapy (RT) of more than 66 Gy were prospectively enrolled and treated with AVC or a comparator Johnson's Baby Oil (JBO). Acute skin reaction was monitored and classified according to the Radiation Therapy Oncology Group (RTOG) four-point rating scale on a weekly basis. Results: The results indicate that there was a statistically significant delay in the incidence (p = 0.04) of dermatitis at week three in the AVC application group. Application of AVC reduced the incidence of Grade 1, 2, and 3 dermatitis at subsequent time points, while Grade 4 dermatitis was not seen in either cohort. The other most important observation was that the continued application of AVC two weeks after the completion of RT was effective in reducing the average grade of dermatitis and was statistically significant (p < 0.02). Conclusions: Prophylactic use of an AVC-based cream is thus effective in delaying radiation dermatitis in head and neck cancer.

Sandalwood Oil and Turmeric-Based Cream Prevents Ionizing Radiation-Induced Dermatitis in Breast Cancer Patients: Clinical Study.

Background: The primary objective of this study was to ascertain the benefit of Vicco turmeric Ayurvedic cream (VTC; Vicco Laboratories, Mumbai, India) sandalwood oil and turmeric-based cream in preventing radiodermatitis in women undergoing curative radiotherapy for their breast cancer. Methods and Materials: The study was an investigator-blinded randomized study with Johnsons Baby Oil (JBO; Johnson & Johnson Ltd., Baddi, India) as a comparator, administered daily from the start of radiation therapy for 5 weeks in women receiving breast radiation therapy, 50 Gy in 2 Gy fractions daily for 5 weeks. The endpoints were to ascertain the delay in the appearance and the degree of severity of dermatitis throughout the study period in accordance to the Therapy Oncology Group (RTOG) score. Results: The results indicated that the topical application of VTC delayed and mitigated the radiodermatitis. When compared to the Johnson's Baby Oil, a significant decrease (p = 0.025) in the incidence of grade 1 was seen at week two, and also in grade 2 and 3 at week 3 (p = 0.003) and week 4 (p = 0.02), respectively, in the VTC cohort. A concomitant decrease in the average severity was also observed at week 2 (p = 0.02), week 3 (p = 0.05) and week 4 (p = 0.03). CONCLUSIONS: The results indicate that VTC cream significantly reduces radiation dermatitis when applied to the breast during and after radiation therapy. The result of this study indicates the beneficial effects. Double blind randomized control studies are required to further confirm the beneficial effects of VTC in mitigating radiodermatitis is people undergoing radiation treatment for their cancer.

The medicinal use of venoms and toxins.

Venoms have long since been known to have therapeutic value. Venoms have been characterised into their individual components and each of their functions extensively studied. These components of venoms and toxins show potential as antihypertensive, anticoagulant, fibrinolytic, anticancerous, immunomodulators, muscle relaxant, etc. Only the most promising and FDA approved and therapeutic options have been discussed here eg, hannalgesin, epibatidine, ancrod, lepirudin, fibrolase, lebecetin, pseutarin, captopril, eristostatin, botox.

Rasayana drugs from the Ayurvedic system of medicine as possible radioprotective agents in cancer treatment.

The use of ionizing radiation, which is the cornerstone of cancer treatment, is compromised by the radiosensitivity of normal tissues. A chemical that can give selective benefit to the normal cells against the deleterious effects of ionizing radiation has been a long-sought goal. However, most of the compounds studied have shown inadequate clinical application owing to their inherent toxicity, undesirable side effects, and high cost. Studies carried out in the past 2 decades have shown that some of the classical Indian Ayurvedic drugs (Amritaprasham, Ashwagandha Rasayana, Brahma Rasayana, Chyavanprasha, Narasimha Rasayana, and Triphala Churna) possess radioprotective effects. In the current review, an attempt is made to summarize the radioprotective observations of these Ayurvedic drugs and the mechanisms responsible for the radioprotective effects.

Ginger in the prevention of nausea and vomiting: a review.

Nausea and vomiting are physiological processes experienced by every human being at some stage of their life. They are complex protective mechanisms and the symptoms are influenced by the emetogenic response and stimuli. However, when these symptoms recur frequently, they can significantly reduce the quality of life and can also be detrimental to health. The existing antiemetic agents are ineffective against certain stimuli, are expensive, and possess side effects. Herbal medicines have been shown to be effective antiemetics, and among the various plants studied, the rhizome of Zingiber officinale, commonly known as ginger, has been used as a broad-spectrum antiemetic in the various traditional systems of medicine for over 2000 years. Various preclinical and clinical studies have shown ginger to possess antiemetic effects against different emetogenic stimuli. However, conflicting reports especially in the prevention of chemotherapy-induced nausea and vomiting and motion sickness prevent us from drawing any firm conclusion. The current review for the first time summarizes the results. An attempt is also made to address the lacunae in these published studies and emphasize aspects that need further investigations for it to be of use in clinics in the future.

Are medical students inclined to do research?".

BACKGROUND: Medical research at undergraduate level has been given poor importance in developing countries including India. Less incentives, poor resources, lack of benefits has all been the reason for curbing the research interests of the students. OBJECTIVE: This research was done to understand if medical students perceived research to be important at an undergraduate level, to understand the reasons for doing research and the benefits obtained from research. STUDY DESIGN: Cross sectional study. MATERIAL AND METHODS: Questionnaires were distributed to medical students studying in second, third, fourth and fifth years in the MBBS course at an undergraduate medical conference and a medical college. Questions were so designed to verify student's ideas on research, their research involvement and their reasons for conducting research. The answers were tabulated, data analyzed and statistics were made based on their answers. STATISTICAL ANALYSIS: Frequency and percentage. RESULTS: Out of the given sample, it was seen that though only 20.9% of the students had credited publications, 81.7% of the students admitted to research being essential to understanding and changing their perception of medicine. Only 38.3% of the sample found research to be cumbersome. 24.3% of the students were involved in research purely for the purpose of acquiring knowledge, 18.3% were pursuing interest in the field and a meager 1.7% were doing research to improve their curriculum vitae. Conclusion : These results are in conformance with other studies from elsewhere that shows decreased Indian medical student's engagement in researches, compared to those from developed countries, but on par with those from the developing countries.

Scientific validation of the ethnomedicinal properties of the Ayurvedic drug Triphala: a review.

Triphala, a herbal formula composed of the three fruits of Terminalia chebula Retz. (Haritaki, Family: Combretaceae), Terminalia bellirica Roxb. (Bibhitaki, Family: Combretaceae) and Phyllanthus emblica Linn. or Emblica officinalis Gaertn. (Amalaki or the Indian gooseberry, Family: Euphorbiaceae) is considered to be a universal panacea in the traditional Indian system of medicine the Ayurveda. It has been described in the Ayurveda text as a "Rasayana' and to rejuvenat the debilitated organs. Ayurvedic physicians use Triphala for many ailments but most importantly to treat various gastrointestinal disorders. Scientific studies carried out in the past two decades have validated many of the ethnomedicinal claims and researches have shown Triphala to possess free radical scavenging, antioxidant, antiinflammatory, antipyretic, analgesic, antibacterial, antimutagenic, wound healing, anticariogenic, antistress, adaptogenic, hypoglycaemic, anticancer, chemoprotective, radioprotective and chemopreventive effects. Clinical studies have also shown that Triphala was found to have good laxative property, to improve appetite and reduce gastric hyperacidity. Studies have also shown that Triphala was effective in preventing dental caries and that this effect was equal to that of chlorhexidine. The current review addresses the validated pharmacological properties of Triphala and also emphasizes on aspects that need further investigation for its future clinic application.

Pharmacotherapy for weight management.

Weight management means lifestyle modification, behavioral therapy, pharmacotherapy and surgery. Drugs have wide ranging side effects and contraindication for its widespread use. Orlistat and sibutramine are the most popular in the present day context. Anti depressants especially fluoxetine is a valuable adjunct for therapy of obesity. There are many newer concepts in weight management and these are mainly hormonal and receptor based, thereby reducing the uncalled adverse effects of drugs like orlistat and sibutramine. Anti-obesity vaccine, an immunotherapy to be looked out for.

Medicinal plants as antiemetics in the treatment of cancer: a review.

Chemotherapy- and radiotherapy-induced nausea and vomiting are the most common, intractable and unpleasant side effects in patients undergoing treatment for cancer. 5-Hydroxytryptamine-3 (5-HT3) receptor antagonists plus dexamethasone have significantly improved the control of acute nausea and vomiting, but delayed nausea and vomiting remains a significant clinical problem. Combined neurokinin-1 receptor antagonists with 5-HT3 antagonists and steroids are observed to be better in the control of both acute and delayed emesis. However, the use of these antiemetics is observed to possess inherent side effects. The medicinal plants such as Scutellaria baicalensis, Korean red ginseng, American ginseng berry, Ganoderma lucidum, Zingiber officinale, grape seed extract, and the oil of Mentha spicata are reported to be effective in the treatment of nausea and vomiting mostly in preclinical studies. Of these, ginger has also been evaluated for its efficacy in humans and the results have been contradictory. The current review for the first time summarizes the results related to these properties. An attempt is also made to address the lacunae in these published studies and to emphasize aspects that need further investigations for these plants to be of use in clinics in the future.

Status of disulfiram in present day alcoholic deaddiction therapy.

AIM: Assessment of safety and efficacy profile of disulfiram (DSM) in the alcoholic de-addiction regimen. OBJECTIVES: a. Assessment of Adverse Drug Reaction (ADR) profile; b. Evaluation of effectiveness of various deaddiction regimen; c. Defaulters and dropouts PATIENTS AND METHODS: Fifty-one patients in a de-addiction center were investigated on 0(th) , 30(th) and 60(th) day along with psychiatric evaluation, ADR surveillance was made. Statistical analysis was done thereafter. RESULTS: 125 mg DSM given OD for 2 months. 76.5% patients had taken full course of treatment, 45% didn't complain of any ADR. Of ADR reported 27.4% had drowsiness, 21.4% tiredness, 7.8% skin manifestation. CONCLUSION: DSM is the main drug among naltrexone, acamprosate, nalmefene and other drugs used in alcoholic de-addiction. Relative and effectiveness is lost by the degree of dropouts and hence relapses. Low-dose DSM had decreased adverse effects with 76.5% patients taking the full course of treatment. DSM alters liver functions as there were significant changes in the lab parameters of SGPT(P=0.007), SGOT(P=0.001), GGT(P=<0.001) between first and third samples. Occurrence of ADR is not the cause of default; patients find it confusing to differentiate between the symptoms of alcohol withdrawal and those due to ADR of DSM.