DocumentsDate added
Research article:
Dosunmu Adedoyin O1,*, Daniel Folashade A2 , Richards Atinuke K1, Arogundade Olarenwaju1, Akinbo Akinyemi2, Bonadventure Basil1,Oke David A3
Affiliation:-
1Department of Hematology, Lagos State University College of Medicine. 1 Oba Akinjobi street, P.M.B. 21266 Ikeja, Lagos. Nigeria
2Department of Medicine, Lagos State University College of Medicine, 1 Oba Akinjobi street, P.M.B. 21266 Ikeja, Lagos. Nigeria
3Chief Medical Director’s Office Lagos State University Teaching Hospital, 1 Oba Akinjobi street, P.M.B. 21266 Ikeja, Lagos. Nigeria
The name of the department(s) and institution(s) to which the work should be attributed:
Lagos State University College of Medicine,1 Oba Akinjobi street, P.M.B. 21266 Ikeja, Lagos. Nigeria
*To whom it corresponds:-
Dr. Dosunmu Adedoyin O.
Department of Hematology, Lagos State University College of Medicine,1 Oba Akinjobi street, P.M.B. 21266 Ikeja, Lagos. Nigeria
E mail Address: doyin_dosunmu@yahoo.com
Abstract
Objective: To compare the anti platelet aggregation effect of clopidogrel (CPG) and aspirin (ASP) in stable hypertensive patients.
Method: A randomized, crossover and blinded study was conducted in hypertensive patients attending the outpatient clinic between January and March 2013. Patients were randomly assigned to take 75mg of CPG and 150mg of ASP once daily for two weeks. After a 2 week wash out period, subjects were switched. Platelet aggregation test was run every 2 weeks. The primary end point was percent inhibition of maximum platelet aggregation while the secondary end points were the incidence of adverse events and changes in the hematological and biochemical profiles.
Results: Thirty two patients were enrolled and 4 were lost to follow up. The inhibition of maximum aggregation tended to be higher in patients treated with clopidogrel than those on aspirin (36.7% vs. 25.4%; p=0.06). There were more patients who achieved more than 30% inhibition while on clopidogrel than aspirin (51.9% vs. 25.9%; p= 0.05). At the end of the study, there was significant reduction in hemoglobin, erythrocyte sedimentation rates, fasting blood sugar and prothrombin time international normalized ratio but values were within normal ranges.
Conclusion: This study supports the existing view that both aspirin and clopidogrel reduce platelet aggregation effectively with minimal but comparable adverse events. There is a wide individual variation in the efficacy of these drugs. It is therefore suggested that, platelet aggregation studies be done on patients in order to ensure the efficacy of medications and to avoid their undue usage.
Keywords: Aspirin; clopidogrel; inhibition of platelet aggregation; platelet aggregation test.
REFERENCES
1.Antithrombotic Trialists Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ. 2002; 324: 71–86.
2.Behan M W H, Storey R F. Antiplatelet therapy in cardiovascular disease. Postgrad Med J. 2004; 80: 155-1642.
3.Brook R.D, Julius S. Autonomic imbalance, hypertension and cardiovascular risk. Am. J. Hypertens. 2000; 13: 1128.
4.Catella-Lawson F, Reily MP, Kapoor SC et al. Cyclooxygenase inhibitors and the antiplatelet effect of aspirin. N Engl J Med 2001, Dec 20; 345: 1809-17
5.Celi A, Pellegrini G, Lorenzet R, De Blaisi A, Ready N, Furie B C, Furie B. P-selectin induces the expression of tissue factor on monocytes. Proc. Natl Acad Sci USA. 1994; 91: 8767-8771.
6.Cermuzynsky J. Col, Commerford P.J, Diaz R, Flather M, Franzosi M.G, Gersh B, et. Al. CURE Study Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001; 345: 494–502.
7.Denninger MH, Necciari J, Serre-Lacroix E, Sissmann J. Clopidogrel antiplatelet activity is independent of age and presence of atherosclerosis. Seminar in thrombosis and haemeostatsis. 1999; 25 Supply, 2: 41-5.
8.Eugenia Gkaliagkousi, Gabriella Passacquale, Stella Douma, Chrysanthos Zamboulis, Albert Ferro. Platelet activation in hypertension: Implications for antiplatelet treatment. American Journal of Hypertension. 2010; 233: 229-236.
9.Gawaz M, Langer H, May A E. Platelet in inflammation and arterosclerogenesis. J Clin Invest. 2005; 3378-3384.
10.Gent M, Beaumont D, Blanchard J, Bousser M.G, Coffman J, Easton J.D, et al, CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events. Lancet. 1996; 348: 1329-39.
11.Hanson L, Zanchetti A, Carruthers S G, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn K H, Wedel H, Westerling S. HOT Study Group Effects of intensive blood pressure lowering and low dose aspirin in patients with hypertension: principal result of the hypertension optimal treatment (HOT)randomized trial.. Lancet. 1998; 351: 1755-1762.
12.Klinkhardt U, Bauersachs R, Adams J, Graff J, Lindhoff-Last E, Harder S. Clopidogrel but not aspirin reduces P-selectin expression and formation of platelet-leikocyte aggregation in patients with atherosclerotic vascular disease. Cin Pharmacol Ther. 2003; 73: 232-241.
13.Leslie V Parise, Susan S Smith, Arun S Shet, Barry S Coller. Platelet morphology, biochemistry, and function. Williams Haematology. 7th Edition. Mc Graw-Hill Companies Inc. 2006; pp 1587-1635.
14.Lorddzipanki M, Pharand C, Nguyen T A, et al. Comparison of four tests to assess inhibition of platelet function by clopidogrel in stable coronary artery disease. Eur Heart J. 2008; 29: 2877-2885
15.Medical Research Council’s General Practice Research Framework. Thrombosis prevention trial of low intensity oral anticoagulation with warfarin and low dose aspirin in the primary prevention of ischemic heart disease in men at increased risk. Lancet. 1998; 24: 233-241.
16.Radomski MW, Palmer RM, Moncada S. Endogenous nitric oxide inhibits human platelet adhesion to vascular endothelium. Lancet. 1987; 2: 1057-1058.
17.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee.Hypertension. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.2003 Dec;42(6):1206-52. Epub 2003 Dec 1.
18.Touyz RM, Schiffrin E.L. Effects of angiotensin II and endothelin-1 on platelet aggregation and cytosolic Ph and free calcium ion concentrations in essential hypertension. Hypertension. 1993; 22: 853-862
19.Wei C L, Paul A G, Paul B W, Charlene J Neer, Amy S Hopp, David G M Carville, Kirk E Guver, Allan R Tait. Contribution of Hepatic Cytochrome P450 3A4 Metabolic Activity to the Phenomenon of Clopidogrel Resistance. Circulation. 2004; 109: 166-171.
20.Yun KH, Rhee SJ, Park HY, Yoo NJ, Kim NH, Oh SK, Jeong JW. Effects of omeprazole on the antiplatelet activity of clopidogrel. International Heart Journal. 2010, Jan.; 51(1): 13-6.
Source of support: Kalbe International, Nigeria
Competing interest / Conflict of interest
The investigators are all staff of Lagos State University and the Teaching Hospital. They have no financial commitment with Kalbe International, Nigeria or any other entity mentioned above that may constitute a conflict of interest. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Copyright © 2014 Dosunmu AO, Daniel FA, Richards AK, Arogundade OA, Akinbo A, Bonadventure B et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case Report
Ajay K Yadlapalli 1,*, Veeranjaneyulu P2, Krishna Santosh B3,Haseena Md4, Asif Mahajan5
Affiliation:-
1Ajay K Yadlapalli, Assistant Professor, Department of ENT, 2Veeranjaneyulu P, Professor & Head, Department of ENT,3Krishna Santosh B, Senior Resident, Department of ENT,4Haseena Md, Junior Resident, Department of ENT,5Asif Mahajan, Junior Resident, Department of ENT, GSL Medical College, Rajanagaram, Rajahmundry, Andhra Pradesh–533 296,India
The name of the department(s) and institution(s) to which the work should be attributed:
GSL Medical College, Rajanagaram, Rajahmundry, Andhra Pradesh – 533 296, India
Author’s contributions
All of the authors drafted, revised the article and approved the final version.
*To whom it corresponds:
Dr. Ajay Kumar Yadlapalli,
Assistant Professor, Department of ENT,
GSL Medical College, Rajanagaram, Rajahmundry
Andhra Pradesh – 533 296, India
Contact no: +91-9966526322
Abstract: Laryngeal tuberculosis is a rare form of extrapulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis.
It has been estimated that laryngeal TB accounts for less than 1% of all TB cases and may present as a primary infection or secondary to pulmonary tuberculosis.
Due to uncommon clinical presentations and lack of clinical suspicion, laryngeal TB is frequently confused with other laryngeal diseases such as chronic laryngitis and laryngeal carcinoma.
Here we present a case of a 32yr old male, daily labourer with laryngeal tuberculosis secondary to pulmonary tuberculosis. The approach to diagnosis and the treatment was presented followed by discussion on clinico-pathological features of laryngeal tuberculosis and the importance of its early diagnosis.
Keywords: Antituberculous agents; carcinoma; Dysphonia; laryngeal tuberculosis; mycobacterium tuberculosis; stridor; vocal cords.
REFERENCES
1.Ismael Kassim, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.
2.Scott-Brown’’s Otolaryngology; 6th edition; volume 5; pg no 5/5/14-5/5/15.
3.Changing trends in clinical manifestations of laryngeal tuberculosis Jung-eun et al; The Laryngoscope; Volume 110; Issue 11; pg no. 1950-1953; November 2000.
4.Case report: Acute tuberculous laryngitis presenting as acute epiglottitis El Beltagi Ah etal Indian journal Radial Imaging 2011, October 21st; Volume 4; pg no.284-286.
5.Tuberculosis, S.K.Sharma , A. Mohan 1st edition : 2001 page no : 288–292.
6.Kulkarni Neeta et al., Epidemiological and clinical study of ENT tuberculosis reported that the commonest presenting feature in all the patients was hoarseness. J Laryngol Otol. 2001; 115(7):555-558.
7.Rajat Bhatia et al., Tubercular laryngitis: case series, Indian J. Otolaryngol. Head Neck Surg.(October–December 2008) 60:331–334.
8.Khan KA, Khan NA, Maqbood M, Otorhinolaryngological Manifestation of Tuberculosis, JK science, July-september 2002;4(3):115-118.
9.Galletti F et al., Laryngeal tuberculosis: considerations on the most recent clinical and epidemiological data and presentation of a case report, Acta Otorhinolaryngol Ital. 2000 Jun;20(3):196-201.
10.Varshney S, Hasan SA. Clinico – Histopathological study of Laryngeal Biopsies. SDMH Journal.1995;19:140–141.
11.Anil Mehndiratta et al., Primary tuberculosis of larynx, Ind J Tub 1997;44:211-212.
12.Keyvan Kiakojuri, Mohammad Reza Hasanjani Roushan, Laryngeal tuberculosis without pulmonary involvement : Caspian J Intern Med. 2012;3(1):397-399.
Article citation:
Yadlapalli AK, Veeranjaneyulu P, Krishna SB,Haseena Md, Mahajan A, Laryngeal Tuberculosis: A Rare Case Report. J Pharm Biomed Sci 2014; 04(06):497-501.
Source of support: None
Competing interest / Conflict of interest
The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Copyright © 2014 Yadlapalli AK,Veeranjaneyulu P,Krishna SB,Mahajan A, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Research article
Aruna Pancharia1,*, Vandana Yadav2, Charu Taneja3, Sunanda Chauhan4, Rupa Chauhan5 ,Vinod Gauttam6
Affiliation:-
1M.D. Scholar, Department of Pathology Geetanjali Medical College & Hospital, Udaipur (Raj.), India
2M.D. Scholar, Department of Pathology M. G. Institute of Medical Sciences Sewagram Wardha Maharashtra, India
3Assistant Prof. Department of Anatomy Geetanjali Medical College & Hospital, Udaipur (Raj.), India
4Assistant Prof. Department of Pathology Geetanjali 5Medical College & Hospital, Udaipur (Raj.), India
DCP, Department of Pathology Geetanjali Medical College & Hospital, Udaipur (Raj.), India
6Medical officer at Savina Khera PHC Udaipur, India
The name of the department(s) and institution(s) to which the work should be attributed:
1. Department of Pathology, Geetanjali Medical
College & Hospital, Udaipur (Raj.), India
2. Department of Pathology M. G. Institute of Medical
Sciences Sewagram Wardha Maharashtra, India
3. Departments of Anatomy Geetanjali Medical
College & Hospital, Udaipur (Raj.), India
4. Medical College & Hospital, Udaipur (Raj.), India
Authors contributions
All of the authors drafted, revised the article and approved the final version.
*To whom it corresponds:-
Dr. Aruna Pancharia.
Department of Pathology Geetanjali Medical College & Hospital, Udaipur (Raj.), India
Abstract
Introduction: Lung cancer is one of the commonest malignant neoplasm all over the world. lt accounts for more cancer deaths in both men and women worldwide than any other cancer and is increasingly being recognized in India. Lung cancer is one of the leading causes of death in western countries and In India also, lung cancer is most common in males in all urban registries. Fiberoptic bronchoscopy has an excellent result in diagnosis of lung cancer when combined with brushing cytology & biopsy.
Method: A total of 58 cancer positive biopsies were included in this study on whom bronchoscopy was performed specimens were collected over the period of 2 year. Bronchial brushing, biopsy specimens were collected & processed accordingly.
Results: Out of 58 malignant cases, the most common was the squamous cell carcinoma (58.62%), followed by adenocarcinoma (18.96%), small cell carcinoma (12.06%), miscellaneous (8.62%) & large cell carcinoma (1.72%). There were 53 male & 5 female with male to female ratio 10.6. The average age of the cases ranged from 21 years to 86 years, the average age being 59 years. Thus, cytohistological correlation was done in 58 malignant cases.
Conclusion: Bronchial biopsy has better detection rate than brushing cytology in this study. Bronchial brushing cytology is an inexpensive, less invasive, quick and effective diagnostic tool in detection of lung cancer. However combination of these modalities gives higher detection rate for bronchoscopically visible tumor. Therefore, bronchial brush cytology should be performed whenever possible in all suspected cases of lung cancer.
Keywords: Bronchial brushing cytology; bronchial biopsy; lung cancer.
REFERENCES
1.Sweta Kasana, comparative study of bronchial washings, bronchial brushings and bronchial biopsies in diagnosing centrally located carcinoma lung, M.D. thesis in Sawai Mansingh Medical College Jaipur, Rajasthan 2012.
2.Eva Piya, Geeta Sayami, Brajendra Srivastava. Correlation of bronchial brushing cytology with bronchial biopsy in diagnosis of lung cancer. Medical Journal of Shree Birendra Hospital 2011;10(2):4-7.
3.DS Gaur, NC Thapliyal, S Kishore, VP Pathak. Efficacy of broncho-alveolar lavage and bronchial brush cytology in diagnosing lung cancer. Journal of cytology 2007;24:(2):73-77.
4.Johnston WW, Elson CE. Respiratory tract.in: Bibbo M ,Editor,Comprehensive Cytopathology. 2nd ed. Philadelphia: WB Saunder company ;1997.P 325-401
5.Gaber KA. Cytologic examinati on of whole endobronchial brush in bronchoscopic diagnosis of lung cancer. Respiratory Medicine. 2002;96(4):259-61.
6.Thomas LP. Sputum cytology for early diagnosis of lung cancer.Current Opinion in Pulmonary Medicine. 2003;19(40):309-12.
7.Kawaraya M, Gemba K, Ueoka H, Nishii K, Kodani T. Evaluation of various cytological examinati ona by bronchoscopy in diagnosis of peripheral lung cancer. British Journal of Cancer.2003; 89:1885-88.
8.Sayami G. Sayami P. Bronchial brushing cytology in suspected lung cancer. JNMA.1993; 31:132-7.
9.Ramesh C,Prakrita Bhushan P, Devkota Kc. Clinical & Histocytological Profi Le Of 200 Consecuti Ve Video Bronchoscopies. Nepal Medical College Journal 2002;4(2):64-67.
10.Saita S. Bronchial Brushing Biopsy: A Comparative Evaluation in Diagnosing Visible Lesions .Eur.J.Cardithoracic Surg.1990; 4(5):270-72.
11.Minoru Matsuda, Takeshi Horai, Shinichiro Nakamura, Bronchial Brushing And Bronchial Biopsy: Comparison Of Diagnostic Accuracy And Cell Typing Reliability In Lung Cancer Thorax 1986;41:475-478.
12.Ashok K, Tanwani, H Anwar Ul. Correlati On Of Bronchial Brushing and Biopsy in Lung Lesions. Pakistan J Med Res.2000; 39(3)1:15-20.
Article citation:
Pancharia A, Yadav V, Taneja C, Chauhan S, Chauhan R, Gauttam V. A study of correlation of bronchial brushing cytology with bronchial biopsy in diagnosis of lung cancer. J Pharm Biomed Sci 2014; 04(06):492-496. Available at www.jpbms.info.
Copyright © 2014 Pancharia A, Yadav V, Taneja C, Chauhan S, Chauhan R, Gauttam V. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Source of support: None
Competing interest / Conflict of interest
The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Case report:
Muhittin Serkan Yilmaz1, Miray Baba1, Cemil Kavalcı2,*, Fevzi Yılmaz1, Müge Sonmez1,
Gulsüm Kavalci3,Bahattin Işik4, Bahadir Danişman5
Affiliation:-
1Numune Training and Research Hospital, Emergency Department, Ankara/Turkey
2Baskent University Faculty of Medicine, Emergency Department, Ankara/Turkey
3Yenimahalle state Hospital, Anesthesia Department, Ankara/Turkey
4Keciören Training and Research Hospital, Emergency Department, Ankara/Turkey
5Okmeydani Training and Research Hospital, Emergency Department, Istanbul/Turkey
The name of the department(s) and institution(s) to which the work should be attributed:
1.Numune Training and Research Hospital, Emergency Department, Ankara/Turkey
2.Baskent University Faculty of Medicine, Emergency Department, Ankara/Turkey
3.Yenimahalle state Hospital, Anesthesia Department, Ankara/Turkey
4.Keciören Training and Research Hospital, Emergency Department, Ankara/Turkey
5.Okmeydani Training and Research Hospital, Emergency Department, Istanbul/Turkey
*To whom it corresponds:-
Dr.Kavalci Cemil1, (Asoc.Prof)
Baskent University Faculty of Medicine, Emergency Department, Bahcelievler/Ankara/Turkey
Phone:+90 505 5762819
Fax;+90 312 223 6439
Abstract
Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of antipsychotic drug use. Its incidence varies between 0.07% and 2.2%. We aimed to report a case with NMS that developed after use of clozapine, an atypical antipsychotic agent.
Case: A 36-year-old man presented to emergency department with fever, sweating, difficulty in breathing, excessive muscle contractions, impaired speech, and altered consciousness. Approximately 10 days before he had been begun on clozapine (leponex) and ketiapin (seroquel) at a psychiatry clinic. Nearly 1 week after therapy onset he began to have loss of appetite, diffuse sweating, tremor in whole body including hands, and fever. He also began to have difficulty in breathing and altered consciousness three days before his presentation. On physical examination his body temperature was 42 0C, pulse rate 165 bpm, and blood pressure 90/50mmHg. CK-total: 973 U/L. Having reached a presumed diagnosis of neuroleptic malignant syndrome, we requested a neurology consultation.
Conclusion Risk of NMS should be taken into account at the time of starting antipsychotic medications and changing their doses in all patients.
Keywords: Emergency; neuroleptic malignant syndrome; atypical antipsychotic.
REFERENCES
1.Bottoni TN. Neuroleptic malignant syndrome: A brief review. Hosp Physician 2002; 38:58-63.
2.Kasantikul D, Kanchanatawan B. Neuroleptic malignant syndrome: a review and report of six cases. J Med Assoc Thai 2006; 89:2155-2160.
3.Kunz M, Gomes FA, Tramontina JF, Kapczinski F. Late-onset neuroleptic malignant syndrome in a patient using olanzapine. J Clin Psychopharmacol 2007;27:303-4.
4.Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T. Neuroleptic malignant syndrome and atypical antipsychotic drugs. J Clin Psychiatry 2004;65:464-70.
5.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision. Washington, DC, American Psychiatric Association, 2000.
6.Pope HG Jr, Cole JO, Choras PT, et al. Apparent neuroleptic malignant syndrome with clozapine and lithium. J Nerv Ment Dis 1986;174:493-5.
7.Mathews T, Aderibigbe YA. Proposed research diagnostic criteria for neuroleptic malignant syndrome. Int J Neuropsychopharmacol 1999;2:129-44.
8.Nierenberg D, Disch M, Manheimer E, et al. Facilitating prompt diagnosis and treatment of the neuroleptic malignant syndrome. Clin Pharmacol Ther 1991;50:580-6.
9.Rosebush PI, Stewart T, Mazurek MF. The treatment of neuroleptic malignant syndrome.Are dantrolene and bromocriptine useful adjuncts to supportive care? Br J Psychiatry 1991;159:709-12.
10.Miyaoka H, Shishikura K, Otsubo T, Muramatsu D, Kamijima K. Diazepamresponsive neuroleptic malignant syndrome: a diagnostic subtype? Am J Psychiatry 1997;154:882.
11.Seitz DP, Gill SS. Neuroleptic malignant syndrome complicating antipsychotic treatment of delirium or agitation in medical and surgical patients: Case reports and a review of literature. Psychosomatics 2009; 50:8-15.
12.Strawn JR, Keck PE, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007; 164:870-876.
Article citation:
Yilmaz MS, Baba M, Kavalci C, Yilmaz F, Sonmez M, Kavalci G, et al., A fatal neuroleptic malignant syndrome as a result of atypical Antipsychotic drug Use. J Pharm Biomed Sci 2014; 04(06):489-491.
Source of support: None
Competing interest / Conflict of interest
The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Copyright © 2014 Yilmaz MS, Baba M, Kavalci C, Yilmaz F, Sonmez M, Kavalci G, et al., This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Research article:
Anshul Jhanwar1,*,O.P.Patidar2,R.N.Sharma3,Ashutosh Chourishi3,Abhay Jain4
Affiliation:-
1Demonstrator, Pharmacology, J.M.C., Jhalawar (Raj), India
2Associate professor, Medicine, J.M.C., Jhalawar (Raj), India
3Professor, Pharmacology, R.D.G.M.C., Ujjain (M.P.), India
4Professor, Psychiatry, R.D.G.M.C., Ujjain (M.P.), India
The name of the department(s) and institution(s) to which the work should be attributed:
R.D.Gardi Medical College,Ujjain (M.P),India
*To whom it corresponds:-
Dr. Anshul Jhanwar,
III/2, Doctor’s residence, Medical College Campus, Jhalawar, Dist- Jhalawar (Raj.)– 326001, India
Mobile – 07726097704
Abstract
Aim: To compare the efficacy of Baclofen and Diazepam in alcohol withdrawal syndrome.
Materials and Methods: This was a 15 days, randomized, parallel, double blind comparative study. Fourty eight in-patients were randomized in two groups (Group I (Baclofen =24), mean age = 33±6.76 and Group II (Diazepam = 24), mean age = 35±8.16. All patients with mild to moderate AWS were enrolled for study after obtaining informed written consent. The patients were administered either Baclofen 10mg or Diazepam 10mg tablets at the dose of one tablets twice a day for five days followed by one tablet once a day for the next five days. The in-patient unit offered a 10-day in-patient stay with flexibility to allow negotiation of the discharge date between day 10 and day 15.
Statistics: The data were analyzed by using the statistical software SPSS, version 16.0.The continuous variables were analyzed by using the Student t-test while categorical data was analyzed by using the Chi-square (x2) test. The results were presented as median (range) and number (percentage) for continuous variables.
Main outcome measures: Primary variables were CIWA-Ar total score (The revised Clinical Institute Withdrawal Assessment for Alcohol).
Clinical trial registry: India (CTRI) number: CTRI/2011/08/001938.
Results: In both groups, from 2nd to 3rd day all participants had achieved a clinically relevant improvement of their withdrawal symptoms. There was drastic reduction on the scores of CIWA-Ar scale from baseline to day 10 & day 15. These changes were statistically highly significant (p < 0.001), which shown that both drugs were efficacious in the treatment of acute mild to moderate AWS. But there were no statistically significant differences between both of the treatment groups on day 10 & day 15 in all efficacy measures, so that the results obtained with them can be considered as equal. Side-effects were slightly more common in the Diazepam group than in Baclofen group.
Conclusions: From the present study it can be concluded that, Baclofen is equivalent in efficacy to Diazepam in the treatment of mild to moderate AWS.
Keywords: Baclofen, Diazepam,CIWA-Ar Scale, Alcohol withdrawal syndrome.
REFERENCES
1.Hall W, Zador DZ. The alcohol withdrawal syndrome. Lancet. 1997; 349:1897-1900.
2.Fiellin DA, O’Connor PG, Holmboe ES. Risk for delirium tremens in patients with AWS. Subst Abuse. 2002;23:83-94.
3.Srivastava A, Pal H, Dwivedi SN. A National Household Survey of Drug Abuse in India. Report submitted to Ministry of Social Justice and Empowerment, Government of India and United Nations Office on Drugs and Crime, Regional Office for South Asia; 2002.
4.Ray R. The extent, pattern and trends of drug abuse in India: National survey. Ministry of Social Justice and Empowerment and United Nations Office on Drugs and Crime, 2004.
5.Saitz R, Mayo-Smith MF, Roberts MS, et al. Individualized treatment for alcohol withdrawal. JAMA. 1994;272:519-523.
6.Colombo G, Serra S, Brunetti G et al. The GABAB receptor agonists baclofen and CGP 44532 prevent acquisition of alcohol drinking behaviour in alcohol-preferring rats. Alcohol Alcohol 2002; 37: 499.
7.Daoust M, Saligaut C, Lhuintre JP et al. GABA transmission, but not benzodiazepine receptor stimulation, modulates ethanol intake by rats. Alcohol 1987; 4: 469–72.
8.Colombo G, Serra S, Brunetti G et al. Suppression by baclofen of alcohol deprivation effect in Sardinian alcohol- preferring (sP) rats. Drug Alcohol Depend 2003; 70:105–8.
9.Colombo G, Serra S, Vacca G et al. Suppression by baclofen of the stimulation of alcohol intake induced by morphine and WIN 55,212–2 in alcohol-preferring rats. Eur J Pharmacol 2004; 492: 189–93.
10.Anstrom KK, Cromwell HC, Markowski T, Woodward DJ. Effect of baclofen on alcohol and sucrose self-administration in rats. Alcohol Clin Exp Res 2003; 27: 900–8.
11.Addolorato G, Caputo F, Capristo E et al. Rapid suppression of AWS by baclofen. Am J Med 2002; 112: 226–9.
12.Addolorato G, Leggio L, Abenavoli L et al. Suppression of alcohol delirium tremens by baclofen administration: a case report. Clin Neuropharmacol 2003; 26: 258–62.
13.Addolorato G, Caputo F, Capristo E et al. Ability of baclofen in reducing alcohol craving and intake:preliminary clinical evidence. Alcohol Clin Exp Res 2000; 24:67- 71.
14.Caputo F, Capristo E et al. Baclofen efficacy in reducing alcohol craving and intake: A preliminary doubleblind randomized controlled study. Alcohol Alcohol 2002; 37: 504–8.
15.Flannery BA, Garbutt JC, Cody MW et al. Baclofen for alcohol dependence: a preliminary open-label study. Alcohol Clin Exp Res 2004; 28: 1517–23.
16.Ameisen O. Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose baclofen: a self-case report of a physician. Alcohol Alcohol 2005; 40: 147–50.
Article citation:
Jhanwar A., Patidar OP., Sharma RN, Chourishi A., Jain A. A double blind study for efficacy of Diazepam and Baclofen in the treatment of Alcohol withdrawal syndrome. J Pharm Biomed Sci. 2014; 04(05):482-488. Available at www.jpbms.info.
Source of support: None
Competing interest / Conflict of interest
The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Copyright © 2014 Jhanwar A., Patida OP., Sharma RN, Chourishi A., Jain A. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.