Nephroprotective effect of Sphaeranthus amaranthoides Burm f.: Sivakaranthai (a Siddha Kayakalpa drug) against gentamicin induced nephrotoxicity

Ganesan Rethinam,Anand Duraiswamy,G. Dayanand Reddy,P. Elankani,Sampath Kundrapakkam Srinivasan 경희대학교 융합한의과학연구소 2022 Oriental Pharmacy and Experimental Medicine Vol.22 No.2

Acute kidney injury (AKI) is described as a disorder with a sudden loss of kidney function. AKI is also attributed to several aetiologies such as diabetes, cardiac problems, etc. Developing a therapy for AKI is challenging due to its complex pathophysiology. The present study investigated the effect of Sphaeranthus amaranthoides Burm f. aqueous extract, a Siddha Kalpha drug, against gentamicin-induced AKI. Animals were initially pre-administered with different concentrations of S. amaranthoides and later induced with gentamicin on the 8th day. Biochemical, anti-inflammatory and antioxidant markers were analysed. Further, HRLCMS analysis was carried out to identify the bioactive components. Components including myo-inositol, traumatic acid, rosmarinic acid, etc. were identified. In the animals induced with gentamicin, KIM1, LDH, GGT, creatinine, BUN and electrolytes were elevated in both serum and urine, while noted within normal range in S. amaranthoides pre-administered groups. Histopathology analysis revealed prevention of necrosis, tubular epithelial cell degeneration and glomerular congestion in S. amaranthoides administered animals. Lipid peroxidation, KIM1, Cystatin C, TNFα, IL6 and NFκB were within normal range in tissues. Thus, it is evident that S. amaranthoides is effective in protecting kidney damage and treating AKI. Further studies will be conducted to analyse the pathways resurrecting kidney damage.

An alternative approach to confirm mixed lineage involvement in acute leukemia with KMT2A rearrangement– an illustrative report

Debadrita Ray,Sreejesh Sreedharanunni,Anand Balakrishnan,Praveen Sharma,Nabhajit Mallik,Srinivasan Peyam,Man Updesh Singh Sachdeva 대한혈액학회 2023 Blood Research Vol.58 No.2

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Efficacy and Safety of Anti-CGRP Monoclonal Antibodies in Prevention of Chronic Migraine: A Bayesian Network Meta-analysis

Mundot Puliappadamb Haridas,Amruta Tripathy,Rituparna Maiti,Anand Srinivasan 대한정신약물학회 2024 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.22 No.1

Due to the unmet needs in the management of migraine, a primary headache, and disabling disorder, the past decade has focused on developing monoclonal antibodies (mAbs) against the calcitonin-gene-related peptide (CGRP) as migraine prophylactic agents. The objective of the study was to evaluate the efficacy and safety of various anti-CGRP mAbs in the prevention of chronic migraine. Network meta-analysis (NMA) was performed using the Bayesian framework to estimate the efficacy and safety of mAbs after performing a literature search in PubMed, MEDLINE, Cochrane database, and International Clinical Trial Registry Platform (ICTRP). The outcomes calculated were in terms of mean difference (MD) or odds ratio (OR) with a 95% credible interval (95%CrI). Network graphs were constructed and node-split analysis was done to analyze the inconsistency. The NMA included a total of 10 clinical trials. Galacanezumab (120 mg) (MD: −2.7; 95%CrI: −4.8 to −0.83) was found to be better than other mAbs in terms of the difference in mean migraine days (MMD). Fremanezumab quarterly dose administration showed the best response (OR: 2.9; 95%CrI: 1.9 to 4.6) in terms of responder rate. Eptinezumab was found to be safer (OR: 0.88; 95%CrI: 0.61− 1.3) as compared to other mAbs in terms of the rate of adverse events. Fremanezumab (quarterly) ranked better in terms of response rate, and eptinezumab was found to be the safest in the prophylactic management of migraine. Galacenequmab was better at reducing MMD. Further studies are needed to evaluate the long-term safety, efficacy, and use of mAbs in migraine patients.

Subanesthetic intravenous ketamine vs. caudal bupivacaine for postoperative analgesia in children undergoing infra-umbilical surgeries: a non-inferiority randomized, single-blind controlled trial

Sahoo Alok Kumar,Misra Satyajeet,Behera Bikram Kishore,Srinivasan Anand,Jena Sritam Swarup,Mohanty Manoj Kumar 대한마취통증의학회 2022 Korean Journal of Anesthesiology Vol.75 No.2

Background: Subanesthetic intravenous (IV) ketamine acts as an analgesic and has opioid-sparing effects, particularly for acute postoperative pain; however, its effectiveness in children is understudied. The primary aim of this study was to evaluate the non-inferiority of subanesthetic IV ketamine vs. caudal bupivacaine for postoperative analgesia in children undergoing infraumbilical surgery.Methods: Children aged < 6 years were enrolled in this single-blind study and randomized to receive either subanesthetic IV ketamine (0.3 mg/kg) or caudal 0.125% bupivacaine (1 ml/kg) along with general anesthesia. Postoperative pain was assessed using the FLACC scale at 30 minutes and 1, 2, 3, and 6 h post-operation. Intra- and postoperative opioid consumption, time to extubation, postoperative vomiting, agitation, sedation, and inflammatory markers were also assessed.Results: Altogether, 141 children completed the study (ketamine group: n = 71, caudal group: n = 70) The cumulative proportion of children without significant postoperative pain (FLACC score < 4) in the first 6 h post-surgery was 45.1% in the ketamine group vs. 72.9% in the caudal group (P < 0.001). More children in the ketamine group required an additional dose of intraoperative fentanyl (33.8% vs. 5.7%, P < 0.001) and postoperative tramadol (54.9% vs. 27.1%, P < 0.001). However, postoperative agitation, sedation, and other secondary outcomes were similar between the groups.Conclusions: Subanesthetic ketamine is inferior to caudal bupivacaine for postoperative analgesia in children aged < 6 years undergoing infra-umbilical surgeries; however, other postoperative outcomes are similar.

Effect of Repetitive Transcranial Magnetic Stimulation on Seizure Frequency and Epileptiform Discharges in Drug-Resistant Epilepsy: A Meta-Analysis

Archana Mishra,Rituparna Maiti,Biswa Ranjan Mishra,Monalisa Jena,Anand Srinivasan 대한신경과학회 2020 Journal of Clinical Neurology Vol.16 No.1

Background and Purpose The role of low-frequency repetitive transcranial stimulation (rTMS) in drug-resistant epilepsy (DRE) has been conflicting and inconclusive in previous clinical trials. This meta-analysis evaluated the efficacy of rTMS on seizure frequency and epileptiform discharges in DRE. Methods A standard meta-analysis protocol was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO: CRD42018088544). After performing a comprehensive literature search using specific keywords in MEDLINE, the Cochrane database, and the International Clinical Trial Registry Platform (ICTRP), reviewers assessed the eligibility and extracted data from seven relevant clinical trials. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. A random-effects model was used to estimate the effect size as the mean difference in seizure frequency and interictal epileptiform discharges between the groups. Quality assessment was performed using a risk-of-bias assessment tool, and a meta- regression was used to identify the variables that probably influenced the effect size. Results The random-effects model analysis revealed a pooled effect size of -5.96 (95% CI= -8.98 to -2.94), significantly favoring rTMS stimulation (p=0.0001) over the control group with regard to seizure frequency. The overall effect size for interictal epileptiform discharges also significantly favored rTMS stimulation (p<0.0001), with an overall effect size of -9.36 (95% CI=-13.24 to -5.47). In the meta-regression, the seizure frequency worsened by 2.00±0.98 (mean±SD, p=0.042) for each week-long lengthening of the posttreatment follow-up period, suggesting that rTMS exerts only a short-term effect. Conclusions This meta-analysis shows that rTMS exerts a significant beneficial effect on DRE by reducing both the seizure frequency and interictal epileptiform discharges. However, the meta-regression revealed only an ephemeral effect of rTMS.

Effect of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy and intubation: a randomized control trial

Misra Satyajeet,Behera Bikram Kishore,Mitra Jayanta Kumar,Sahoo Alok Kumar,Jena Sritam Swarup,Srinivasan Anand 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.2

Background: Dexmedetomidine, an alpha-2 agonist, has been used for attenuation of hemodynamic response to laryngoscopy but not through the nebulized route. We evaluated the effects of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy and intubation and examined the intraoperative anesthetic-analgesic requirements and recovery outcomes. Methods: Overall, 120 ASA I & II adult patients (of either gender) undergoing elective surgeries and requiring tracheal intubation, were randomized to receive nebulized dexmedetomidine (1 µg/kg in 3–4 ml of 0.9% saline) or 0.9% saline (3–4 ml), 30 min before anesthesia induction. Heart rate and non-invasive systolic blood pressure were monitored for 10 min following laryngoscopy. Results: After laryngoscopy, linear mixed effect modelling showed significantly lower trend of increase in heart rate in the dexmedetomidine group versus saline (P = 0.012); however, there was no difference in the systolic blood pressure changes between the two groups (P= 0.904). Induction dose of propofol (P < 0.001), intraoperative fentanyl consumption (P = 0.007), and isoflurane requirements (P = 0.013) were significantly lower in the dexmedetomidine group. There was no difference in the 2-h incidence of postoperative nausea and vomiting (PONV) (P = 0.612) or sore-throat (P = 0.741).Conclusions: Nebulized dexmedetomidine at 1 µg/kg attenuated the increase in heart rate but not systolic blood pressure following laryngoscopy and reduced the intraoperative anesthetic and analgesic consumption. There was no effect on early PONV, sore-throat, or increase in incidence of adverse effects. Nebulized dexmedetomidine may represent a favorable alternative to the intravenous route in short duration surgeries.