Current Drug Therapy - Volume 10, Issue 2, 2015

In Parkinson’s disease a dopaminergic/cholinergic and a GABAergic/ glutaminergic neurotransmitter imbalance occurs in the extrapyramidal system. Here, in this system, we describe the alterations of the classical neurotransmitters dopamine, acetylcholine, serotonin, glutamate and GABA. Dopamine degeneration occurs by oxidative stress and also partly through the function of susceptibility genes. There is an antagonistic interaction between D2 dopaminergic and 5-HT2A serotonergic neurons in the putamen, while serotonin hyperactivity is associated with l-dopa-induced dyskinesia. Nicotinic cholinergic neurons, via ß2 nicotinic cholinergic receptors, activate dopaminergic neurons located in the putamen. 5 metabotropic glutaminergic receptor antagonists could increase dopamine levels through a reduced presynaptic inhibition in the putamen. A2A adenosine antagonists could also have an anti-Parkinsonian effect. A question arises of whether analogues, agonists or antagonists of neuropeptides, such as neurotensin NTS1 antagonists, could be of therapeutic value in the treatment of Parkinson's disease. Neural networks in the extrapyramidal system are also described. Clinical trials should explore the issue of whether a multimodal pharmacotherapy in the treatment of Parkinson's disease is better than a treatment with only dopaminergic drugs.

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with a devastating prognosis. The pathogenesis is not clear but involves repetitive lung injury with aberrant inflammatory response. In the last two decades, multiple therapeutic drug trials have been completed failing to identify an effective treatment for this disease. Lung transplant has been the only effective option for patients with IPF. Over the last 5 years, two agents have demonstrated significant slowing in IPF progression. Pirfenidone and nintedanibe are new drugs that showed promising results in IPF treatment. The drugs were approved in Japan and Europe in 2008 and 2011 respectively. The U.S Food and Drugs Administrations approved these medications recently in October 2014. Published clinical trials are reviewed with these two agents and the risks and benefits of therapy for IPF are discussed. Information is provided in this review to assist physicians in the decision making process related to starting one of these agents in patients with IPF.

Progestins, which are synthetic progestational compounds, have been used in the management of symptomatic endometriosis, both as primary therapy and as an adjunct to surgery. Several oral compounds have been used for this purpose, and different degrees of benefits have been shown. The lack of a standardized instrument to evaluate painful symptoms makes comparative analysis very difficult. We performed a systematic search of the Pubmed database from January 1980 to January 2015. The database used the term “endometriosis” as the relevant medical subject heading; selected sub- headings were “progestins”, “medical therapy”, “review” and “randomized controlled trials”, “controlled trials”, “case-control studies”, and “descriptive studies”. We aimed to review all available trials in order to investigate the medical treatment of endometriosis solely with progestins, with special attention to pharmacodynamic activity. The drugs studied were cyproterone acetate, norethisterone acetate, medroxyprogesterone acetate, levonorgestrel, etonogestrel, dienogest, and selective progesterone receptor modulators. However, it is very difficult to reach a definitive conclusion because most trials were small, retrospective, and uncontrolled. Nevertheless, it is clear that progestins are generally safe, effective, and well tolerated and should be considered as the first line of medical treatment in symptomatic endometriosis provided the patients have no desire for pregnancy.

Purpose: The study aims at assessing the organizational and economic impact related to the use of a new portable syringe pump (Pompa Infonde®, Italfarmaco S.p.A., Cinisello Balsamo, Italy) at a hospital level. Methodology: Based on the HTA approach, the analysis assessed the organizational and economic impact of the new device at hospital level, using the traditional methods of Iloprost infusion as comparator. After a pilot evaluation, the organizational impact was assessed within 24 Italian hospitals. Structured interviews were conducted with clinicians and nurses. According to the Hospital-Based HTA approach, a questionnaire assessed the impact on human resources, training activities, internal meetings, spaces needed, facilities, clinical practice implications. Using Activity Based Costing approach, the economic evaluation was performed within the pilot center “Ospedale Civile” of Legnano, Italy. Findings: The new device leads to a positive managerial impact, with a substantial reduction of time to monitor patients by nurses. This resulted in a better management of human resources and in a reduction in nursing cost. Although a mild negative impact on training time for personnel, the structured interviews allowed the identification of three main areas of positive impact: (i) efficiency of internal processes, (ii) clinical pathways, (iii) synergies between wards. Originality: The organizational impact of Pompa Infonde®, showed that it is an efficient alternative to traditional methods, with benefits in the management of patients administered with Iloprost.

Objectives: Abelmoschus esculentus is an important medicinal plant for its traditional and folkloric uses against different types of diseases such as headaches, arthritis, abdominal pain, inflammation etc. It also has been reported that root of the Abelmoschus esculentus possesses good CNS depressant activity along with high analgesic activity in Swiss albino mice. So present study investigated the anti-inflammatory, analgesic and anti-nociceptive activities of methanolic and water extracts of the peel of the Abelmoschus esculentus fruits. Methods and Materials: Anti-inflammatory study was done by carrageenan induced inflammation test for anti-inflammation activities while acetic acid induced writhing test and formalin induced pain test was done for analgesic activities and anti-nociceptive activities respectively in Swiss albino mice. Results: The experimental activities of the methanolic and water extracts of the peels of Abelmoschus esculentus fruits showed statistically significant anti-inflammatory activity (50.87% and 40.87%) in carrageenan induced inflammation test, analgesic activity (77.59% and 68.04%) in acetic acid induced writhing test and anti-nociceptive activity (70.06% and 63.40%) in formalin induced pain test in Swiss albino mice for 200mg. Conclusion: Based on the results of the present study, we conclude that the methanolic and water extracts of peels possess strong anti-inflammatory, analgesic and anti-nociceptive activities. However, further studies are necessary to scrutinize underlying mechanisms of anti-inflammatory, analgesic and anti-nociceptive effects and to isolate the active compounds responsible for these pharmacological activities.

Chronic liver disease (such as hepatitis) is a major health problem worldwide, especially in developing countries. Despite the tremendous advancements in modern medicine, there is no effective drug available that stimulates liver function. The search of new drugs to protect hepatic injury has been of recent interest. The use of natural remedies for the treatment of liver disease has a long history and medicinal plants and their derivatives are still used all over the world. Nigella sativa is used as analgesic, antiinflammatory, anti-diarrhoeal, antimicrobial, anticancer, immunomodulator, bronchodilator, and also said to be hepatoprotective. The aim of this work is to evaluate the hepatoprotective activity of Nigella sativa in Wistar rats and to bring about scientific justification for the use of this drug in hepatitis. Healthy male Wistar rats were treated with the extract of Nigella sativa for 14 days and on day 14 hepatotoxicity was induced by the administration of D-galactosamine through Intraperitoneal (IP) route, blood was collected and analyzed for various biochemical parameters, animals were sacrificed for histopathology, and were compared with the effect of Silymarine as a standard drug. The substantially elevated levels of aspartate amino transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and albumin were restored significantly by the extract of Nigella sativa. The histological studies supported these findings. From the present study it can be concluded that, the extract of Nigella sativa has appreciable hepatoprotective potential.