The gravity of the impact of renal failure on human health is well known and as there is no specific pharmacotherapy for renal failure, the current study was undertaken to evaluate the effect of root extract of Azima tetracantha, an ancient medicinal plant used in Siddha and Ayurvedhic systems of medicine.The experiment was done in glycerol-induced acute renal failure in Wistar albino rats. Thirty rats were divided into five groups. Group 1 was given normal saline (10 ml/kg) per oral, group 2 with single dose of hypertonic glycerol (8 ml/kg) by intramuscular injection into the hind limbs, group 3 with glycerol and ethanolic extract of A. tetracantha root (ATR) 250 mg/kg, group 4, glycerol and ATR 500 mg/kg and group 5, 500 mg/kg ATR. Extract was given orally 60 min prior to glycerol injection. 24 h urine output, serum creatinine, blood urea nitrogen, total proteins and albumin were measured for all the groups. Kidneys were examined for histopathological changes.The antioxidant activity of the extract was tested in vitro and in vivo. Rats treated with ATR showed significant improvement in biochemical parameters and histopathological changes compared to glycerol treated group. The protective effect was highly significant at 500 mg/kg. Both in vitro and in vivo assays showed significant antioxidant activity. The in vitro activity was comparable to vitamin-C.The ethanolic extract of ATR has nephroprotective effect in glycerol-induced acute renal failure and the mechanism of action could be the antioxidant effect.

Objective: To estimate a) monthly expenditure for treatment of diabetes mellitus (DM), hypertension (HTN) and both (DM+HTN) and b) economic burden (EB) and psychological burden (PB) of therapy of DM, HTN and DM+HTN.Methods: An observational questionnaire-based study was conducted among 180 patients. The monthly cost of drug therapy was assessed based on the drugs they were taking and the cost of individual drugs. The EB and PB were assessed using a validated questionnaire and data analysed by ANOVA followed by post hoc test.Results: Among 216 patients who were interviewed, 180 fulfilled the selection criteria. Among 180, 75 had DM, 40 HTN and 65 had both. Prevalence of DM and DM+HTN was higher among females and of HTN equal among males and females. The average total monthly cost of therapy for DM was INR 2077, for HTN INR 1464 and for DM+HTN INR 2269.Significant correlation was found between income and percentage of expenditure (p<0.001) in all the groups. The PB was found to correlate with low income (p<0.001), poor education (p<0.05) occupation (p<0.01) in DM+HTN and number of tablets (p<0.01) in DM and DM+HTN groups. Conclusion:The cost of therapy was higher for DM+HTN and DM. The percentage of expenditure was higher in low-income group and burden of therapy was directly proportional to the number of tablets, poor educational and occupational status; and inversely proportional to income.

Objective: To evaluate the antiepileptic activity of ethanolic extract of Azima tetracantha root (EEATR) against Maximal electroshock (MES) and Pentylenetetrazole (PTZ) induced seizures in mice.Methods: 48 adult male mice were used and 4 groups with six in each were allocated to each model. 4 Groups are divided into control, standard and two test groups. The control group received normal saline, standard group, Sodium valproate-200 mg/kg and the two test groups received an ethanolic extract of roots of Azima tetracantha (EEATR) 250 and 500 mg/kg respectively. Antiepileptic activity was assessed based on hind limb tonic extension duration, the onset of convulsions and mortality. The results were compared with control and standard.Results: In MES model EEATR reduced the duration of hind limb extension (HLE) and seizure protection was 50% and 66.6% with 250 and 500 mg/kg respectively. In PTZ model both the doses of EEATR delayed the onset of clonic phase and prevented death in 50% of animals in the group treated with 500 mg/kg EEATR, similar to sodium valproate. Results were analysed by ANOVA with p<0.05 considered as significant.Conclusion: EEATR has shown anticonvulsant activity in both MES and PTZ models. 500 mg/kg of EEATR has better protection than 250 mg/kg against seizure in MES model and equally efficacious as sodium valproate standard in PTZ model.

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Background Molnupiravir is an oral antiviral drug that received Emergency Use Authorization in three countries for the treatment of mild COVID-19. The aim of this systematic review was to find out the safety and efficacy of Molnupiravir in SARS-COV-2 infections. Methods The electronic databases such as PubMed, MedRxiv, BioRxiv, FDA, ClinicalTrials.Gov, ctri.nic.in and Google Scholar were searched for articles from January 2021 to March 2022 using the keywords such as "Molnupiravir", "COVID-19", "Oral antiviral pill", "MK-4482", "EIDD-280", "Efficacy" and "Safety". Details of published, unpublished with interim reports and ongoing studies of Molnupiravir in COVID-19 were retrieved, and a systematic review was performed. Results A total of 6 articles and 18 ongoing trials data were collected. Out of these, data from 4 published and 2 unpublished with interim reports were extracted. After review of these studies, it was observed that the daily dose of 1600 mg Molnupiravir for 5 days was safe and tolerable with nausea, diarrhea and headache as the common adverse effects. The results also showed significant decrease in time to viral clearance with 800 mg twice daily in mild patients and reduction in the risk of hospitalization or death by 50% in non-hospitalized COVID-19 patients. Conclusion Evidence from clinical studies showed that Molnupiravir caused significant reduction in the risk of hospitalization or death in high-risk mild COVID-19 patients. Molnupiravir was also found to be well tolerated and safe without any major adverse events on short-term use. For confirmative use of this drug in mild-to-moderate COVID-19 disease, further studies are required in vaccinated COVID-19 patients and against emerging variants.

Objective: This review was performed to compare the efficacy and safety among hospitalized patients with COVID-19 who received baricitinib and those who received tocilizumab independently with placebo or the standard of care (SOC).Methods: Relevant databases were searched for randomized controlled trials which evaluated the effect of baricitinib or tocilizumab as compared to placebo or the SOC in hospitalized patients with COVID-19. The primary endpoint was the comparison of the 28-day mortality. Risk ratios (RR) and mean differences were compared and pooled for dichotomous and continuous variables, respectively. A two-staged exploratory network meta-analysis using a multivariate meta-analysis was also performed. All analyses were performed in Stata version 16.0. The GRADE approach was used to assess the quality of the generated evidence (PROSPERO ID: CRD42022323363).Results: Treatment with baricitinib [RR, 0.69 (95% CI, 0.50–0.94), p = 0.02, i2 = 64.86%] but not with tocilizumab [RR, 0.87 (95% CI, 0.71–1.07), p = 0.19, i2 = 24.41%] led to a significant improvement in the 28-day mortality as compared to that with the SOC. Treatment with baricitinib or tocilizumab, both independently led to a significant reduction in the duration of hospitalization [baricitinib: mean difference, −1.13 days (95% CI, −1.51 to −0.76), p &lt; 0.001, i2 = 0.00%; tocilizumab: mean difference, −2.80 days (95% CI, −4.17 to −1.43), p &lt; 0.001, i2 = 55.47%] and a significant improvement in the proportion of patients recovering clinically by day 28 [baricitinib: RR, 1.24 (95% CI, 1.03–1.48), p = 0.02, i2 = 27.20%; tocilizumab: RR, 1.41 (95% CI, 1.12–1.78), p &lt; 0.001, i2 = 34.59%] as compared to those with the SOC. From the safety point of view, both these drugs showed similar results. There were fewer patients who experienced any serious adverse event following treatment with barictinib and tocilizumab as compared to those following treatment with the SOC [baricitinib: RR, 0.76 (95% CI, 0.62–0.92), p = 0.01, i2 = 12.63%; tocilizumab: RR, 0.85 (95% CI, 0.72–1.01), p = 0.07, i2 = 0.00%].Conclusion: As baricitinib and tocilizumab are recommended interchangeably by various guidelines for the management of COVID-19, considering the better 28-day mortality data and other comparable efficacy and safety outcomes, baricitinib may be favored over tocilizumab considering its ease of administration, shorter half-life, and lower cost of treatment.

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