Objectives:To assess the efficacy and safety of NSF-3, a polyherbal sedative-hypnotic (containing standardized extracts of Valeriana officinalis, Passiflora incarnate and Humulus lupulus), in comparison to zolpidem in primary insomnia.Materials and Methods:The present study was designed as a parallel group, double- blind, randomized, controlled trial and registered with Clinical Trials Registry-India (CTRI/2011/12/002197). Patients diagnosed with primary insomnia with a perceived total sleep time of <6 hours per night and insomnia severity index >7 were included. They were treated with either NSF-3 (one tablet) or zolpidem (one 10 mg tablet) at bedtime for two weeks. Total sleep time, sleep latency and number of awakenings per night were assessed using a sleep diary. Quality of life and daytime sleepiness were evaluated by insomnia severity index and Epworth sleepiness score respectively. Vital signs, routine blood counts, liver and renal function tests, and treatment emergent adverse events were recorded for safety assessment.Results:A total of 91 subjects were recruited, of which 39 in each group completed the study. There was significant improvement in total sleep time, sleep latency, number of nightly awakenings and insomnia severity index scores in both groups. However, no statistically significant difference was observed between the groups. Epworth sleepiness scores did not change significantly over the study period. Although 12 treatment emergent adverse events were reported with NSF-3 and 16 with zolpidem (commonest was drowsiness in both), most were mild and no serious adverse events were encountered.Conclusions:NSF-3 is a safe and effective short-term alternative to zolpidem for primary insomnia. It remains to be explored whether the benefits are sustained and whether there is dependence liability with this formulation upon long term use.

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Objectives:The objective of this study was to evaluate the peripheral analgesic effect of Piper betle leaf extract (PBE) along with establishing its putative mechanism of action.Materials and Methods:Male Swiss albino mice after pre-treatment (1 h) with different doses of PBE were injected 0.8% (v/v) acetic acid i.p.; the onset and number of writhes were noted up to 15 min. To evaluate the mechanism of action, the murine peritoneal exudate was incubated with PBE for 1 h, followed by exposure to arachidonic acid (AA) and generation of reactive oxygen species (ROS) was measured by flow cytometry using 2’,7’-dichlorodihydrofluorescein diacetate.Results:PBE in a dose dependent manner significantly reduced acetic acid induced writhing response in mice (P < 0.001). In peritoneal exudates, PBE significantly inhibited AA induced generation of ROS, P < 0.01.Conclusions:The present study indicates that PBE has promising analgesic activity, worthy of future pharmacological consideration.

Objectives:Chronic venous insufficiency (CVI) in lower limbs manifest as stasis dermatitis. The anti-collagenase, anti-inflammatory and immunomodulatory effects of doxycycline and the T-cell inhibitory effects of tacrolimus could theoretically modify the disease pathophysiology. This study was undertaken to evaluate the efficacy and safety of four weeks combination therapy of oral doxycycline 100 mg with topical tacrolimus 0.1% for stasis dermatitis associated with CVI.Materials and Methods:A single-arm, interventional pilot study was conducted on subjects with CVI of C4 to C6 category (CEAP classification: clinical, etiology, anatomical, pathophysiology). Treatment duration was four weeks with fortnightly follow-ups. Primary efficacy was assessed as changes from baseline of pigmentation, erythema, edema, itching and hair loss of the affected area evaluated on Likert scale scores. Secondary efficacy parameters were percentage improvement of the dermatitis area and changes in ulcer dimensions (maximum length and breadth), if present. Safety evaluation included all treatment emergent clinical signs and symptoms reported by the patients and/or observed by the physician.Results:Out of 19 recruited subjects, 15 completed the study for analysis. Significant (P<0.01) improvement in pain, edema, pigmentation, erythema and exudation were observed. Reduction of ulcer dimensions was also statistically significant (P<0.01). 86.6% showed improvement of the dermatitis area, 6.7% patients failed to show any improvement and 6.7% showed worsening. Adverse effects were observed in only two subjects.Conclusion:This pilot study suggests efficacy of this combination therapy in controlling features of stasis dermatitis but further studies are needed for validation.

The antivertigo drug betahistine exerts a histamine modulatory action in the vestibular system and the brain. It is marketed both as the dihydrochloride and the mesilate salt in India. We conducted a published literature based systematic review to ascertain differences, in any, between the salt and ester forms of the drug. Search of the Medline database was supplemented by searching through references in full text papers and retrieving summary of product characteristic literature. Although the weight of published evidence is greater for betahistine dihydrochloride, in the absence of head-to-head studies comparing the efficacy of the two formulations in Ménière's disease and other vertigo disorders of vestibular origin, it is not possible to conclude that there are definite differences in this regard. However, potentially relevant differences exist to suggest that the two forms are not interchangeable for the treatment of vestibular dysfunction. Molecular weight comparison indicates that the pill burden would be higher for betahistine mesilate for delivering equivalent doses. There could be ethnically influenced differences in pharmacokinetic behavior. There are concerns of potential long-term DNA toxicity due to mesilate ester contaminants during production of betahistine mesilate, which is not there for the hydrochloride form. Detailed post-marketing surveillance data exists only for the dihydrochloride salt. Otorhinolaryngologists and other physicians seeking to optimize treatment with betahistine should be aware of these differences.