Anita Kotwani

Vallabhbhai Patel Chest Institute, Old Delhi, NCT, India

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Publications (41)93.41 Total impact

  • Tapan Behl · Ishneet Kaur · Anita Kotwani
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    ABSTRACT: The pathophysiology of diabetic retinopathy is highly complex and encompasses the detrimental roles of numerous factors/mediators in inducing various molecular pathological alterations. Although the roles of many inflammatory mediators, involved in the progression of this complication, have been thoroughly researched and studied, the part played by leukotrienes remains widely neglected. This review focuses on leukotrienes-induced mediation and aggravation of the pathological pathways, such as inflammation, oxidative stress and retinal angiogenesis, responsible for exhibition of various characteristic events including leukostasis, macular edema, retinal neovascularization and vitreous hemorrhages, hence, marking the advent of diabetic retinopathy. Acknowledging these roles, it might be possible to potentially utilize leukotrienes antagonists for suppressing or reducing the intensity of the mentioned pathological alterations. Hence, leukotrienes antagonists may act as an effective adjuvant therapy either along with other developing novel therapies (such as anti-VEGF or anti-TNF-α therapy), or with the established conventional laser photocoagulation treatment, to provide additional symptomatic relief or, possibly prevent the progression of diabetic retinopathy.
    No preview · Article · Dec 2015 · Prostaglandins & other lipid mediators
  • Tapan Behl · Ishneet Kaur · Anita Kotwani
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    ABSTRACT: In past decades, role of numerous factors in the pathophysiology of diabetic retinopathy has been explored; following which marked progress has been made in developing several novel therapeutic options, such as anti-VEGF, anti-TNF-α and various other anti-inflammatory and anti-angiogenic agents, for the treatment of diabetic retinopathy. However, the involvement of endocannabinoid system in its pathogenesis has not been much explored. This review aims at unveiling every aspect of association of the endocannabinoid system and its interactions with various physiological and pathological pathways to induce disease progression. The various alterations induced by endocannabinoids, such as Anandamide and 2-arachidonylglycerol, in retina during hyperglycemia clearly demonstrate and verify their involvement in aggravating the pathological conditions, hence leading to the progression of diabetic retinopathy. Exploring this involvement furthermore, in greater depths, might be beneficial in acknowledging and understanding the hidden aspects of the pathogenesis of this complication even better, and might provide a therapeutically beneficial alternative target to combat and restrict its progression amongst diabetic patients. This article is protected by copyright. All rights reserved.
    No preview · Article · Sep 2015 · Diabetes/Metabolism Research and Reviews
  • Tapan Behl · Ishneet Kaur · Heena Goel · Anita Kotwani
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    ABSTRACT: Diabetic retinopathy is an ocular complication associated with the chronic endocrine disorder of diabetes mellitus. Angiogenesis is adjudged as a prime modulatory event in this complication. The formation of new blood vessels on the pre-existing vasculature gives rise to an abundant of anatomical and physiological alterations which ultimately result in vision loss. The drastic consequences of this complication prompt the obligation of developing effective therapies for its cure. The existing therapy mainly includes destructive techniques such as laser photocoagulation. Owing to the various drawbacks associated with this technique, there is a need to develop alternative therapies which could halt the progression of diabetic retinopathy without causing considerable damage to the retinal cells. One such possible alternative treatment being researched upon is the antiangiogenic therapy. Since angiogenesis is a critical event during the progression of this disorder, targeting this event may perhaps prove effective in its treatment. Amongst several antiangiogenic agents, thalidomide holds a reputable position due to its effectiveness in terminating angiogenesis during various pathological conditions. This review focuses on the diverse molecular mechanisms proposed to explain the antiangiogenic properties of thalidomide and their applicability in diabetic retinopathy. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jul 2015 · Vascular Pharmacology
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    ABSTRACT: The objective of this study was to determine patterns and frequency of antimicrobial drug use among hospitalized patients with community-acquired pneumonia (CAP). A retrospective 5 years (April 2007-March 2012) detailed medical record review of patients diagnosed with CAP and discharged to home from Non-Intensive Care Unit respiratory medicine wards of two public hospitals in Delhi. A total of 261 medical records were analyzed. Over the 5 years, 82.0% (2007-08), 78.6% (2008-09), 59.5% (2009-10), 64.7% (2010-11), and 67.8% (2011-12) patients were prescribed two antimicrobials. In the last two study years, the proportion of patients receiving three antimicrobials increased (from 2.0% to 26.5% and 28.8%), while the proportion receiving monotherapy decreased (from 16.0% to 8.8% and 3.4%). In accordance with guidelines, beta-lactams and macrolides were the two most frequently prescribed antimicrobials (34.1%). However, newer generation beta-lactams were prescribed. A total of 37 patients were prescribed beta-lactam-tazobactam combination preparations. Overall, beta-lactams constituted more than 40% of prescriptions while macrolides were the second most prescribed class. Cephalosporin prescriptions significantly increased (P < 0.01) and penicillin prescriptions significantly decreased over study periods. The prescription of fluoroquinolones also decreased (21.5-6.0%, P < 0.01) and aminoglycoside prescription ranged from 9.7% to 16.4%, over 5 years. Reasons for prescribing three antimicrobials, use of aminoglycosides, or higher-end/reserve antibiotics were not mentioned in the medical records. There were no hospital-specific guidelines for doctors to follow in the treatment of CAP. These findings suggest the need for implementing antimicrobial treatment guidelines. Adequate documentation and monitoring of antibiotic use for feedback are also lacking. An antimicrobial stewardship program may offer the most comprehensive solution for appropriate use of antimicrobials.
    No preview · Article · Jul 2015 · Indian Journal of Pharmacology
  • Tapan Behl · Anita Kotwani
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    ABSTRACT: Diabetic Retinopathy is one of various complications of diabetes mellitus, which is one of the most prevalent chronic disorders in the modern world. Diabetic retinopathy is one of the secondary complications encountered by the patients suffering from chronic diabetes mellitus. Two major characterizing features of diabetic retinopathy are - macular edema and angiogenesis. It has been noted in the past few years that by controlling or completely inhibiting the factors contributing to the progression of events leading to angiogenesis, there is a noticeable amount of progress seen in the prevention and cure of the animal models of diabetic retinopathy. Endostatin is one such antiangiogenic agent being studied at present. It is a carbon terminal protein fragment obtained after cleavage from the carbon terminus of collagen XVIII. It is one of the most potent inhibitors of angiogenesis known at present and is currently undergoing clinical trials. Although the exact mechanism of action of endostatin is not completely known, various factors which are altered/influenced by the action of endostatin are being studied. These include the downregulation and activation/inactivation of various factors which have been proven to have some role in the progression of angiogenesis. Endostatin could be well exploited as a durable agent in the antiangiogenic therapy, once the clinical trials show positive results. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jun 2015 · Life sciences
  • Tapan Behl · Ishneet Kaur · Anita Kotwani
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    ABSTRACT: Diabetic retinopathy, a severe, sight threatening complication of diabetes mellitus, accounts for a large number of cases of acquired, yet potentially avoidable, blindness. The principal mechanism of its pathogenesis appears to be alterations in the microvasculature of retina as the result of hyperglycemia. The elevated concentration of blood glucose is a harbinger of numerous molecular changes. These lead to various responses that result in microangiopathy. Oxidative stress, one such response, attributable to disruption in the homeostasis of free radical production during the various vital processes such as the electron transport chain reaction and the scavenging mechanisms designed to neutralize these damaging molecules. This imbalance has been linked to the pathophysiology of diabetic retinopathy. Excessive formation of free radicals influences almost all pathways involved in normal human physiology. Thus, hyperglycemia-induced oxidative stress is one of the factors associated with biochemical changes. These changes are further responsible for the various structural and functional abnormalities seen in diabetic retinopathy. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · Survey of Ophthalmology
  • Tapan Behl · Anita Kotwani
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    ABSTRACT: Diabetic Retinopathy, a sight-threatening microvascular complication of diabetes mellitus, is initiated by retinal endothelial dysfunction and succeeded by various pathological events, eventually resulting in vision-loss. These events are regulated by numerous mediators, including vascular endothelial growth factor (VEGF), which induces the progression of various events characterizing diabetic retinopathy, such as neovascularization and macular edema. VEGF is physiologically required for regulating proliferation and assembling of endothelial cells, during vasculogenesis, as well as for their maintenance and survival throughout the lifetime of blood vessels. However, various pathological conditions are induced in the body during diabetes (such as ischemia, oxidative stress and overactivation of protein kinase C), which upregulate the expression of VEGF, thereby deviating it from its physiological role and leading to various pathological demonstrations such as angiogenesis, increased permeability of endothelium, decreased inhibition of pro-apoptotic proteins and activation of various other inflammatory mediators. Such events disrupt vascular homeostasis and play key roles in the pathophysiology of diabetic retinopathy. Hence, acknowledging various VEGF-mediated pathways helps in understanding the deeper aspects related to progression of this disorder. Targeting and inhibiting VEGF-mediated disease progression might provide an effective alternative therapy and hence prove beneficial in the treatment of diabetic retinopathy. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Jun 2015 · Pharmacological Research
  • A. Kotwani · C. Wattal · Z. Siddiqui · P. Joshi

    No preview · Article · May 2015 · Value in Health
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    Tapan Behl · Anita Kotwani · Ishneet Kaur · Heena Goel
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    ABSTRACT: Nephrogenic diabetes insipidus is a clinical sub-type of a diversely expounded disorder, named diabetes insipidus. It is characterized by inability of the renal cells to sense and respond to the stimulus of vasopressin. Amongst its various etiologies, one of the most inevitable causes includes lithium-induced instigation. Numerous studies reported marked histological damage to the kidneys upon long-term treatment with lithium. The recent researches have hypothesized many lithium-mediated mechanisms to explain the damage and dysfunction caused in the kidneys following lithium exposure. These mechanisms, widely, intend to justify the lithium-induced electrolyte imbalance, its interference with some vital proteins and a specific steroidal hormone, obstruction caused to a certain imperative transducer pathway and the renal tubular acidification defect produced on its prolonged therapy. Thorough study of such mechanisms aids in better understanding of the role of lithium in the pathophysiology of this disorder. Hence, the ameliorated knowledge regarding disease-pathology might prove beneficial in developing therapies that aim on disrupting the various lithium-mediated pathways. Hence, this may effectively lead to the demonstration of a novel treatment for nephrogenic diabetes insipidus, which is, at present, limited to the use of diuretics which block lithium reuptake into the body. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Mar 2015 · European Journal of Pharmacology
  • Anita Kotwani · Kathleen Holloway
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    ABSTRACT: Objective To obtain information on prescribing rates and choice of antibiotics for acute, uncomplicated respiratory tract infections (RTIs) in the community.Methods Antibiotic use in acute, uncomplicated RTIs consisting of common cold/sore throat/cough for not more than five days was surveyed in the community (December 2007–November 2008) using patient exit interviews at public and private facilities from four localities in New Delhi. Data were collected from 10 public sector facilities and 20 private clinics over one year. The percentage of acute, uncomplicated RTIs patients receiving antibiotics in general and using the Anatomical Therapeutic Chemical classification and the Defined Daily Dose (ATS/DDD) were analysed.ResultsAt public and private facilities, 45% (746/1646) and 57% (259/457) of acute, uncomplicated RTI patients were prescribed at least one antibiotic, respectively. The main antibiotic class calculated as percentage of total antibiotics DDDs/1000 prescribed to acute, uncomplicated RTI patients at private clinics was cephalosporins, J01DA (39%), followed by fluoroquinolones, J01MA (24%), penicillins, J01C (19%) and macrolides, J01FA (15%). Newer members from each class were prescribed; older antibiotics such as co-trimoxazole or tetracyclines were rarely prescribed. At public facilities, the main class of antibiotic prescribed was penicillins (31%), followed by macrolides (25%), fluoroquinolones (20%) and cephalosporins (10%).Conclusions Study clearly shows overuse and inappropriate choice of antibiotics for the treatment of acute, uncomplicated RTIs which are mainly due to virus and do not require antibiotic treatment. Results of the study warrant interventional strategies to promote rational use of antibiotics to decrease the overgrowing threat of antibiotic resistance.
    No preview · Article · Apr 2014 · Tropical Medicine & International Health
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    Anita Kotwani · Kathleen Holloway
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    ABSTRACT: The present survey was conducted to investigate the price and availability of a basket of 24 essential antibiotics and eight high-end antibiotics at various levels of health care in public and private sector in National Capital Territory of Delhi, India using standardized WHO/HAI methodology. DATA ON PROCUREMENT PRICE AND AVAILABILITY WAS COLLECTED FROM THREE PUBLIC HEALTHCARE PROVIDERS IN THE STATE: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Overall a total of 83 public facilities, 68 primary care, 10 secondary cares and 5 tertiary care facilities were surveyed. Data was also collected from private retail (n = 40) and chain pharmacies (n = 40) of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR). PUBLIC SECTOR: Delhi state government has its essential medicine list (Delhi state EML) and was using Delhi state EML 2007 for procurement; the other two agencies had their own procurement list. All the antibiotics procured including second and third generation antibiotics except for injections were available at primary care facilities. Antibiotic available were on the basis of supply rather than rationality or the Delhi state EML and none was 100% available. There was sub-optimal availability of some essential antibiotics while other non-essential ones were freely available. Availability of antibiotics at tertiary care facilities was also sub-optimal. Private sector: Availability of antibiotics was good. For most of the antibiotics the most expensive and popular trade names were often available. High-end antibiotics, meropenam, gemifloxacin, and moxifloxacin were commonly available. In retail pharmacies some newer generation non-essential antibiotics like gemifloxacin were priced lower than the highest-priced generic of amoxicillin + clavulanic acid, azithromycin, and cefuroxime aexitl. Inappropriate availability and pricing of newer generation antibiotics, which may currently be bought without prescription, is likely to lead to their over-use and increased resistance. All providers should follow the EML of whichever of the three concerned Delhi public sector agencies that it is under and these EMLs should follow the essential medicine concept. The Indian regulatory authorities need to consider urgently, drug schedules and pricing policies that will curtail inappropriate access to new generation antibiotics.
    Preview · Article · Aug 2013 · Journal of Pharmaceutical Policy and Practice
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    Anita Kotwani
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    ABSTRACT: Inequitable access to medicines is a major weakness in the Indian health care system. Baseline data needed to develop effective public health policy and provide equitable access to essential medicines. The present survey was conducted to investigate the price, availability, and affordability of fifty essential medicines in the public and private sector in Delhi, India using standardized WHO/HAI methodology. Data on procurement price and availability was collected (July-October 2011) from three public healthcare providers: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Data on price and availability of medicines was collected from private retail and chain pharmacies of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR). The procurement price of surveyed medicines was 0.53-0.82 times the international reference price-IRP. However, the overall mean availability of surveyed medicines in facilities under state government and MCD was 41.3% and 23.2%, respectively. The overall mean availability of medicines in three tertiary care facilities operated by the federal government was 49.3%. Availability of generic medicines was much higher in the private sector. Off-patented medicines, like diazepam, diclofenac, and doxycycline had the highest MPRs. The price ratio between procurement and retail was as high as 28 (range 11--28) for certain medicines. Seven-day treatment with a popular brand of amoxicillin+clavulanic acid or one inhaler each of budesonide and salbutamol cost 2.3 and 1.4 days' wages for the lowest paid government worker. A majority of India's population cannot afford these prices. This study revealed that procurement prices of surveyed medicines were reasonable in comparison to IRP. However, variation in procurement prices of certain medicines by different public procurement agencies was noted. Availability of medicines was very poor in public sector facilities, which are the primary source of free medicines for a majority of India's low-income population. Availability of medicines is better in private retail pharmacies but affordability remains a big challenge for a majority of the population. These data have significant policy implications that could help in amending policies to increase the access to essential medicines for India's population.
    Preview · Article · Jul 2013 · BMC Health Services Research
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    Full-text · Article · May 2013 · Value in Health
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    A Kotwani · S Shendge

    Preview · Article · May 2013 · Value in Health
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    Anita Kotwani · Sushil Shendge
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    ABSTRACT: Poorly controlled asthma imposes a considerable burden and is a serious public health problem in the developing world. A key challenge for healthcare professionals is to help patients to engage in self-management behaviours with optimal adherence to appropriate treatment. The aim of the present study was to investigate the pattern of self-management in asthmatic patients enrolled as out-patients in a tertiary care referral public chest hospital, in Delhi, India. The study population was adult asthma patients (n=200) visiting the emergency room (December 2008-December 2009) of a chest hospital for asthma exacerbation. The data was collected through a questionnaire regarding the self-management of asthma. Enrolled patients (64.0% female) were registered as asthma out-patients in the study hospital for a mean of 5.4±4.4 years. Patients visiting the emergency room (ER) and having an unscheduled visit to doctor at least twice in the previous 12 months were 86.5% and 91.0%. Patients were classified according to the disease severity as having intermittent (17.0%) or persistent (83.0%) asthma. Not all patients had metered dose inhalers at home. Only 2.0% of patients were prescribed peak flow meters and were keeping a diary of their readings. With one exception, patients did not have written action plans for treatment provided by doctor or health facility. No statistical difference was found in the pattern of self-management of patients having persistent or intermittent asthma. Findings revealed poor self-management of asthma and poor communication from doctors regarding self-management to the patients. Suitable actions and interventions are needed by health professionals to implement patient self-management asthma programme for optimum asthma control.
    Preview · Article · Dec 2012 · Southern Med Review
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    Anita Kotwani · Barnali Deka · Sushil Shendge

    Preview · Article · Jun 2012 · Value in Health
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    A. Kotwani · S. Shendge

    Preview · Article · Jun 2012 · Value in Health
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    ABSTRACT: To obtain information on the current prescribing rates of antibiotics in acute diarrhea in the community. Antibiotic use in acute diarrhea in the community (December 2007-November 2008) was surveyed by using patients' exit interviews at public and private facilities from four residential localities. Data were collected from 10 public sector facilities and 20 private clinics over 1 year. The percentage of patients receiving antibiotics and the prescribing pattern of antibiotics were analyzed by using the anatomical therapeutic chemical classification and the defined daily dose. At public facilities 43% (171 of 398) and at private facilities 69% (76 of 110) of the patients with acute diarrhea were prescribed at least one antibiotic. Diarrhea increased during peak humid summer months, but doctors were fairly consistent in their antibiotic prescribing throughout the year. The main antibiotic class that was prescribed in both public and private sector facilities was fluoroquinolones, J01MA (91.5% and 96%, respectively). Pediatricians working in the private sector prescribed antibiotics to 51.5% (17 of 33) of children with diarrhea, whereas pediatricians working in the public sector prescribed antibiotics to 23% of children with acute diarrhea. At public facilities, the most commonly prescribed fluoroquinolone was norfloxacin, followed by ofloxacin and ciprofloxacin. At private clinics, it was ofloxacin followed by ciprofloxacin. This study clearly showed the irrational use of antibiotics for the treatment of acute diarrhea in children and adults that warrants interventional strategies.
    Preview · Article · Feb 2012 · Value in Health
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    Anita Kotwani · S K Chhabra · Vandana Tayal · V K Vijayan
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    ABSTRACT: High prevalence and poor control of asthma make its management a major public health issue worldwide, especially in developing countries. Optimum review of asthma management in the community is essential to improve asthma control. This study was conducted to investigate the quality of asthma management, knowledge about asthma and quality of life of asthma patients referred to a public tertiary care chest hospital in Delhi. Diagnosis of asthma was confirmed by symptoms and reversible spirometry in 50 referred patients on their first visit. Patients were interviewed using three questionnaires on quality of asthma management before visiting referral hospital, asthma knowledge and asthma quality of life (AQLQ). Correlation amongst quality of treatment, asthma quality of life, and asthma knowledge was also determined. Findings revealed that only 60 per cent of patients were informed about their disease, and 10 per cent had undergone lung function tests previously. Only 44 per cent of patients were prescribed inhalers. None were provided with any educational material. Patients had poor knowledge of aetiology, pathophysiology, medication and how to assess the severity of their asthma. The mean scores in AQLQ indicated a moderate degree of impairment in quality of life. INTERPRETATIONS & CONCLUSIONS: This study provides evidence of unsatisfactory asthma management and patient-doctor interaction as patients had limited knowledge of asthma disease, its management and had poor quality of life as measured by a standardized questionnaire. Thus, there is need to implement suitable interventions to improve asthma management according to standard treatment guidelines in the community.
    Full-text · Article · Feb 2012 · The Indian Journal of Medical Research
  • Masrat Rashid · Mohammad Fahim · Anita Kotwani
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    ABSTRACT: The present study was carried out to investigate the effects of long-acting phosphodiesterase five inhibitor, tadalafil, on pulmonary hypertension induced by chronic hypobaric hypoxia in rats. Adult Albino Wistar rats were exposed to 2 weeks of hypobaric hypoxia for 8 h daily and treated with tadalafil or tempol, a standard antioxidant agent. Right ventricular systolic pressure (RVSP) was taken as an index for pulmonary arterial pressure; malondialdehyde, reduced glutathione and superoxide dismutase were chosen as the markers of oxidative stress; serum tumour necrosis factor alpha (TNF-α) levels and inflammatory changes in lungs were assessed for inflammation. Chronic hypobaric hypoxia was found to induce pulmonary hypertension, as it significantly (P < 0.001) increased RVSP. Chronic hypobaric hypoxia also leads to an increase in oxidative stress as was evidenced by an increase in malondialdehyde levels (P < 0.001) and a significant decrease in (P < 0.001) reduced glutathione levels and superoxide dismutase activity. Chronic hypobaric hypoxia-induced inflammation was revealed by lung histology and increase in serum TNF-α levels. Tadalafil significantly prevented (P < 0.001) rise in hypobaric hypoxia-induced rise in RVSP. Tadalafil partially while tempol completely reversed hypobaric hypoxia-induced oxidative stress. Lung inflammation and serum TNF-α levels were significantly attenuated by both tadalafil and tempol. However, effect of tadalafil on inflammation was more marked than that of tempol. These data indicate that tadalafil possess antioxidant as well as antinflammatory action in addition to its vasodilatory property. All these three actions combined may have positive impact of tadalafil in the treatment of hypobaric hypoxia-induced pulmonary hypertension.
    No preview · Article · Jan 2012 · Fundamental and Clinical Pharmacology

Publication Stats

349 Citations
93.41 Total Impact Points

Institutions

  • 2007-2015
    • Vallabhbhai Patel Chest Institute
      Old Delhi, NCT, India
    • Sir Ganga Ram Hospital
      New Dilli, NCT, India
  • 2006-2015
    • University of Delhi
      • Department of Pharmacology
      Old Delhi, NCT, India