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Namoju R, Chilaka KN. Protective effect of alpha‑lipoic acid against in utero cytarabine exposure-induced hepatotoxicity in rat female neonates. Naunyn Schmiedebergs Arch Pharmacol 2024:10.1007/s00210-024-03036-4. [PMID: 38459988 DOI: 10.1007/s00210-024-03036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
Cytarabine, an anti-metabolite drug, remains the mainstay of treatment for hematological malignancies. It causes various toxic effects including teratogenicity. Alpha lipoic acid (ALA) is a natural antioxidant reported to offer protection against hepatotoxicity induced by various pathological conditions, drugs, or chemicals. We investigated the protective effect of ALA against prenatal cytarabine exposure-induced hepatotoxicity in rat female neonates. A total of 30 dams were randomly assigned to five groups and received normal saline, ALA 200 mg/kg, cytarabine 12.5 mg/kg, cytarabine 25 mg/kg, and cytarabine 25 mg/kg + ALA 200 mg/kg, respectively, from gestational day (GD)8 to GD21. Cytarabine and ALA were administered via intraperitoneal and oral (gavage) routes, respectively. On postnatal day (PND)1, all the live female neonates (pups) were collected and weighed. The blood and liver from pups were carefully collected and used for histopathological, and biochemical evaluations. A significant and dose-dependent decrease in maternal food intake and weight gain was observed in the pregnant rats (dams) of the cytarabine groups as compared to the dams of the control group. The pups exposed to cytarabine showed a significant and dose-dependent (a) decrease in body weight, liver weight, hepatosomatic index, catalase, superoxide dismutase, glutathione, glutathione peroxidase, serum albumin levels and (b) increase in malondialdehyde, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, AST/ALT ratio, and histopathological anomalies. Maternal co-administration of ALA ameliorated these biochemical changes and histopathological abnormalities by combating oxidative stress. Future studies are warranted to explore the molecular mechanisms involved in the ALA's protective effects against prenatal cytarabine-induced hepatotoxicity.
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Affiliation(s)
- Ramanachary Namoju
- Department of Pharmacology, GITAM School of Pharmacy, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, 530045, India.
- Department of Pharmacology, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, 500075, India.
| | - Kavitha N Chilaka
- Department of Pharmacology, GITAM School of Pharmacy, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, 530045, India
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Chilaka KN, Namoju R. Maternal supplementation of alpha-lipoic acid ameliorates prenatal cytarabine-induced mutilation in reproductive development and function in F1 male adult rats. Naunyn Schmiedebergs Arch Pharmacol 2023:10.1007/s00210-023-02852-4. [PMID: 38010397 DOI: 10.1007/s00210-023-02852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
AIMS Cytarabine (CYT), a prevalent anticancer drug for blood cancers, detrimentally affects male reproductive development and function. Alpha-lipoic acid (ALA), a universal antioxidant, offers defense against chemical-induced reproductive dysfunction. Our study sought to explore ALA's protective role against prenatal CYT-induced reproductive impairment in F1 male adult rats. MAIN METHODS Pregnant rats were divided into 5 groups and administered normal saline, ALA 200 mg/kg, CYT 12.5 mg/kg, CYT 25 mg/kg, and CYT 25 mg/kg + ALA 200 mg/ kg from gestational day 8 to 21. On postnatal day 73, F1 male rats were sacrificed, and general, oxidative, steroidogenic, spermatogenic, histological, and morphometrical parameters were evaluated. KEY FINDINGS Prenatal CYT caused dose-dependent reductions in body weight, testis, and accessory gland weights; elevated oxidative stress; delayed puberty onset; sperm anomalies (decreased count, motility, viability, seminal fructose; increased morphological anomalies); impeded steroidogenesis (lower testosterone, follicle-stimulating hormone, luteinizing hormone, 3β-Hydroxysteroid dehydrogenase(HSD), 17β-HSD, and elevated cholesterol); and testicular histopathological and morphometric disturbances. Maternal supplementation of ALA was found to alleviate all the CYT-induced reproductive disruptions. SIGNIFICANCE The present work accentuates the beneficial actions of ALA against CYT-induced impairment in reproductive development and functions by combating disruptions in oxidative balance, steroidogenesis, spermatogenesis, and testicular histological aberrations. However, future experimental and clinical studies are warranted to explore the molecular mechanisms involved in the ALA's protection against prenatal CYT-induced testicular injury.
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Affiliation(s)
- Kavitha N Chilaka
- GITAM Institute of Pharmacy, GITAM Deemed to Be University, Rushikonda, Visakhapatnam, Andhra Pradesh, 530045, India
| | - Ramanachary Namoju
- GITAM Institute of Pharmacy, GITAM Deemed to Be University, Rushikonda, Visakhapatnam, Andhra Pradesh, 530045, India.
- Department of Pharmacology, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, 500075, India.
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Namoju R, Chilaka NK. Maternal supplementation of α-lipoic acid attenuates prenatal cytarabine exposure-induced oxidative stress, steroidogenesis suppression and testicular damage in F1 male rat fetus. Beni-Suef Univ J Basic Appl Sci 2022. [DOI: 10.1186/s43088-022-00240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cytarabine (Ara-C) is an anticancer drug, which is considered as the mainstay in the treatment of hematological malignancies, known to cause various teratogenic effects. Alpha-lipoic acid (ALA) is a natural antioxidant and its supplementation proved to improve pregnancy outcomes in several pathological conditions. We aimed at exploring the benefits of maternal supplementation of ALA against in-utero Ara-C exposure-induced testicular toxicity in rat fetuses.
Methods
Pregnant rats (dams) received normal saline (control group), ALA 200 mg/kg (ALA group), Ara-C 12.5 mg/kg (Ara-C 12.5 group), Ara-C 25 mg/kg (Ara-C 25 group), and Ara-C 25 mg/kg + ALA 200 mg/kg (protection group) from gestational day (GD)8 to GD21. Ara-C and ALA were administered via the intraperitoneal and oral routes, respectively. The day of parturition was considered as postnatal day (PND)1. On PND1, all the live male pups were collected. The maternal parameters evaluated include (a) food intake, (b) bodyweight, and (c) oxidative stress (OS) markers. The fetal parameters evaluated include (a) bodyweight, (b) anogenital distances (AGD), (c) testicular weight (d) testicular testosterone levels (e) testicular histopathology, and (f) morphometrical parameters.
Results
A significant and dose-dependent decrease in maternal food intake, weight gain, and an increase in oxidative stress (OS) were observed in the pregnant rats of the Ara-C groups as compared to pregnant rats of the control group. Further, a significant and dose-dependent (a) reduction in bodyweight, AGD, testicular weight, and testosterone levels, (b) increase in OS, and (c) structural and morphometrical anomalies in fetal testes were observed in fetuses of Ara-C groups as compared to fetuses of the control rats. These deleterious effects observed in the Ara-C groups were found to be diminished in the pregnant rats and fetuses of the Protection group as compared to the pregnant rats and fetuses of the Ara-C 25 group.
Conclusions
From the results of this study, we conclude that the maternal supplementation of ALA may ameliorate the Ara-C exposure-induced impairment in prenatal development and function of the testes in the rat fetuses. However, future experimental and clinical studies are warranted to explore the possible mechanisms involved in the protection offered by maternal supplementation of ALA against Ara-C induced testicular toxicity.
Graphical Abstract
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Mannur S, Jabeen T, Khader MA, Namoju R, Rao LSS. Severe Ovarian Hyperstimulation Syndrome in a Case of Nonmutated Recurrent Genuine Empty Follicle Syndrome. J Hum Reprod Sci 2021; 14:321-324. [PMID: 34759625 PMCID: PMC8527081 DOI: 10.4103/jhrs.jhrs_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/04/2021] [Accepted: 08/08/2021] [Indexed: 11/09/2022] Open
Abstract
Empty follicle syndrome (EFS) is a rare event in which no oocytes are retrieved from apparently normal growing follicles with normal steroidogenesis despite meticulous follicular aspiration in assisted reproductive technology (ART) cycles. EFS is mainly of two types, genuine EFS and false EFS. Here, we report a case of a 24-year-old woman presenting with primary infertility with normal ovarian reserve and regular menstrual cycles, husband having severe “oligo-astheno-teratozoospermia,” and planned for ART treatment. We could not retrieve any oocytes in successive cycles despite optimum human chorionic gonadotropin (hCG) levels on the day of oocyte retrieval and using different management protocols mentioned until now in the literature. The whole genomic analysis was found to be normal (46, XX). Further, the patient had experienced severe ovarian hyperstimulation syndrome (OHSS) after the second cycle of ovarian stimulation despite no luteal hCG support. We were ineffectual to find the cause of recurrent EFS in this patient and therefore counseled the patient for donor oocytes. This case highlights the difficulty in treating genuine EFS patients and the need for monitoring serum estradiol levels during ovarian stimulation to prevent another serious complication of OHSS.
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Affiliation(s)
- Sumina Mannur
- Department of Obstetrics and Gynecology, Angels Fertility Center, Hyderabad, Telangana, India
| | - Talha Jabeen
- Department of Pharmacology and Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
| | - Mohd Abdul Khader
- Department of Pharmacology and Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
| | - Ramanachary Namoju
- Department of Pharmacology, GITAM University, Vishakhapatnam, Andhra Pradesh, India
| | - Lendale Sai Shakti Rao
- Department of Pharmacology and Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
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Namoju R, Ismail M, Golla VK, Bamini T, Akarapu TL, Baloju D. A Case of Acute Generalized Exanthematous Pustulosis by Cefixime with Oral Mucosal Involvement. Curr Drug Saf 2021; 15:236-239. [PMID: 32729426 DOI: 10.2174/1574886315999200729144555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse reaction characterized by the development of numerous sterile and non-follicular pustules on an erythematous base with no or minimal mucous membrane involvement associated with fever and leucocytosis. Cefixime is a cephalosporin-type beta-lactam antibiotic commonly used for the management of several infections. The Cefixime-induced AGEP cases are known to be rare. Here, we present the case report of a 26-year old female who developed Cefixime-induced AGEP with mucosal membrane involvement. To the best of our knowledge, this is the first case to report the mucosal membrane involvement in Cefixime-induced AGEP. We are presenting this case report to draw the attention on the existence and plethora of symptoms of Cefixime-induced AGEP hoping that the clinicians will reckon these in their differential diagnosis and implement the appropriate management strategies for this rare adverse event in their clinical practice.
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Affiliation(s)
- Ramanachary Namoju
- Department of Pharmacology Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad,
Telangana 500075, India,Department of Pharmacology, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh, India
| | - Mohammed Ismail
- Department of Pharmacology Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad,
Telangana 500075, India
| | - Vinay Kumar Golla
- Department of Pharmacology Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad,
Telangana 500075, India
| | - Tejaswini Bamini
- Department of Pharmacology Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad,
Telangana 500075, India
| | - Thanmaya Lakshmi Akarapu
- Department of Pharmacology Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad,
Telangana 500075, India
| | - Deepika Baloju
- Patient Safety Pharmacovigilance Associate, Adverse Drug Reaction Monitoring Centre
– Pharmacovigilance Program of India, Department of Pharmacology, Bhaskar Medical College, Hyderabad, Telangana
500075, India
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Abstract
Cytarabine (Ara-C) is a nucleoside analogue used in the treatment of cancers and viral infections. It has teratogenic potential and causes a variety of birth defects in fetuses. Alpha-lipoic acid (ALA) is a natural antioxidant offers protection against the developmental toxicity induced by drug- or toxicant-exposure or pathological conditions. This study was aimed at evaluating the protective effect of ALA against Ara-C induced developmental toxicity in rat fetus. Pregnant rats divided into five groups and received normal saline, ALA200 mg/kg, Ara-C12.5 mg/kg, Ara-C25 mg/kg and, Ara-C25 mg/kg plus ALA200 mg/kg respectively from gestational day (GD) 8 to GD14 and sacrificed on GD21. Ara-C treatment led to a significant and dose-dependent decrease in food intake, weight gain, placental weight, and an increase in oxidative stress in pregnant rats. Further, the in-utero exposure to Ara-C led to an increase in fetal mortality, resorptions, oxidative stress, external morphological anomalies and limb abnormalities, and impaired ossification. Co-administration of ALA resulted in amelioration of the footprints of Ara-C induced toxicity in pregnant rats as well as the fetus. These findings indicate that the ALA supplementation offers protection against developmental toxicity caused by Ara-C prenatal exposure in rats.
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Affiliation(s)
- Ramanachary Namoju
- Department of Pharmacology, 78997GITAM Institute of Pharmacy, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh, India.,Department of Pharmacology, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
| | - Naga Kavitha Chilaka
- Department of Pharmacology, 78997GITAM Institute of Pharmacy, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh, India
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Khader MA, Jabeen T, Namoju R. A cross sectional study reveals severe disruption in glycemic control in people with diabetes during and after lockdown in India. Diabetes Metab Syndr 2020; 14:1579-1584. [PMID: 32858476 PMCID: PMC7434486 DOI: 10.1016/j.dsx.2020.08.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Uncontrolled diabetes has been associated with poorer clinical outcomes in COVID-19. We aimed to evaluate and assess the impact of COVID-19 pandemic on management of diabetes and challenges faced by people with diabetes in India during and after the lockdown phase. METHODS A cross-sectional study based on an online questionnaire survey was designed. The questions collected socio-demographic details, medical and social history, and impact of the pandemic on medical and social life from 1582 participants. Linear regression was employed to evaluate association of different parameters with the change in glycemic levels. RESULTS The frequency of clinical visits during the COVID-19 pandemic were reduced in 87.28% of participants. 92.45% of participants were able to monitor their blood glucose levels (BGLs) in which 78.42% (49.35%, 20.91%, and 8.16%) participants experienced an increase in BGL (mild, moderate, and severe respectively). Only 47.41% of participants possessed the digital glucometer at home. 69.07% of participants reported a decrease in physical activity while 46.88% reported an increase in food intake. 80.06% of participants were able to buy all medicines and 29.80% were gone for virtual consultations while 87.81% reported that they didn't have access to healthcare services. Overall, 89.47% participants experienced disruption in therapy. A highly significant correlation (r = 0.89, p = 0.0145) was found between increasing age and reporting of higher BGLs. CONCLUSION This study provides a firsthand evidence of major disruption in diabetes care activities during and after the lockdown phase in India and increased risk of poorer clinical outcomes, if infected by SARS-CoV-2.
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Affiliation(s)
- Mohammed Abdul Khader
- Department of Pharmacology & Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, 500075, India.
| | - Talha Jabeen
- Department of Pharmacology & Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, 500075, India.
| | - Ramanachary Namoju
- Department of Pharmacology & Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, 500075, India; Department of Pharmacology, GITAM University, Gandhi Nagar, Vishakhapatnam, Andhra Pradesh, 530045, India.
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Khader MA, Jabeen T, Namoju R. A cross sectional study reveals severe disruption in glycemic control in people with diabetes during and after lockdown in India. Diabetes Metab Syndr 2020; 14:1579-1584. [DOI: https:/doi.org/10.1016/j.dsx.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Namoju R, Chilaka NK, Beda DP, Avanapu SR. Pre-pubertal cyclophosphamide exposure-induced mutilation in spermatogenesis, steroidogenesis and testicular architecture in SD rat: Protection from an alternative herbal viagra. Rev Int Androl 2020; 19:177-186. [PMID: 32682734 DOI: 10.1016/j.androl.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The children and adolescents with cancer who are getting remission and becoming long-term survivals are at high risk of impaired fertility. Cyclophosphamide (CP), the most frequently used drug for childhood-cancers causes various types of reproductive toxicity. We aimed at evaluating protective role of chlorophytum borivillianum (CB) extract against pre-pubertal CP exposure-induced testicular toxicity in rats. MATERIALS AND METHODS Sixty male pre-pubertal SD rats aged postnatal day (PND) 24 were divided into 5 groups. Group-I (control), group-II (CP), and group-III (CB) received normal saline (NS), CP15mg/kg/day and CB200mg/kg/day respectively during PND29-42; group-IV and group-V received CB100mg/kg/day and CB200mg/kg/day respectively along with CP15mg/kg/day for the same period. Half of the rats from each group were sacrificed on PND43 (puberty) to evaluate alterations in oxidative stress parameters and histopathology. Remaining rats were sacrificed on PND63 (young adult age) and sperm analysis (density, motility, viability, and morphology), hormonal (Testosterone, Luteinizing hormone, Follicle stimulating hormone) estimation and histomorphometrical evaluation was done. Co-administration of CB have shown a dose-dependent and significant improvement in anomalies caused by CP as compared to rats received CP only. RESULTS CP treatment led to significant decrease in body weight gain, organ weights, oxidative defense mechanisms, hormone levels, steroidogenesis, spermatogenesis, sperm parameters and increase in oxidative stress, percentage of sperm abnormal morphology as compared to control rats. CP-treated rats have shown severe damage in testicular architecture and development as compared to control rats as evidenced by histopathology and morphometric analysis. CONCLUSION Co-administration of CB extract significantly reversed the footprints of these effects in dose-dependent manner. These protective effects of CB may be exploited in improving gonadal function in childhood cancer long-term survivals.
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Affiliation(s)
- Ramanachary Namoju
- Department of Pharmacology, GITAM Institute of Pharmacy, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh 530045, India; Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana 500075, India.
| | - Naga Kavitha Chilaka
- Department of Pharmacology, GITAM Institute of Pharmacy, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh 530045, India
| | - Durga Prasad Beda
- Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana 500075, India
| | - Srinivasa Rao Avanapu
- Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana 500075, India
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Bommakanti J, Namoju R, Jabeen T, Mohammed AK, Kothakoti G, Pashikanti S, Chilaka NK, Avanapu SR. A case of dapsone hypersensitivity syndrome in an Indian leprosy patient: Retrospective screening reveals the genetic connection with HLA-B*13:01. Dermatol Ther 2020; 33:e13825. [PMID: 32535989 DOI: 10.1111/dth.13825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Janardhan Bommakanti
- Department of Dermatology, Bhaskar Medical College and General Hospital, Telangana, India
| | - Ramanachary Namoju
- Department of Pharmacology & Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India.,Department of Pharmacology, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh, India
| | - Talha Jabeen
- Department of Pharmacology & Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
| | - Abdul Khader Mohammed
- Department of Pharmacology & Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
| | - Greeshma Kothakoti
- Department of Pharmacology & Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
| | - Sruthi Pashikanti
- Department of Dermatology, Bhaskar Medical College and General Hospital, Telangana, India
| | - Naga Kavitha Chilaka
- Department of Pharmacology, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh, India
| | - Srinivasa Rao Avanapu
- Department of Pharmacology & Pharmacy Practice, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
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