A Clinicopathological Study with Risk-Stratified Staging of Pediatric Hepatoblastoma: A 5-Year Experience from a Tertiary Cancer Center

Background & Objective

Hepatoblastoma encompasses 1% of pediatric malignancies and is the most common liver malignancy in children. Ninety percent of cases are younger than 5 years of age. Clinical and pathological risk stratification forms a crucial role in determining the treatment strategy. This study aimed to assess the clinicopathological profile of hepatoblastoma with risk stratification and follow-up in children.

Methods

A retrospective evaluation was performed on all pediatric patients diagnosed as hepatoblastoma between 2016 and 2020 in our institution. Clinical, radiological, biochemical, pathological, and treatment data were analyzed. Cases were stratified based on the SIOPEL protocol and compared with the outcome.

Results

The median age of all children was 1 year, the male-to-female ratio was 2.3:1, and elevated α-fetoprotein (AFP) was observed in all cases. SIOPEL risk stratification showed that 50% of children were at high risk. The histopathological types were fetal (30%), embryonal (20%), and macrotrabecular (5%) patterns under epithelial type and mixed epithelial and mesenchymal type (45%) with 1 case showing teratoid features. During the follow-up period, 6 out of the 7 children who died, belonged to the high-risk SIOPEL category, and 5 presented a mixed epithelial and mesenchymal pattern.

Conclusion

Our study found a significant correlation between clinicopathological data, histopathological patterns, and outcomes. Accordingly, histopathological patterns could be considered one of the criteria for risk stratification. Histopathological risk stratification indicators (such as SIOPEL and PRETEXT) have strong prognostic and predictive outcomes; hence, our study emphasizes such parameters to aid oncologists.

Arthritis flares mediated by tissue-resident memory T cells in the joint

Rheumatoid arthritis is a systemic autoimmune disease, but disease flares typically affect only a subset of joints, distributed in a distinctive pattern for each patient. Pursuing this intriguing pattern, we show that arthritis recurrence is mediated by long-lived synovial resident memory T cells (T_RM). In three murine models, CD8+ cells bearing T_RM markers remain in previously inflamed joints during remission. These cells are bona fide T_RM, exhibiting a failure to migrate between joints, preferential uptake of fatty acids, and long-term residency. Disease flares result from T_RM activation by antigen, leading to CCL5-mediated recruitment of circulating effector cells. Correspondingly, T_RM depletion ameliorates recurrence in a site-specific manner. Human rheumatoid arthritis joint tissues contain a comparable CD8+-predominant T_RM population, which is most evident in late-stage leukocyte-poor synovium, exhibiting limited T cell receptor diversity and a pro-inflammatory transcriptomic signature. Together, these findings establish synovial T_RM as a targetable mediator of disease chronicity in autoimmune arthritis.

Abstract P5-15-06: Potential Medicare beneficiary out-of-pocket cost reductions through use of biosimilar filgrastim-sndz over reference filgrastim among breast cancer patients: A simulation model analysis

Rationale & Objective: Granulocyte colony-stimulating factors (G-CSFs) are utilized to decrease the incidence of febrile neutropenia (FN) in patients with cancers undergoing chemotherapy treatments. In 2015 biosimilar filgrastim-sndz was the first biosimilar to be approved and launched in the US market. Limited data exists in ascertaining the impact of biosimilars on patient out-of-pocket (OOP) expenditures. The objective of this simulation model was to estimate potential OOP cost savings through use of filgrastim-sndz over reference filgrastim from a Medicare breast cancer patient perspective.

Methods: An Excel simulation analysis was conducted among breast cancer patients treated with biosimilar filgrastim-sndz or the branded reference filgrastim (identified through HCPCS codes). Data from the 2016 Medicare Limited Data Set (5% sample of the carrier file) was used to populate the model. The payment calculation worksheet within the Medicare carrier file was used to calculate the average Medicare payment to the provider and the average beneficiary OOP responsibility per claim of either filgrastim-sndz or reference filgrastim. The average OOP reduction per claim for a filgrastim-sndz beneficiary relative to a reference filgrastim beneficiary was multiplied to a hypothetical FN prevalent population of 100,000 beneficiaries (average of 10 claims per beneficiary) to estimate the potential OOP savings.

Results: Data for 616 filgrastim-sndz and 1,064 reference filgrastim claims were used to populate the model. The average Medicare allowed charge amount per claim for a filgrastim-sndz beneficiary was $362.8 versus $406.9 for a reference filgrastim beneficiary, while corresponding average Medicare payments to the provider were $284.1 and $316.9, respectively. On an average, OOP responsibility for a filgrastim-sndz beneficiary was lower compared to a reference filgrastim beneficiary ($72.9 versus $82.5) leading to a cost saving per claim of $9.60. When extrapolated to 100,000 beneficiaries (1,000,000 claims), the overall cost saving was projected to be around $9.6 million.

Conclusions: Our simulation model estimated a potential OOP Medicare breast cancer beneficiary saving of around $9.6 million, based on a hypothetical population of 100,000 FN beneficiaries, with the use of biosimilar filgrastim-sndz over reference filgrastim. Further real-world analyses are required to evaluate the true cost saving potential from a breast cancer patient perspective with the use of biosimilars over reference biologics.

Citation Format: Puckrein G, Xu L, Ryan A, Campbell K, Balu S. Potential Medicare beneficiary out-of-pocket cost reductions through use of biosimilar filgrastim-sndz over reference filgrastim among breast cancer patients: A simulation model analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-06.

Abstract P4-12-07: Cost-minimization of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar ZARXIO® over NEUPOGEN®, NEULASTA®, and NEULASTA/ONPRO®: Breast cancer case study

RATIONALE & OBJECTIVES: Biosimilar filgrastim may offer significant cost advantages over originator filgrastim and pegfilgrastim. The objectives were (1) to evaluate for the US the comparative cost-minimization of chemotherapy-induced (febrile) neutropenia (CIN/FN) prophylaxis with biosimilar filgrastim ZARZIO® over originator filgrastim NEUPOGEN®, and originator pegfilgrastim NEULASTA® and NEULASTA/ONPRO® injection device with the health-care provider (HP) providing full administration, using 3Q2016 average selling price (ASP); and (2) to apply the different savings estimates to a breast cancer case study.

METHODS: Cost-minimization analysis of [1] acquisition costs for one patient for one chemotherapy cycle for 1 to 14 days (d) using per unit dose, and [2] administration costs using Current Procedural Terminology (CPT) codes. We calculated [1] the general cost of prophylaxis for one cycle with each agent, with standard filgrastim administrations ranging from 1-14 days and pegfilgrastim limited to single administration; and [2] the cost-savings that could be accrued from 1-14d prophylaxis with ZARXIO® over the three originator options. The case study concerns a 43 y/o Caucasian female, newly diagnosed with stage 2 HER2-negative breast cancer being started on TAC (FN risk >20%); unremarkable medical history; no comorbidities; with primary prophylaxis initiated in cycle 1 and continued through 6 cycles per local protocol (single NEULASTA® or NEULASTA/ONPRO® or 11d NEUPOGEN® or ZARXIO®).

RESULTS: Using ASP+CPT, prophylaxis cost per dose (rounded) was $260 for ZARXIO®, $326 for NEUPOGEN®, $3,926 for NEULASTA®; $3,910 for NEULASTA®. In general, cost-savings per cycle from ZARXIO® over NEUPOGEN® ranged from $65 (1d) to $916 (14d); over Neulasta®, from $3,666 (1d) to $284 (14d); and over NEULASTA/ONPRO®, from $3,649 (1d) to $267 (14d). In the breast cancer case study, cost of prophylaxis per one cycle was $2,862 for ZARXIO® (11d), $3,582 for NEUPOGEN® (11d) vs. $3926 for NEULASTA® and $3910 for NEULASTA/ONPRO® single-injection. Cost-savings per cycle from ZARXIO® use were $719 vs. NEUPOGEN®, $1,064 vs. NEULASTA®, and $1,047 vs. NEULASTA/ONPRO®. Total savings from ZARXIO® use over all 6 TAC cycles were $4,316 vs. NEUPOGEN®, $6,385 vs. NEULASTA®, and $6,284 vs. NEULASTA/ONPRO®.

CONCLUSIONS: In general, CIN/FN prophylaxis with ZARXIO® for 1-14d generates significant cost savings over NEUPOGEN®, NEULASTA® and NEULASTA/ONPRO generating significant cost-savings. In the case study of the 43 y/o HER-negative breast cancer patient treated with TAC and prescribed 6 cycles of primary prophylaxis with 11d standard or single-administration pegfilgrastim, savings reached as high as $6,385 for the full course of chemotherapy. Given the trial evidence of non-inferiority of pegfilgrastim over filgrastim, the clinical trend for <14d of filgrastim prophylaxis, and payer trends to authorize filgrastim vs. pegfilgrastim prophylaxis, using biosimilar Zarxio® is rational from both a economic perspective; as illustrated also in the breast cancer case study.

Citation Format: McBride A, Campbell K, Bikkina M, MacDonald K, Abraham I, Balu S. Cost-minimization of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar ZARXIO® over NEUPOGEN®, NEULASTA®, and NEULASTA/ONPRO®: Breast cancer case study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-12-07.

Budget impact of rosuvastatin initiation in high-risk hyperlipidemic patients from a US managed care perspective

INTRODUCTION

Statins reduce low-density lipoprotein cholesterol (LDL-C) levels, which, when elevated, represent a significant risk factor for cardiovascular (CV) disease. Hyperlipidemic patients at risk of CV events initiated on simvastatin or atorvastatin may be less likely to meet LDL-C goals (defined in National Cholesterol Education Program guidelines) and more likely to experience CV events than patients initiated on rosuvastatin. A 3-year budget impact model was developed to estimate the clinical impact and cost to a US managed care organization (MCO) with 1 million members of initiating high-risk hyperlipidemic patients on rosuvastatin rather than simvastatin or atorvastatin.

METHODS

A total of 1000 adult patients were assumed to initiate statins. The average baseline LDL-C level was 189 mg/dL. In scenario 1, all patients were initiated on simvastatin or atorvastatin and titrated to a higher dose, or switched to atorvastatin (if initiated on simvastatin) or rosuvastatin; in scenario 2, 50% of the 520 high-risk patients were initiated on rosuvastatin. Drug acquisition and administration costs were considered. Product labeling, clinical trial results, national prescription claims data, and published literature were used to populate the model.

RESULTS

Over 3 years, 75 additional patients reached their LDL-C goal in scenario 2, compared with scenario 1 (633 vs 558, respectively), at an increased cost of $240,628 ($1,415,516 vs $1,174,888, respectively). The additional per member per month (PMPM) cost of scenario 2 was $0.007.

LIMITATIONS

This analysis assumed that statin efficacy is the same in real life as in trials, and used titration and switching patterns not based on patients' goal attainment. However, sensitivity and scenario analyses showed that the model was less sensitive to these parameters than to cost-related parameters.

CONCLUSIONS

Initiating high-risk hyperlipidemic patients on rosuvastatin may increase the number of patients reaching LDL-C goal at a relatively modest increase in PMPM cost to an MCO.

Variation of health-care resource utilization according to GERD-associated complications

Complications associated with gastroesophageal reflux disease (GERD) can include esophageal stricture, Barrett's esophagus, gastrointestinal hemorrhage, and extraesophageal symptoms. The impact of GERD-associated complications on health-care utilization deserves further evaluation. We identified commercial enrollees 18-75 years old with claims for GERD (International Classification of Diseases, Ninth Revision, Clinical Modification Codes: 530.81 or 530.11) and subsequent usage of proton pump inhibitors from 01/01/05 to 06/30/09. The initial GERD diagnosis date was designated as the index date, and patients were studied for 6 months preindex and postindex. Eligible patients were subsequently stratified based on medical claims for GERD-associated complications as follows: stage A (GERD diagnosis, no other symptoms), stage B (GERD + extraesophageal symptoms), stage C (GERD + Barrett's esophagus), stage D (GERD + esophageal stricture), and stage E (GERD + iron-deficiency anemia or acute upper gastrointestinal hemorrhage). Patient characteristics, health-care utilization, and costs were compared between stage A and each stage with complicated GERD (B-D). Of the 174,597 patients who were eligible for analysis, 74% were classified as stage A, 20% stage B, 1% stage C, 2% stage D, and 3% stage E. Relative to stage A, patients in stages C, D, and E were significantly more likely to visit a gastroenterologist (13% vs. 68%, 71%, and 38%, respectively) and had higher rates of esophageal ulcers (0.3% vs. 8%, 5%, and 3%, respectively) and Nissen fundoplication (0.05% vs. 0.6%, 0.3%, and 0.2%, respectively). Six-month GERD-related costs ranged from $615/patient (stage A) to $1714/patient (stage D); all-cause costs ranged from $4195/patient (stage A) to $11,340/patient (stage E). Compared with stage A, all other cohorts had significantly higher all-cause and GERD-related costs (P < 0.0001 for all comparisons). While patients with more severe GERD represented a relatively small portion of the GERD cohort, they demonstrated significantly greater health-care costs and overall utilization than patients with uncomplicated GERD.

Treatment patterns and costs following metastatic breast cancer diagnosis in U.S. women: A SEER-Medicare analysis

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Background: To use SEER-Medicare data to evaluate treatment (tx) patterns and health care costs in U.S. women with metastatic breast cancer (MBC).

Methods: Key inclusion criteria included women diagnosed (dx) with breast cancer in 2001-2005 with 1) enrollment in Medicare 12 mo prior to dx through follow-up (2008) or death; 2) initial dx of “distant” disease or 2 indications of secondary malignancy >2 mo after initial dx; and 3) indication of tx with injectable hormonal, chemotherapy (chemo) or targeted/biologic therapies. Lines of tx were designated as: 1st-line if 1st agent (or agents, if on same day) after dx of MBC; new agents administered > 42 d after the previous agent are a new line, as well as an agent administered > 60 d after last dose of the same agent. Oral medication data were not available. Kaplan-Meier techniques estimated lifetime total health costs by partitioning data into 30-d intervals starting with MBC dx date and then summing the product of mean cost in each interval by the probability of survival to the start of the interval. Bootstrapping methods were used to generate 95% confidence intervals (CI).

Results: The table lists the top 5 injectable tx for first, second, and third line, with associated mean lifetime costs.

Conclusions: In this population, the injectable fulvestrant was the most commonly used first-line tx, with vinorelbine most frequently used in second- and third-line settings for MBC. Mean lifetime cost of MBC was $110,000.

[Table: see text]

Development of a refractory gastro-oesophageal reflux score using an administrative claims database

BACKGROUND

Approximately one-third of gastro-oesophageal reflux disease (GERD) patients demonstrate refractory symptoms following treatment with proton pump inhibitor (PPI) therapy.

AIM

To develop a refractory GERD score that can be applied to predict patients' healthcare utilisation.

METHODS

We enrolled adults (≥18 years) with a diagnosis of GERD. Refractory GERD was evaluated on an 8-point scale where 1 point was given for each of the following criteria: doubling, addition, or switching of GERD medication dose, receipt of a GERD-related endoscopic procedure or surgery, or ≥3 GERD-related outpatient visits. Refractory GERD was defined as the presence of two or more points.

RESULTS

A total of 135,139 GERD patients (44% male) were analysed with a mean (±s.d.) age of 52.9 ± 15 years. The mean overall refractory GERD score was 1.12 ± 1.2 (range 0-8 on an 8-point scale); 31% of patients had refractory GERD with a mean score of 2.56 ± 0.82. Among patients with refractory GERD, 31% doubled their GERD medication, 28% added a new GERD medication, 60% switched GERD medications, 54% had a GERD-related procedure and 1% had a GERD-related surgery. Patients with refractory GERD were more likely to be female (59% vs. 55%, P < 0.001) and had a higher co-morbidity score (0.78 vs. 0.56, P < 0.001). The overall mean costs for refractory patients during the study period were significantly higher compared with treatment-responsive patients ($18,088 ± $36,220 vs. $11,044 ± $22,955, P < 0.001).

CONCLUSIONS

Refractory GERD was present in approximately one-third of the GERD patients. We created a GERD refractory score that could define need for increased anti-reflux therapy and predict higher healthcare resource utilisation.

Palonosetron versus other 5-HT3–receptor antagonists for chemotherapy-induced nausea and vomiting prevention in patients with noncolon gastrointestinal cancers

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Background: This study analyzed the risk of chemotherapy induced nausea and vomiting (N&V) [CINV] associated with palonosetron versus other 5-HT3 receptor antagonists (5-HT3-RAs) initiation among patients with non-colon gastrointestinal cancers receiving chemotherapy (CT) in a hospital outpatient setting.

Methods: Patients diagnosed with any non-colon gastrointestinal cancer initiating any CT and antiemetic prophylaxis with palonosetron (Group 1) or other 5-HT3-RAs (Group 2) for the first time (index date) between 4/1/2007-3/31/2009 were identified from the Premier Perspective database. Patients included were aged ≥ 18 years, with no evidence of N&V, CT, and antiemetic medication in the 6 month pre-index date period, and with at least 36 consecutive months of data. A negative binomial GLM regression analysis was done estimating the number of CINV events (identified through either ICD-9-CM codes for N&V and/or volume depletion or CINV-related rescue medications 1 day after CT administration) in the follow-up period (first of 8 CT cycles or 6 months post index date) between the 2 groups (after matching on CT and specific CT cycle).

Results: Of 658 identified patients, 215 initiated on palonosetron (Group 1; 32.7%). Group 1 patients were significantly younger [61.7 (SD: 11.3) vs. 62.2 (12.1) years; p = 0.0073], a higher percent received highly emetogenic chemotherapy (27.4% vs. 19.4%; p < 0.0001), and comprised of less African Americans (7.0% vs. 13.3%). In the follow-up period, the unadjusted number of CINV events per patient per CT cycle for Group 1 patients was lower versus Group 2 patients, though statistically non-significant (4.7 vs. 5.2; p = 0.1714). However, after controlling for differences in demographic and clinical variables, the regression model predicted a statistically significant reduction (30.9%) in the total CINV events per patient per CT cycle in favor of Group 1 patients; p = 0.0086.

Conclusions: In this analysis, patients with non-colon gastrointestinal cancers initiated on palonosetron were more likely to experience a significantly lower rate of CINV events per patient per CT cycle versus those initiated on other 5-HT3-RAs.

[Table: see text]

Production and characterisation of monoclonal antibodies specific for chicken interleukin-12

Using genetic immunisation of mice, we produced antibodies against chicken interleukin-12p40 (chIL-12p40), also known as IL-12β. After a final injection with a recombinant chIL-12p40 protein, several stable hybridoma cell lines were established which secreted monoclonal antibodies (mAbs) to this component of the heterodimeric IL-12 cytokine. Specific binding of three of the mAbs to COS-7 cell-derived recombinant chIL-12p40 and the chIL-12p70 heterodimer was demonstrated in an indirect ELISA, and in dot blots. Two of the mAbs were used to develop a capture ELISA, suitable for detecting both recombinant protein (chIL-12p40 and the heterodimeric p70 protein) and native chIL-12. The mAbs were further characterised to show utility in immunocytochemistry.

Traditional Medicinal Knowledge on Moringa concanensis Nimmo of Perambalur District, Tamilnadu

Moringa concanensis Nimmo (Moringaceae) is one of the important medicinal plant. It is restricted in its distribution. The present study was aimed at recording traditional knowledge about this plant in various localities of Perambalur district, Tamilnadu. The medicinally useful part, drug preparation, mode of administration and the disease which can be treated have been discussed in this paper.

MASS MULTIPLICATION OF THE INDIAN MEDICINAL PLANT Tylophora Indica (Burm.f.) Merr

Tylophora indica (Burm.f) Merr. (ASCLEPIDACEAE) is an important Indian medicinal plant. It is called "ASTHMA KODI" OR "NANJARUPPAN" IN Tamil in the Siddha system of medicine. Tamil medical literature reveal that it is an ideal plant medicine for respiratory problems and is also a cardiac tonic. For medicinal purposes it is collected only from the wild. It has not yet been brought under cultivation. Its taxonomy, morphology, ecology and medicinal uses were studied. Since, tissue-culture is a costly technology and requiring a high-tech laboratory a low-cost mass- multiplication technique has been invented through water-culture experiments, in order to make its saplings available to the interested herbal farmers in a larger scale. The results are reported in this paper, which will be of immense help and use to the herbal farmers.

Isolation of Neospora caninum genes detected during a chronic murine infection

In order to isolate genes coding for antigens of Neospora caninum which are recognised by the host immune system during a chronic murine infection, a cDNA library was immunoscreened with pooled sera from mice which survived three independent infections by N. caninum. Two new genes from N. caninum were isolated and expressed in Escherichia coli. The genes identified include one homologous to GRA1 of Toxoplasma gondii, plus another (NCP20) previously unknown in any taxon. Both genes encode small polypeptides which induced an IgG response in the mouse and were also recognised by IgG from a cow chronically infected with N. caninum. These results are consistent with the hypothesis that the polypeptides encoded by these genes are a target for the host immune system during chronic infections of N. caninum.

Isolation, characterization and expression of a GRA2 homologue from Neospora caninum

A cDNA library derived from mRNA of tachyzoites of Neospora caninum (NC-Liverpool strain) was screened with antisera from a cow naturally infected with N. caninum. The DNA sequence of 1 recombinant isolated predicted a significant protein sequence homology of the gene product to the 28 kDa (GRA2) antigen of Toxoplasma gondii. Studies on the N. caninum gene coding for this antigen demonstrated the presence of a single intron flanked by 2 exons; the gene was also highly expressed in culture-derived tachyzoites. The antigen was expressed in Escherichia coli; when injected into mice it stimulated the production of antibodies which detected a 29 kDa antigen of N. caninum. Secondary structure predictions made for the N. caninum protein showed support for several amphipathic helices separated by loops and turns. The available evidence indicates maintenance of protein secondary structure, and not DNA or amino acid sequence, has occurred during the evolution of GRA2 proteins in N. caninum and T. gondii.

Treatment of eye diseases by the healers of marakanam bio-region

The present study is an attempt to list some of the medicinal plants used by the traditional practitioners of the Marakanam bio-region in the treatment of various eye diseases. The survey of folk medicine men from this bio-region has revelaed that there are 24 medicinal plants locally available for treating both simple and complex eye diseases. Most of these diseases have been identified in Sanskrit and Tamil and are correlated with their English terms.

Phytochemical observations on some species of andrographis wall

Phytochemical studies of leaf of the herbs, Andrographis paniculata and Andrographis lineate (Acanthaceae) were carried out. Presence of phenolic compounds, flavonoids, alkaloids saponins and tannins and absence of steroids and triterpenoids have been reported there in this herbs for the first time.

Nomenclatural confusion of some species of andrographis wall

Andrographis paniculata Nees, Andrographis alata Nees and Andrographis lineate Nees. (Acanthaceae) are important medicinal plants useful in the treatment of various human ailments. Nomenclatural confusion prevails with regards to these medicinal plants in India medical literature and vernacular nomenclature. This nomenclatural confusion has been clarified in the present paper.

Propagation of andrographis lineata nees by stem cuttings

Androgaphis lineate Nees., an important tribal medicinal plant of the Shevaroy Hill was noted to be restricted in its distribution due to biotic pressure. The species was successfully propagated by stem cuttings in its habitat. The percentage establishment of stem cuttings was 67.

Antivenom activities of some species of andrographis wall

Antivenom activities of the alcoholic extracts of three species of Andrographis wall, were measured at a concentration of 10,25,50,75 and 100 μg/ml by in vitro assay of HRBC membrane lysis. All the extracts were found to be effective in the inhibition of in vitro HRBC lysis. The maximum antivenom activity was found in the alcoholicextract of Andrographis paniculata Nees.

Rapid multiplication of wedelia chinensis (osbeck) merr - a valuable medicinal herb

Stem-cuttings of Wedelia chinensis (Osbeck.) Merr. Were treated with different concentrations of IBA and GA. The results indicate that 100 ppm IBA treatment greatly enhances root production and quick establishment of the stem-cuttings.

Antipyretic activities of some species of andrographis wall

The antipyretic activities of the alcoholic extracts of three species of Andrographis Wall, were assayed at a dose of 500 mg/kg body weight in pyrogenic polysaccharide - induced hyperpyrexia in male albino rats. All the extracts were found to be effective in the inhibition of pyrexia. The maximal antipyretic activity was found with the alcoholic extract of Andrographis alata Nees.

Nomenclatural confusion on eclipta prostrate (L.) L

Eclipta prostrate (L.) L. (Asterceae) is a valuable plant used in the treatment of various human ailments in Ayurveda and Siddha systems. Nomenclatural confusion prevails as different plants are mentioned in Indian medical literature as Bhringaraja and Karisalahganni. It is evident from the present study that the nomenclature Bhringaraja and Karisalanganni must be restricted only to Eclipta prostrate (L.) L.