SlideShare a Scribd company logo
1 of 15
“COMPARISON OF TOPICAL ANTI- FUNGAL AGENTS SERTACONAZOLE AND CLOTRIMAZOLE IN 
THE TREATMENT OF TINEA CORPORIS-AN OBSERVATIONAL STUDY” 
1 
ABSTRACT 
Objectives: To compare the efficacy of topical antifungal agents, Sertaconazole and 
Clotrimazole in Tinea corporis patients. 
Methods: A total of 60(n=60) patients were included in the study. They were divided into two 
groups of 30 patients each. First group included patients treated with topical Sertaconazole as 
test drug whereas the second group constituted patients treated with topical Clotrimazole as 
standard drug. The patients were advised to apply the drug on affected area twice daily for 
three weeks. The parameters like erythema, scaling, itching, margins and size of the lesion and 
KOH mount were taken for the assessment of efficacy. This was an open labelled study and 
patients were followed up every week for three weeks. 
Results: The total score included all grades in erythema, itching, scaling, margins and size of 
lesion and KOH mount. There was significant reduction in erythema (p<0.02) and highly 
significant reduction in scaling (p<0.001), itching (p<0.001) and margins of lesion (p<0.001) 
among Sertaconazole group. The mean difference and the standard deviation of total scores for 
Clotrimazole were 7.20 and 1.69 and for Sertaconazole group 8.80 and 1.52 respectively. The p 
value on application of students unpaired‘t’ test was p<0.001. (Highly significant) 
Conclusion: From the present study,it can be concluded that topical Sertaconazole shows 
better improvement in the clinical parametersthan topical Clotrimazole within a span of 3 
weeks in the treatmentof T. corporis. 
Keywords: Antifungal Agents, Clotrimazole, Sertaconazole, Tinea Corporis.
4 
Clotrimazole is broad spectrum topical antifungal agent. It is generally 
2 
INTRODUCTION 
The incidence of topical fungal infections has progressively increased in recent years primarily 
because of an increased number of immunocompromised patients and the increased use of 
health clubs and community swimming pools, which favour the spread of 
1,2 
infections. 
Dermatophytes are group of taxonomically related fungi that invade the 
keratinized tissue (skin, hair, nails) of humans or other animals resulting in an infection called 
dermatophytosis. 
3 
Tinea corporis refers to all dermatophytosis of glabrous skin except the 
palms, soles and groin. This disease can be treated with topical and oral antifungal drugs. There 
are several topical antifungal agents like Fluconazole, Clotrimazole, Ciclopirox, Naftifine, and 
Terbinafine and so on. 
well tolerated but in some cases erythema, burning, stinging, peeling, blistering, edema, pruritis 
and urticaria at site of application are reported. It is applied twice daily for three weeks for 
5,6 
T.corporis. 
Sertaconazole is a newer topical imidazole found to be more active than other 
7,8 
azole antifungals in several studies. 
It is also reported that once daily application for three 
weeks regimen of Sertaconazole showed improved patient compliance which is important in 
successful treatment of dermatomycoses. 
7,8 
Hence, the present study was undertaken to study the antifungal efficacy of Sertaconazole and 
compare with the commonly used antifungal Clotrimazole in Tinea corporis.
3 
OBJECTIVES OF THE STUDY 
1) To compare the efficacy of topical antifungal agents, Sertaconazole and Clotrimazole in 
Tinea corporis patients. 
METHODOLOGY 
The present study on dermatophytosis was carried out after the Institutional Ethical Committee 
approval in the Department of Dermatology, J. J. M. Medical College and Chigateri General 
Hospital, Davangere, Karnataka, over a period of two years from Dec 2009 to Jan 2012. A total 
of 60(n=60) patients were included in the study. Written informed consent was taken from all 
the patients. The diagnosis and treatment of Tinea corporis was done with the help of 
consultant Dermatologist. They were divided into two groups of 30 patients each. The average 
age of clotrimazole and sertaconazole groups were 31.93 and 33.33 with standard deviation of 
13.18 and 11.99 respectively, showing that their age group was much similar. After taking 
history, a detailed clinical examination of the patient was done in good light to determine the 
number of lesions, the types, presence of inflammatory margin and the extent of involvement. 
First group included patients treated with topical Sertaconazole cream as test drug whereas 
the second group constituted patients treated with topical Clotrimazole cream as standard 
drug. The patients were advised to apply the drug twice daily for three weeks. The parameters 
like erythema, scaling, itching, margins and size of the lesion and KOH mount were taken prior 
to treatment and at the end of three weeks. The study method was open label method. 
Chemicals and drugs: 
a) Sertaconazole 2% cream used as the test drug was obtained from Torrent Company.
b) Clotrimazole 2% cream used as standard drug was obtained from government hospital. 
(Karnataka antibiotics and pharmaceuticals limited) 
c) All the patients received tab. Teczine (levocetrizine 5mg ) once daily for 10 days 
d) Potassium hydroxide (KOH) mount of skin scrapings from the affected site was used for 
4 
confirmation of clinical diagnosis. 
9 
Patient Inclusion Criteria: 
The patients were included from the age group of 15-60years, having clinical manifestations of 
Tinea corporis such as erythema, scaling, vesicles, pustules , itch, and skin scraping positive for 
KOH (Potassium hydroxide) mount. 
Patients Exclusion Criteria: 
Patients with systemic mycosis or mycosis of the hands face and scalp, Oropharyngeal mycosis, 
vaginal mycosis, Pre-treatment with antifungal drugs and immunosuppressive agents within 14 
and 30 days respectively, prior to the onset of study were excluded. Pregnancy, lactation or 
inadequate contraception in women of child bearing potential, Participation in another study 
within 30 days prior to the commencement of the study, Patients with history of 
hypersensitivity to azole drugs or vehicle ingredients, Patients with history of diabetes mellitus, 
severe psychiatric illness and other systemic illness and Patients who are unwilling to give 
written consent were also excluded. 
Efficacy parameters: 
The patients were monitored for the following signs.
6 
: Change in colour from erythema to normal skin colour was noted. The 
5 
Colour of the lesion 
scoring was given in following manner.0=absent, 1=mild, 2=moderate, 3=severe 
Scaling of the lesion6:The Scoring was given in the following manner. 0=Absent, 1=Mild, 
2=Moderate, 3=Severe. 
Itching6: The scoring was given in the following manner.0=no itching, 1=Mild itching not 
affecting daily activities, 2=Moderate itching affecting daily activities, 3=Severe itching 
disturbing the sleep. 
Margins of the lesion6: whether the lesion shows progressive (presence of papules, vesicles) or 
regressive pattern (return to normal skin pattern). Scoring was given in following manner: 
0=Regressive, 1=Stagnant, 2=Progressive 
Size of the lesion6: Whether there was increase or decrease in size. Scoring for lesion size was 
as follows: 0=size less than 5cms in circumference, 1=size 5-10cms, 2=size 10-20cms, 3=size > 
20cms. 
KOH mount6: The scoring was given as 0=KOH negative, 2=KOH positive. 
In the present study, the efficacy of the topical treatment is determined by shifting of patients 
from grade 3 to grade 2, grade 2 to grade 1, grade 1 to grade 0 with each parameter. Grade 0 is 
the highest level of cure that can be attained by any patient. So the primary aim of treatment 
was to bring the patient to grade 0. The total score includes the scores of colour of the lesion, 
scaling of the lesion, itching, margins of the lesion, size of the lesion and KOH mount. 
Statistical analysis: 
After collecting the raw data, the values in all the groups were analyzed by using Wilcoxon 
signed rank test, Mann Whitney test and students unpaired ‘t’ test.
Erythema Clotrimazole group Sertaconazole group 
Grade Pre treatment 
Pre treatment 
No. (%) No. (%) No. (%) No. (%) 
0 0(0.0) 9(30.0) 0(0.0) 29(96.7) 
1 10(33.3) 19(63.3) 0(0..0) 0(0.0) 
2 15( 50.0) 2(6.7) 30(100.0) 1(3.3) 
3 5(16.7) 0(0.0) 0(0.0) 0(0.0) 
Total 30(100) 30(100) 30(100) 30(100) 
6 
74 
RESULTS 
Table 1:Comparison of pre and post treatment erythema in Clotrimazole group and 
Sertaconazole group 
patients 
Post treatment 
patients 
P< 0.001HS, Wilcoxon signed rank test 
patients 
Post treatment 
patients 
Table 2: Comparison of pre and post treatment scaling in Clotrimazole group and 
Sertaconazole group 
Scaling Clotrimazole group Sertaconazole group 
Grade Pre treatment 
patients 
Post treatment 
patients 
Pre treatment 
patients 
Post treatment 
patients 
No. (%) No. (%) No. (%) No. (%) 
0 0(0.0) 9(30.0) 0(0.0) 17(56.7) 
1 5(16.7) 20(66.7) 13(43.3) 13(43.30) 
2 21( 70.0) 1(3.3) 16(53.3) 0(0.0) 
3 4(13.3) 0(0.0) 1(3.3) 0(0.0) 
Total 30(100) 30(100) 30(100) 30(100)
Table 3: Comparison of pre and post treatment itching in Clotrimazole group and 
7 
Sertaconazole group: 
Itching Clotrimazole group Sertaconazole group 
Grade Pre treatment 
patients 
Post treatment 
patients 
Pre treatment 
patients 
Post treatment 
patients 
No. (%) No. (%) No. (%) No. (%) 
0 0(0.0) 9(30.0) 0(0.0) 23(76.7) 
1 0(0.0) 20(66.7) 9(30.0) 7(23.30) 
2 30( 100.0) 1(3.3) 20(66.7) 0(0.0) 
3 0(0.0) 0(0.0) 1(3.3) 0(0.0) 
Total 30(100) 30(100) 30(100) 30(100) 
Table 4: Comparison of pre and post treatment margins in Clotrimazole group and 
Sertaconazole group 
Margins Clotrimazole group Sertaconazole group 
Grade Pre treatment 
patients 
Post treatment 
patients 
Pre treatment 
patients 
Post treatment 
patients 
No. (%) No. (%) No. (%) No. (%) 
0 0(0.0) 7(23.3) 0(0.0) 2(6.7) 
1 0(0.0) 23(76.6) 1(3.3) 28(93.3) 
2 30( 100.0) 0(0.0) 0(0.0) 0(0.0) 
3 0(0.0) 0(0.0) 0(0.0) 0(0.0) 
Total 30(100) 30(100) 30(100) 30(100) 
p<0.001 HS, Wilcoxon signed rank test
TABLE 5: Comparison of pre and post treatment size in Clotrimazole group and Sertaconazole 
8 
group 
Size Clotrimazole group Sertaconazole group 
Grade Pre treatment 
patients 
Post treatment 
patients 
Pre treatment 
patients 
Post treatment 
patients 
No. (%) No. (%) No. (%) No. (%) 
0 2(6.7) 13(43.3) 0(0.0) 15(50.0) 
1 10(33.3) 8(26.7) 20(66.7) 15(50.0) 
2 14(46.7) 6(20.0) 9(30.0) 0(0.0) 
3 4(13.3) 3(10.0) 1(3.3) 0(0.0) 
Total 30(100) 30(100) 30(100) 30(100) 
p<0.001 HS, Wilcoxon signed rank test 
Table 6: Comparison of pre and post treatment KOH mounts investigation in Clotrimazole 
group and Sertaconazole group. 
KOH Clotrimazole group Sertaconazole group 
Grade Pre treatment 
patients 
Post treatment 
patients 
Pre treatment 
patients 
Post treatment 
patients 
No. (%) No. (%) No. (%) No. (%) 
0 0(0.0) 29(96.7) 0(0.0) 30(100.0) 
1 0(0.0) 0(0.0) 0(0.0) 0(0.0) 
2 30(100.0) 1(3.3) 30(100.0) 0(0.0) 
3 0(0.0) 0(0.0) 0(0.0) 0(0.0) 
Total 30(100) 30(100) 30(100.0) 30(100.0) 
P<0.001 HS, Wilcoxon signed rank test
Table 7:Comparison of pre treatment values of both the Clotrimazole and Sertaconazole 
9 
groups 
Parameter Range Median Range Median Median 
difference 
P* value, sig 
ERYTHEMA 1-3 2 1-3 2 0 0.2 NS 
SCALING 1-3 2 1-3 2 0 0.06 NS 
ITCHING 1-3 2 1-3 2 0 0.21 NS 
MARGINS 1-3 2 1-3 2 0 0.31 NS 
SIZE 0-3 2 0-3 1 1 0.07 NS 
KOH MOUNT 0-2 2 0-2 2 0 1.0 NS 
*Mann Whitney U 
test 
Table 8: Comparison of post treatment values of both the Clotrimazole and 
Sertaconazolegroups 
CLOTRIMAZOLE GROUP SERTACONAZOLE GROUP 
Parameter Range Median Range Median Median 
difference 
P* value, 
sig 
ERYTHEMA 0-2 1 0-1 0 1 0.02 S 
SCALING 0-2 1 0-1 0 1 0.001 S 
ITCHING 0-1 1 0-1 0 1 <0.001 HS 
MARGINS 0-1 1 0-1 0 1 <0.001 HS 
SIZE 0-3 1 0-1 1 1 0.11 NS 
KOH MOUNT 0-2 0 0-2 0 0 0.31 NS 
*Mann Whitney U test
Table 9: Comparison of pre and post treatment total scores in Clotrimazole and Sertaconazole 
10 
group: 
Mean difference 
Parameter CLOTRIMAZOLE 
GROUP 
SERPTACONAZOLE 
GROUP 
P* value, sig 
Mean 7.20 8.80 P<0.001 HS 
SD 1.69 1.52 
*Student's unpaired t test 
DISCUSSION 
The antifungal properties of Sertaconazole have been evaluated in a few in-vitro studies. 
10, 11 
In one of these studies, isolates of T. Rubrum showed a higher sensitivity to Sertaconazole 
than to Bifonazole, Fluconazole And Cyclopyroxolamine but not to Amorolfine or 
Terbinafine. 
12 
In a comparative study of susceptibility against 250 clinical isolates of 
dermatophytes and Scopulariopsis Brevicaulis, Sertaconazole was shown to be one of the most 
effective among ten antifungal agents evaluated.13Sertaconazole showed a broad range of 
fungicidal activity in one study. 
14 
The pharmacokinetic data shows that, immediately following 
topical application of 100mg single dose 2% Sertaconazole cream on the skin of the back of 12 
healthy volunteers, about 89% of the compound was recovered on the skin surface. 
15 
The 
clinical efficacy data shows that clinical cure rate and the mycological cure rate of 2% 
Sertaconazole cream twice daily was significantly greater than that of 2% miconazole cream 
twice daily in patients with a range of cutaneous mycoses. 
16
In the present study we have compared Sertaconazole and Clotrimazole topical cream among 
two groups of patients with comparable age. The pre-treatment values of both the groups in 
terms of erythema, scaling, itching, margins and size of the lesion and KOH mount were not 
significantly different (table 7). In order to compare the grading, the median grading in each of 
the parameters in each group was taken and after applying Mann Whitney U test, the p value 
was calculated which was insignificant.(table 7)This shows that both the Clotrimazole and 
Sertaconazole groups were comparable in all parameters before treatment. 
Fungal infections of the dermis may elicit a local inflammatory response that results in irritation 
and itching. The anti-inflammatory properties of Sertaconazole have been evaluated in both in-vitro 
and in-vivo animal studies. In human peripheral blood lymphocytes stimulated with 
phytohaemagglutinin, Sertaconazole significantly reduced the release of several 
proinflammatory cytokines compared with a range of other antifungal agents tested.17In the 
present study, the patients with grade 0 and 1 erythema in Clotrimazole group were 30% and 
63.3% and in Sertaconazole group, the patients with grade 0 and 1 erythema were 96.7% and 
0% after the treatment period (table 1). This shows that a significantly better reduction in 
erythema by Sertaconazole(p<0.02, table 1). This can again be attributed to anti-inflammatory 
property and better clinical efficacy with Sertaconazole. After the treatment period, in 
Clotrimazole group the patients with grade 0 and 1 size were 43.3% and 26.7% and in 
Sertaconazole group were 56.7% and 43.3 % (table 5). Though the p value was not significant 
(>0.11, Table 6), there was better result with Sertaconazole. The results of KOH test in both the 
groups were negative in post treatment period (table 6).The mean difference and the standard 
11
deviation of total scores for Clotrimazole are 7.20 and 1.69 and for Sertaconazole group are 
8.80 and 1.52 respectively(Table 9). The p value is highly significant (p<0.001). 
The above results signify that Sertaconazole 2% cream is better than Clotrimazole 2% cream in 
treating Tinea corporis. Most azole drugs are fungistatic, which, although limits fungal cell 
growth, does not prevent the shedding of viable mycelial cells from the skin surface. 
Sertaconazole, however, has an additional fungicidal activity. In general, fungicidal drugs are 
preferred over fungistatic drugs for superficial dermatophyte infections because higher cure 
rates are achieved in shorter treatment times, thus increasing the likelihood of patient 
adherence and decreasing the incidence of recurrence.17One of the drawbacks of 
Sertaconazole may be the cost factor which may come down after some time. 
The limitations of this study are the small sample size and the efficacy of creams was not 
evaluated in other forms of dermatophytosis like Tinea cruris, Tinea capitis, and Tinea 
unguinum. Further studies are needed to evaluate the efficacy of Sertaconazole in these other 
forms of Tinea infections and in larger sample size. 
12 
CONCLUSION 
In the present study efficacy of 2% Sertaconazole cream was compared with 2% Clotrimazole 
cream applied topically for three weeks on the lesions of T. Corporis. At the end of 3 weeks 
Sertaconazole showed a significant reduction in erythema, scaling and other parameters 
compared to Clotrimazole cream. Hence, Sertaconazole has a better antifungal efficacy. 
ACKNOWLEDGEMENTS 
We would like to express our gratitude to Dr. H.R. CHANDRASEKHAR, M.D., former Principal, and 
Dr. S. B. MURUGESH, Professor and Head of Dermatology Department, J.J.M Medical College,
Davangere, Karnataka for allowing the study and providing free samples of Clotrimazole cream. 
We are also thankful to Torrent Pharmaceutical Company Sales Representative Mr. 
BASAVARAJA M.S, for providing free samples of Sertaconazole cream. 
th 
ed. Edinburgh: Wiley Blackwell;2010. Vol 2.p.36.1-36.93. 
13 
REFERENCES 
1. World Health Organization. Laboratory manual for diagnosis of fungal opportunistic 
infections in HIV/AIDS patients. Geneva: World Health Organization;2009. p.4-10. 
2. Jain A, Jain S, Rawat S. Emerging fungal infections among children: A review on its 
clinical manifestations, diagnosis, and prevention. J Pharm Bio allied Sci. 2010;2:314–20 
3. Hay RJ, Ashbee HR. Mycology. In: Rook’s textbook of dermatology. Burns T, Breathnach 
S, Cox N, Griffiths C editors.8 
4. Wolff K, Goldsmith LA, Katz SI, Gilchrist BA, Pallar AS, Leffell DJ. Fitzpatricks dermatology 
in general medicine. 7th ed. New York: McGraw Hill; 2008. p. 1845-46. 
5. Tripathi KD. Essentials of Medical pharmacology. 6thed. New Delhi: Jaypee Brothers 
Medical publishers (p) Ltd.; 2008. p.757-765. 
6. Wolverton SE. Comprehensive dermatologic drug therapy. Philedelphia: WB Saunders 
company; 2001; 24: p. 501-503. 
7. Borelli C, Klovekor G, Ernst TM, Bodeker RH, Korting HC et al, editors. Comparative study 
of 2% sertaconazole solution and cream formulations in patients with Tinea corporis, 
Tinea pedis interdigitalis, or a corresponding candidiasis. Am J Clin Dermatol 
2007;8(6):371-378.
8. Croxtall DJ, Plosker LG. Sertaconazole- A review of its use in the management of 
superficial mycoses in dermatology and gynaecology. Drugs 2009;69(3):339-359. 
9. Milne LJR. Fungi. In: Collee JG, Marmion BP, FraserAG, Simmons A editors. Practical 
th 
ed. Churchill Livingstone;1996.p.695-720. 
14 
Medical Microbiology.14 
10. Palacin C, Sacristan A, Ortiz JA. Invitro activity of Sertaconazole. 
Arzneimittelforschung1992 Ma y;42( 5A):699-705. 
11. Drouhet E, Dupont B. In vitro antifungal activity of Sertaconazole. Arzneimittelforschung 
1992 May; 42(5A):705-10. 
12. Carrillo-Munoz AJ, Quindos G, Del Valle O. In-vitro antifungal activity of Sertaconazole 
nitrate against recent isolates of Onychomycosis causative agents. J Chemother 2008 
Aug; 20(4):521-3. 
13. Carrillo-Munoz AJ, Guglietta A, Palacin C. In-vitro antifungal activity ofSertaconazole 
compared with nineother drugsagainst 250 clinical isolates of Dermatophytes and 
Scopulariopsis brevicaulis. Chemotherapy 2004 Dec;50(6): 308-13. 
14. Martin-Mazuelos E, Aller AI, Morilla D. Antifungal activity of Sertaconazole in-vitro 
against clinical isolates of Candida spp. Chemotherapy1996, 30;42(2):112-7 
15. Alomar C, Bassas S, Casas M. Multi-centre double-blind trial on the efficacy and safety of 
Sertaconazole 2% cream in comparison with Miconazole 2% cream on patients suffering 
from cutaneous mycoses. Arzneimittelforschung 1992 May;42(5A):767-73. 
16. Liebel F, Lyte P, Garay M. Anti-inflammatory and anti-itch activity ofSertaconazole 
nitrate. Arch Dermatol Res 2006 Sep;298(4):191-9. 
17. Kyle AA, Dahl MV. Topical therapy for fungal infections. Am J Clin Dermatol
15 
2004;5(6):443-51.

More Related Content

What's hot

Analytical method Development and Validation for the estimation of Pioglitazo...
Analytical method Development and Validation for the estimation of Pioglitazo...Analytical method Development and Validation for the estimation of Pioglitazo...
Analytical method Development and Validation for the estimation of Pioglitazo...SriramNagarajan15
 
Amniotic membrane wound graft is effective for difficult to-treat ulcerations
Amniotic membrane wound graft is effective for difficult to-treat ulcerationsAmniotic membrane wound graft is effective for difficult to-treat ulcerations
Amniotic membrane wound graft is effective for difficult to-treat ulcerationsLauraHeathDPM
 
Dose determination in preclinical and clinical studies
Dose determination in preclinical and clinical studiesDose determination in preclinical and clinical studies
Dose determination in preclinical and clinical studiesDrSahilKumar
 
Aloe Vera vs. SSD in the Treatment of Burns-Clinical Study
Aloe Vera vs. SSD in the Treatment of Burns-Clinical StudyAloe Vera vs. SSD in the Treatment of Burns-Clinical Study
Aloe Vera vs. SSD in the Treatment of Burns-Clinical StudyJohn Fisher
 
Treatment of Purulent Wounds Immobilized Antiseptics
Treatment of Purulent Wounds Immobilized AntisepticsTreatment of Purulent Wounds Immobilized Antiseptics
Treatment of Purulent Wounds Immobilized Antisepticsinventionjournals
 
laser fracionado 1340 em Acne cistica artigo
laser fracionado 1340 em Acne cistica artigo laser fracionado 1340 em Acne cistica artigo
laser fracionado 1340 em Acne cistica artigo Jauru Freitas
 
Formulation and evaluation of oral biphasic drug delivery system of Metronida...
Formulation and evaluation of oral biphasic drug delivery system of Metronida...Formulation and evaluation of oral biphasic drug delivery system of Metronida...
Formulation and evaluation of oral biphasic drug delivery system of Metronida...inventionjournals
 
Formulation and evaluation of allicin and curcumin gel
Formulation and evaluation of allicin and curcumin gelFormulation and evaluation of allicin and curcumin gel
Formulation and evaluation of allicin and curcumin gelashira manzoor
 
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...
 EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP... EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...DrHeena tiwari
 
Formulation and Evaluation of Mouth Dissolving Tablets in Mirtazapine
Formulation and Evaluation of Mouth Dissolving Tablets in MirtazapineFormulation and Evaluation of Mouth Dissolving Tablets in Mirtazapine
Formulation and Evaluation of Mouth Dissolving Tablets in MirtazapineSriramNagarajan15
 
Design expert software assisted development and evaluation of cefpodoxime pro...
Design expert software assisted development and evaluation of cefpodoxime pro...Design expert software assisted development and evaluation of cefpodoxime pro...
Design expert software assisted development and evaluation of cefpodoxime pro...Makrani Shaharukh
 
Oecd guidelines for the testing of chemicals
Oecd guidelines for the testing of chemicalsOecd guidelines for the testing of chemicals
Oecd guidelines for the testing of chemicalskanchangupta66
 
Wound Management in Domiciliary Palliative Care
Wound Management in Domiciliary Palliative Care Wound Management in Domiciliary Palliative Care
Wound Management in Domiciliary Palliative Care wan zuraini
 

What's hot (18)

Analytical method Development and Validation for the estimation of Pioglitazo...
Analytical method Development and Validation for the estimation of Pioglitazo...Analytical method Development and Validation for the estimation of Pioglitazo...
Analytical method Development and Validation for the estimation of Pioglitazo...
 
PMartinez - Literature Review
PMartinez - Literature ReviewPMartinez - Literature Review
PMartinez - Literature Review
 
Amniotic membrane wound graft is effective for difficult to-treat ulcerations
Amniotic membrane wound graft is effective for difficult to-treat ulcerationsAmniotic membrane wound graft is effective for difficult to-treat ulcerations
Amniotic membrane wound graft is effective for difficult to-treat ulcerations
 
Dose determination in preclinical and clinical studies
Dose determination in preclinical and clinical studiesDose determination in preclinical and clinical studies
Dose determination in preclinical and clinical studies
 
Aloe Vera vs. SSD in the Treatment of Burns-Clinical Study
Aloe Vera vs. SSD in the Treatment of Burns-Clinical StudyAloe Vera vs. SSD in the Treatment of Burns-Clinical Study
Aloe Vera vs. SSD in the Treatment of Burns-Clinical Study
 
Treatment of Purulent Wounds Immobilized Antiseptics
Treatment of Purulent Wounds Immobilized AntisepticsTreatment of Purulent Wounds Immobilized Antiseptics
Treatment of Purulent Wounds Immobilized Antiseptics
 
Journal club
Journal clubJournal club
Journal club
 
laser fracionado 1340 em Acne cistica artigo
laser fracionado 1340 em Acne cistica artigo laser fracionado 1340 em Acne cistica artigo
laser fracionado 1340 em Acne cistica artigo
 
Formulation and evaluation of oral biphasic drug delivery system of Metronida...
Formulation and evaluation of oral biphasic drug delivery system of Metronida...Formulation and evaluation of oral biphasic drug delivery system of Metronida...
Formulation and evaluation of oral biphasic drug delivery system of Metronida...
 
Dose selection
Dose selectionDose selection
Dose selection
 
DU in Burn Population (1)
DU in Burn Population (1)DU in Burn Population (1)
DU in Burn Population (1)
 
73 groah et al int wound journal
73 groah et al int wound journal73 groah et al int wound journal
73 groah et al int wound journal
 
Formulation and evaluation of allicin and curcumin gel
Formulation and evaluation of allicin and curcumin gelFormulation and evaluation of allicin and curcumin gel
Formulation and evaluation of allicin and curcumin gel
 
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...
 EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP... EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...
 
Formulation and Evaluation of Mouth Dissolving Tablets in Mirtazapine
Formulation and Evaluation of Mouth Dissolving Tablets in MirtazapineFormulation and Evaluation of Mouth Dissolving Tablets in Mirtazapine
Formulation and Evaluation of Mouth Dissolving Tablets in Mirtazapine
 
Design expert software assisted development and evaluation of cefpodoxime pro...
Design expert software assisted development and evaluation of cefpodoxime pro...Design expert software assisted development and evaluation of cefpodoxime pro...
Design expert software assisted development and evaluation of cefpodoxime pro...
 
Oecd guidelines for the testing of chemicals
Oecd guidelines for the testing of chemicalsOecd guidelines for the testing of chemicals
Oecd guidelines for the testing of chemicals
 
Wound Management in Domiciliary Palliative Care
Wound Management in Domiciliary Palliative Care Wound Management in Domiciliary Palliative Care
Wound Management in Domiciliary Palliative Care
 

Similar to vancouver style of reference

A comparative study of intralesional injection of triamcinolone acetonide alo...
A comparative study of intralesional injection of triamcinolone acetonide alo...A comparative study of intralesional injection of triamcinolone acetonide alo...
A comparative study of intralesional injection of triamcinolone acetonide alo...iosrjce
 
5_6260200913101654423.pptx
5_6260200913101654423.pptx5_6260200913101654423.pptx
5_6260200913101654423.pptxSanskriti Shah
 
Alma 2016 Clinical Publication - Harmony XL Pro Treats Acne
 Alma 2016 Clinical Publication - Harmony XL Pro Treats Acne  Alma 2016 Clinical Publication - Harmony XL Pro Treats Acne
Alma 2016 Clinical Publication - Harmony XL Pro Treats Acne Hamutal Gozlan
 
Efficacy of itraconazole versus fluconazole in vaginal candidiasis
Efficacy of itraconazole versus fluconazole in vaginal candidiasisEfficacy of itraconazole versus fluconazole in vaginal candidiasis
Efficacy of itraconazole versus fluconazole in vaginal candidiasisAjeet Kumar
 
The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...
The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...
The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...daranisaha
 
Benefits of extracorporeal shockwave in the treatment of skin ulcers: a liter...
Benefits of extracorporeal shockwave in the treatment of skin ulcers: a liter...Benefits of extracorporeal shockwave in the treatment of skin ulcers: a liter...
Benefits of extracorporeal shockwave in the treatment of skin ulcers: a liter...Clínica de Acupuntura Dr. Hong Jin Pai
 
Controversy in the treatment of central giant cell granuloma in search of evi...
Controversy in the treatment of central giant cell granuloma in search of evi...Controversy in the treatment of central giant cell granuloma in search of evi...
Controversy in the treatment of central giant cell granuloma in search of evi...Max Fax
 
Menon, et al. 2020 comparative study of microneedling with tranexamic acid ve...
Menon, et al. 2020 comparative study of microneedling with tranexamic acid ve...Menon, et al. 2020 comparative study of microneedling with tranexamic acid ve...
Menon, et al. 2020 comparative study of microneedling with tranexamic acid ve...Felix J. Tapia
 
High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...
High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...
High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...inventionjournals
 
Resistant urticaria tutorial ppt.
Resistant urticaria tutorial ppt.Resistant urticaria tutorial ppt.
Resistant urticaria tutorial ppt.Dr Daulatram Dhaked
 
jc scar and laser.pptx journal club scar treatment
jc scar and laser.pptx journal club scar treatmentjc scar and laser.pptx journal club scar treatment
jc scar and laser.pptx journal club scar treatmentMalaM67
 

Similar to vancouver style of reference (20)

A comparative study of intralesional injection of triamcinolone acetonide alo...
A comparative study of intralesional injection of triamcinolone acetonide alo...A comparative study of intralesional injection of triamcinolone acetonide alo...
A comparative study of intralesional injection of triamcinolone acetonide alo...
 
5_6260200913101654423.pptx
5_6260200913101654423.pptx5_6260200913101654423.pptx
5_6260200913101654423.pptx
 
Ijss 05
Ijss 05Ijss 05
Ijss 05
 
Alma 2016 Clinical Publication - Harmony XL Pro Treats Acne
 Alma 2016 Clinical Publication - Harmony XL Pro Treats Acne  Alma 2016 Clinical Publication - Harmony XL Pro Treats Acne
Alma 2016 Clinical Publication - Harmony XL Pro Treats Acne
 
185th publication jmos- 5th name
185th publication  jmos- 5th name185th publication  jmos- 5th name
185th publication jmos- 5th name
 
Efficacy of itraconazole versus fluconazole in vaginal candidiasis
Efficacy of itraconazole versus fluconazole in vaginal candidiasisEfficacy of itraconazole versus fluconazole in vaginal candidiasis
Efficacy of itraconazole versus fluconazole in vaginal candidiasis
 
Poster1 new (1)
Poster1 new (1)Poster1 new (1)
Poster1 new (1)
 
The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...
The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...
The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...
 
Benefits of extracorporeal shockwave in the treatment of skin ulcers: a liter...
Benefits of extracorporeal shockwave in the treatment of skin ulcers: a liter...Benefits of extracorporeal shockwave in the treatment of skin ulcers: a liter...
Benefits of extracorporeal shockwave in the treatment of skin ulcers: a liter...
 
Controversy in the treatment of central giant cell granuloma in search of evi...
Controversy in the treatment of central giant cell granuloma in search of evi...Controversy in the treatment of central giant cell granuloma in search of evi...
Controversy in the treatment of central giant cell granuloma in search of evi...
 
THERAPY OF PULMONARY TUBERCULOSIS WITH MULTIDRUG-RESISTANT MYCOBACTERIUM TUBE...
THERAPY OF PULMONARY TUBERCULOSIS WITH MULTIDRUG-RESISTANT MYCOBACTERIUM TUBE...THERAPY OF PULMONARY TUBERCULOSIS WITH MULTIDRUG-RESISTANT MYCOBACTERIUM TUBE...
THERAPY OF PULMONARY TUBERCULOSIS WITH MULTIDRUG-RESISTANT MYCOBACTERIUM TUBE...
 
Combination therapy
Combination therapyCombination therapy
Combination therapy
 
Menon, et al. 2020 comparative study of microneedling with tranexamic acid ve...
Menon, et al. 2020 comparative study of microneedling with tranexamic acid ve...Menon, et al. 2020 comparative study of microneedling with tranexamic acid ve...
Menon, et al. 2020 comparative study of microneedling with tranexamic acid ve...
 
High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...
High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...
High Intensity of Continuous Ultrasound in the Skin Repair Process in Rats: R...
 
Toxic epidermal necrolysis
Toxic epidermal necrolysisToxic epidermal necrolysis
Toxic epidermal necrolysis
 
NAIL ACIDIFICATION VERSUS AMOROLFINE IN THE LOCAL MANAGEMENT OF ONYCHOMYCOSIS...
NAIL ACIDIFICATION VERSUS AMOROLFINE IN THE LOCAL MANAGEMENT OF ONYCHOMYCOSIS...NAIL ACIDIFICATION VERSUS AMOROLFINE IN THE LOCAL MANAGEMENT OF ONYCHOMYCOSIS...
NAIL ACIDIFICATION VERSUS AMOROLFINE IN THE LOCAL MANAGEMENT OF ONYCHOMYCOSIS...
 
Mycosis fungoids
Mycosis fungoids Mycosis fungoids
Mycosis fungoids
 
Resistant urticaria tutorial ppt.
Resistant urticaria tutorial ppt.Resistant urticaria tutorial ppt.
Resistant urticaria tutorial ppt.
 
Isotretinoin in acne
Isotretinoin in acneIsotretinoin in acne
Isotretinoin in acne
 
jc scar and laser.pptx journal club scar treatment
jc scar and laser.pptx journal club scar treatmentjc scar and laser.pptx journal club scar treatment
jc scar and laser.pptx journal club scar treatment
 

More from Raghu Prasada

Class skeletal muscle relaxants
Class skeletal muscle relaxantsClass skeletal muscle relaxants
Class skeletal muscle relaxantsRaghu Prasada
 
Classs drug metabolism
Classs drug metabolismClasss drug metabolism
Classs drug metabolismRaghu Prasada
 
Class antiadrenergic drugs
Class antiadrenergic drugsClass antiadrenergic drugs
Class antiadrenergic drugsRaghu Prasada
 
Class anticancer drugs
Class anticancer drugsClass anticancer drugs
Class anticancer drugsRaghu Prasada
 
Class miscellaneous antibiotics
Class miscellaneous antibioticsClass miscellaneous antibiotics
Class miscellaneous antibioticsRaghu Prasada
 
Class drug absorption
Class drug absorptionClass drug absorption
Class drug absorptionRaghu Prasada
 
Dental pharmacology iii
Dental pharmacology iiiDental pharmacology iii
Dental pharmacology iiiRaghu Prasada
 
Class dental pharmacology 2
Class dental pharmacology 2Class dental pharmacology 2
Class dental pharmacology 2Raghu Prasada
 
Antibiotic resistance 1
Antibiotic resistance 1Antibiotic resistance 1
Antibiotic resistance 1Raghu Prasada
 
Class thyroid and antithyroid drugs
Class thyroid and antithyroid drugsClass thyroid and antithyroid drugs
Class thyroid and antithyroid drugsRaghu Prasada
 
Class introduction to chemoTHERAPY
Class introduction to chemoTHERAPYClass introduction to chemoTHERAPY
Class introduction to chemoTHERAPYRaghu Prasada
 
Class adverse drug reaction
Class adverse drug reactionClass adverse drug reaction
Class adverse drug reactionRaghu Prasada
 
Drm science lecture MENOPAUSE AND CRYOPRESERVATION
Drm science lecture MENOPAUSE AND CRYOPRESERVATIONDrm science lecture MENOPAUSE AND CRYOPRESERVATION
Drm science lecture MENOPAUSE AND CRYOPRESERVATIONRaghu Prasada
 
Drm science lecture 2 CONTRACEPTIVES AND IUDs
Drm science lecture 2 CONTRACEPTIVES AND IUDsDrm science lecture 2 CONTRACEPTIVES AND IUDs
Drm science lecture 2 CONTRACEPTIVES AND IUDsRaghu Prasada
 
Class antileprotic drugs
Class antileprotic drugsClass antileprotic drugs
Class antileprotic drugsRaghu Prasada
 
Class oral contraceptives
Class oral contraceptivesClass oral contraceptives
Class oral contraceptivesRaghu Prasada
 
Class excretion of drugs
Class excretion of drugsClass excretion of drugs
Class excretion of drugsRaghu Prasada
 
Class sources of drugs
Class sources of drugsClass sources of drugs
Class sources of drugsRaghu Prasada
 

More from Raghu Prasada (20)

Class skeletal muscle relaxants
Class skeletal muscle relaxantsClass skeletal muscle relaxants
Class skeletal muscle relaxants
 
Classs drug metabolism
Classs drug metabolismClasss drug metabolism
Classs drug metabolism
 
Class antiadrenergic drugs
Class antiadrenergic drugsClass antiadrenergic drugs
Class antiadrenergic drugs
 
Class anticancer drugs
Class anticancer drugsClass anticancer drugs
Class anticancer drugs
 
Class miscellaneous antibiotics
Class miscellaneous antibioticsClass miscellaneous antibiotics
Class miscellaneous antibiotics
 
Class drug absorption
Class drug absorptionClass drug absorption
Class drug absorption
 
Dental pharmacology iii
Dental pharmacology iiiDental pharmacology iii
Dental pharmacology iii
 
Class dental pharmacology 2
Class dental pharmacology 2Class dental pharmacology 2
Class dental pharmacology 2
 
Antibiotic resistance 1
Antibiotic resistance 1Antibiotic resistance 1
Antibiotic resistance 1
 
Class thyroid and antithyroid drugs
Class thyroid and antithyroid drugsClass thyroid and antithyroid drugs
Class thyroid and antithyroid drugs
 
Class introduction to chemoTHERAPY
Class introduction to chemoTHERAPYClass introduction to chemoTHERAPY
Class introduction to chemoTHERAPY
 
Class adverse drug reaction
Class adverse drug reactionClass adverse drug reaction
Class adverse drug reaction
 
Class intro to cns
Class intro to cnsClass intro to cns
Class intro to cns
 
Drm science lecture MENOPAUSE AND CRYOPRESERVATION
Drm science lecture MENOPAUSE AND CRYOPRESERVATIONDrm science lecture MENOPAUSE AND CRYOPRESERVATION
Drm science lecture MENOPAUSE AND CRYOPRESERVATION
 
Drm science lecture 2 CONTRACEPTIVES AND IUDs
Drm science lecture 2 CONTRACEPTIVES AND IUDsDrm science lecture 2 CONTRACEPTIVES AND IUDs
Drm science lecture 2 CONTRACEPTIVES AND IUDs
 
Class ccf
Class ccfClass ccf
Class ccf
 
Class antileprotic drugs
Class antileprotic drugsClass antileprotic drugs
Class antileprotic drugs
 
Class oral contraceptives
Class oral contraceptivesClass oral contraceptives
Class oral contraceptives
 
Class excretion of drugs
Class excretion of drugsClass excretion of drugs
Class excretion of drugs
 
Class sources of drugs
Class sources of drugsClass sources of drugs
Class sources of drugs
 

Recently uploaded

Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...PhRMA
 
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartCardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartMedicoseAcademics
 
DECIPHERING COMMON ECG FINDINGS IN ED.pptx
DECIPHERING COMMON ECG FINDINGS IN ED.pptxDECIPHERING COMMON ECG FINDINGS IN ED.pptx
DECIPHERING COMMON ECG FINDINGS IN ED.pptxdrwaque
 
Anuman- An inference for helpful in diagnosis and treatment
Anuman- An inference for helpful in diagnosis and treatmentAnuman- An inference for helpful in diagnosis and treatment
Anuman- An inference for helpful in diagnosis and treatmentabdeli bhadarva
 
Why invest into infodemic management in health emergencies
Why invest into infodemic management in health emergenciesWhy invest into infodemic management in health emergencies
Why invest into infodemic management in health emergenciesTina Purnat
 
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1DR SETH JOTHAM
 
Relationship between vascular system disfunction, neurofluid flow and Alzheim...
Relationship between vascular system disfunction, neurofluid flow and Alzheim...Relationship between vascular system disfunction, neurofluid flow and Alzheim...
Relationship between vascular system disfunction, neurofluid flow and Alzheim...Catherine Liao
 
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.GawadHemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.GawadNephroTube - Dr.Gawad
 
MALE REPRODUCTIVE TOXICITY STUDIES(Toxicokinetics).pptx
MALE REPRODUCTIVE TOXICITY STUDIES(Toxicokinetics).pptxMALE REPRODUCTIVE TOXICITY STUDIES(Toxicokinetics).pptx
MALE REPRODUCTIVE TOXICITY STUDIES(Toxicokinetics).pptxKhanSabit
 
Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Anjali Parmar
 
Circulation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationCirculation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationMedicoseAcademics
 
Aptopadesha Pramana / Pariksha: The Verbal Testimony
Aptopadesha Pramana / Pariksha: The Verbal TestimonyAptopadesha Pramana / Pariksha: The Verbal Testimony
Aptopadesha Pramana / Pariksha: The Verbal TestimonyDr KHALID B.M
 
World Hypertension Day 17th may 2024 ppt
World Hypertension Day 17th may 2024 pptWorld Hypertension Day 17th may 2024 ppt
World Hypertension Day 17th may 2024 pptdesktoppc
 
180-hour Power Capsules For Men In Ghana
180-hour Power Capsules For Men In Ghana180-hour Power Capsules For Men In Ghana
180-hour Power Capsules For Men In Ghanahealthwatchghana
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxdrtabassum4
 
Final CAPNOCYTOPHAGA INFECTION by Gauri Gawande.pptx
Final CAPNOCYTOPHAGA INFECTION by Gauri Gawande.pptxFinal CAPNOCYTOPHAGA INFECTION by Gauri Gawande.pptx
Final CAPNOCYTOPHAGA INFECTION by Gauri Gawande.pptxgauripg8
 
Effects of vaping e-cigarettes on arterial health
Effects of vaping e-cigarettes on arterial healthEffects of vaping e-cigarettes on arterial health
Effects of vaping e-cigarettes on arterial healthCatherine Liao
 
Cervical screening – taking care of your health flipchart (Vietnamese)
Cervical screening – taking care of your health flipchart (Vietnamese)Cervical screening – taking care of your health flipchart (Vietnamese)
Cervical screening – taking care of your health flipchart (Vietnamese)Cancer Institute NSW
 
Cardiovascular Physiology - Regulation of Cardiac Pumping
Cardiovascular Physiology - Regulation of Cardiac PumpingCardiovascular Physiology - Regulation of Cardiac Pumping
Cardiovascular Physiology - Regulation of Cardiac PumpingMedicoseAcademics
 

Recently uploaded (20)

Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
 
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartCardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
 
DECIPHERING COMMON ECG FINDINGS IN ED.pptx
DECIPHERING COMMON ECG FINDINGS IN ED.pptxDECIPHERING COMMON ECG FINDINGS IN ED.pptx
DECIPHERING COMMON ECG FINDINGS IN ED.pptx
 
Anuman- An inference for helpful in diagnosis and treatment
Anuman- An inference for helpful in diagnosis and treatmentAnuman- An inference for helpful in diagnosis and treatment
Anuman- An inference for helpful in diagnosis and treatment
 
Why invest into infodemic management in health emergencies
Why invest into infodemic management in health emergenciesWhy invest into infodemic management in health emergencies
Why invest into infodemic management in health emergencies
 
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
 
Relationship between vascular system disfunction, neurofluid flow and Alzheim...
Relationship between vascular system disfunction, neurofluid flow and Alzheim...Relationship between vascular system disfunction, neurofluid flow and Alzheim...
Relationship between vascular system disfunction, neurofluid flow and Alzheim...
 
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.GawadHemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
 
MALE REPRODUCTIVE TOXICITY STUDIES(Toxicokinetics).pptx
MALE REPRODUCTIVE TOXICITY STUDIES(Toxicokinetics).pptxMALE REPRODUCTIVE TOXICITY STUDIES(Toxicokinetics).pptx
MALE REPRODUCTIVE TOXICITY STUDIES(Toxicokinetics).pptx
 
Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.
 
Circulation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationCirculation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulation
 
Aptopadesha Pramana / Pariksha: The Verbal Testimony
Aptopadesha Pramana / Pariksha: The Verbal TestimonyAptopadesha Pramana / Pariksha: The Verbal Testimony
Aptopadesha Pramana / Pariksha: The Verbal Testimony
 
Scleroderma: Treatment Options and a Look to the Future - Dr. Macklin
Scleroderma: Treatment Options and a Look to the Future - Dr. MacklinScleroderma: Treatment Options and a Look to the Future - Dr. Macklin
Scleroderma: Treatment Options and a Look to the Future - Dr. Macklin
 
World Hypertension Day 17th may 2024 ppt
World Hypertension Day 17th may 2024 pptWorld Hypertension Day 17th may 2024 ppt
World Hypertension Day 17th may 2024 ppt
 
180-hour Power Capsules For Men In Ghana
180-hour Power Capsules For Men In Ghana180-hour Power Capsules For Men In Ghana
180-hour Power Capsules For Men In Ghana
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
 
Final CAPNOCYTOPHAGA INFECTION by Gauri Gawande.pptx
Final CAPNOCYTOPHAGA INFECTION by Gauri Gawande.pptxFinal CAPNOCYTOPHAGA INFECTION by Gauri Gawande.pptx
Final CAPNOCYTOPHAGA INFECTION by Gauri Gawande.pptx
 
Effects of vaping e-cigarettes on arterial health
Effects of vaping e-cigarettes on arterial healthEffects of vaping e-cigarettes on arterial health
Effects of vaping e-cigarettes on arterial health
 
Cervical screening – taking care of your health flipchart (Vietnamese)
Cervical screening – taking care of your health flipchart (Vietnamese)Cervical screening – taking care of your health flipchart (Vietnamese)
Cervical screening – taking care of your health flipchart (Vietnamese)
 
Cardiovascular Physiology - Regulation of Cardiac Pumping
Cardiovascular Physiology - Regulation of Cardiac PumpingCardiovascular Physiology - Regulation of Cardiac Pumping
Cardiovascular Physiology - Regulation of Cardiac Pumping
 

vancouver style of reference

  • 1. “COMPARISON OF TOPICAL ANTI- FUNGAL AGENTS SERTACONAZOLE AND CLOTRIMAZOLE IN THE TREATMENT OF TINEA CORPORIS-AN OBSERVATIONAL STUDY” 1 ABSTRACT Objectives: To compare the efficacy of topical antifungal agents, Sertaconazole and Clotrimazole in Tinea corporis patients. Methods: A total of 60(n=60) patients were included in the study. They were divided into two groups of 30 patients each. First group included patients treated with topical Sertaconazole as test drug whereas the second group constituted patients treated with topical Clotrimazole as standard drug. The patients were advised to apply the drug on affected area twice daily for three weeks. The parameters like erythema, scaling, itching, margins and size of the lesion and KOH mount were taken for the assessment of efficacy. This was an open labelled study and patients were followed up every week for three weeks. Results: The total score included all grades in erythema, itching, scaling, margins and size of lesion and KOH mount. There was significant reduction in erythema (p<0.02) and highly significant reduction in scaling (p<0.001), itching (p<0.001) and margins of lesion (p<0.001) among Sertaconazole group. The mean difference and the standard deviation of total scores for Clotrimazole were 7.20 and 1.69 and for Sertaconazole group 8.80 and 1.52 respectively. The p value on application of students unpaired‘t’ test was p<0.001. (Highly significant) Conclusion: From the present study,it can be concluded that topical Sertaconazole shows better improvement in the clinical parametersthan topical Clotrimazole within a span of 3 weeks in the treatmentof T. corporis. Keywords: Antifungal Agents, Clotrimazole, Sertaconazole, Tinea Corporis.
  • 2. 4 Clotrimazole is broad spectrum topical antifungal agent. It is generally 2 INTRODUCTION The incidence of topical fungal infections has progressively increased in recent years primarily because of an increased number of immunocompromised patients and the increased use of health clubs and community swimming pools, which favour the spread of 1,2 infections. Dermatophytes are group of taxonomically related fungi that invade the keratinized tissue (skin, hair, nails) of humans or other animals resulting in an infection called dermatophytosis. 3 Tinea corporis refers to all dermatophytosis of glabrous skin except the palms, soles and groin. This disease can be treated with topical and oral antifungal drugs. There are several topical antifungal agents like Fluconazole, Clotrimazole, Ciclopirox, Naftifine, and Terbinafine and so on. well tolerated but in some cases erythema, burning, stinging, peeling, blistering, edema, pruritis and urticaria at site of application are reported. It is applied twice daily for three weeks for 5,6 T.corporis. Sertaconazole is a newer topical imidazole found to be more active than other 7,8 azole antifungals in several studies. It is also reported that once daily application for three weeks regimen of Sertaconazole showed improved patient compliance which is important in successful treatment of dermatomycoses. 7,8 Hence, the present study was undertaken to study the antifungal efficacy of Sertaconazole and compare with the commonly used antifungal Clotrimazole in Tinea corporis.
  • 3. 3 OBJECTIVES OF THE STUDY 1) To compare the efficacy of topical antifungal agents, Sertaconazole and Clotrimazole in Tinea corporis patients. METHODOLOGY The present study on dermatophytosis was carried out after the Institutional Ethical Committee approval in the Department of Dermatology, J. J. M. Medical College and Chigateri General Hospital, Davangere, Karnataka, over a period of two years from Dec 2009 to Jan 2012. A total of 60(n=60) patients were included in the study. Written informed consent was taken from all the patients. The diagnosis and treatment of Tinea corporis was done with the help of consultant Dermatologist. They were divided into two groups of 30 patients each. The average age of clotrimazole and sertaconazole groups were 31.93 and 33.33 with standard deviation of 13.18 and 11.99 respectively, showing that their age group was much similar. After taking history, a detailed clinical examination of the patient was done in good light to determine the number of lesions, the types, presence of inflammatory margin and the extent of involvement. First group included patients treated with topical Sertaconazole cream as test drug whereas the second group constituted patients treated with topical Clotrimazole cream as standard drug. The patients were advised to apply the drug twice daily for three weeks. The parameters like erythema, scaling, itching, margins and size of the lesion and KOH mount were taken prior to treatment and at the end of three weeks. The study method was open label method. Chemicals and drugs: a) Sertaconazole 2% cream used as the test drug was obtained from Torrent Company.
  • 4. b) Clotrimazole 2% cream used as standard drug was obtained from government hospital. (Karnataka antibiotics and pharmaceuticals limited) c) All the patients received tab. Teczine (levocetrizine 5mg ) once daily for 10 days d) Potassium hydroxide (KOH) mount of skin scrapings from the affected site was used for 4 confirmation of clinical diagnosis. 9 Patient Inclusion Criteria: The patients were included from the age group of 15-60years, having clinical manifestations of Tinea corporis such as erythema, scaling, vesicles, pustules , itch, and skin scraping positive for KOH (Potassium hydroxide) mount. Patients Exclusion Criteria: Patients with systemic mycosis or mycosis of the hands face and scalp, Oropharyngeal mycosis, vaginal mycosis, Pre-treatment with antifungal drugs and immunosuppressive agents within 14 and 30 days respectively, prior to the onset of study were excluded. Pregnancy, lactation or inadequate contraception in women of child bearing potential, Participation in another study within 30 days prior to the commencement of the study, Patients with history of hypersensitivity to azole drugs or vehicle ingredients, Patients with history of diabetes mellitus, severe psychiatric illness and other systemic illness and Patients who are unwilling to give written consent were also excluded. Efficacy parameters: The patients were monitored for the following signs.
  • 5. 6 : Change in colour from erythema to normal skin colour was noted. The 5 Colour of the lesion scoring was given in following manner.0=absent, 1=mild, 2=moderate, 3=severe Scaling of the lesion6:The Scoring was given in the following manner. 0=Absent, 1=Mild, 2=Moderate, 3=Severe. Itching6: The scoring was given in the following manner.0=no itching, 1=Mild itching not affecting daily activities, 2=Moderate itching affecting daily activities, 3=Severe itching disturbing the sleep. Margins of the lesion6: whether the lesion shows progressive (presence of papules, vesicles) or regressive pattern (return to normal skin pattern). Scoring was given in following manner: 0=Regressive, 1=Stagnant, 2=Progressive Size of the lesion6: Whether there was increase or decrease in size. Scoring for lesion size was as follows: 0=size less than 5cms in circumference, 1=size 5-10cms, 2=size 10-20cms, 3=size > 20cms. KOH mount6: The scoring was given as 0=KOH negative, 2=KOH positive. In the present study, the efficacy of the topical treatment is determined by shifting of patients from grade 3 to grade 2, grade 2 to grade 1, grade 1 to grade 0 with each parameter. Grade 0 is the highest level of cure that can be attained by any patient. So the primary aim of treatment was to bring the patient to grade 0. The total score includes the scores of colour of the lesion, scaling of the lesion, itching, margins of the lesion, size of the lesion and KOH mount. Statistical analysis: After collecting the raw data, the values in all the groups were analyzed by using Wilcoxon signed rank test, Mann Whitney test and students unpaired ‘t’ test.
  • 6. Erythema Clotrimazole group Sertaconazole group Grade Pre treatment Pre treatment No. (%) No. (%) No. (%) No. (%) 0 0(0.0) 9(30.0) 0(0.0) 29(96.7) 1 10(33.3) 19(63.3) 0(0..0) 0(0.0) 2 15( 50.0) 2(6.7) 30(100.0) 1(3.3) 3 5(16.7) 0(0.0) 0(0.0) 0(0.0) Total 30(100) 30(100) 30(100) 30(100) 6 74 RESULTS Table 1:Comparison of pre and post treatment erythema in Clotrimazole group and Sertaconazole group patients Post treatment patients P< 0.001HS, Wilcoxon signed rank test patients Post treatment patients Table 2: Comparison of pre and post treatment scaling in Clotrimazole group and Sertaconazole group Scaling Clotrimazole group Sertaconazole group Grade Pre treatment patients Post treatment patients Pre treatment patients Post treatment patients No. (%) No. (%) No. (%) No. (%) 0 0(0.0) 9(30.0) 0(0.0) 17(56.7) 1 5(16.7) 20(66.7) 13(43.3) 13(43.30) 2 21( 70.0) 1(3.3) 16(53.3) 0(0.0) 3 4(13.3) 0(0.0) 1(3.3) 0(0.0) Total 30(100) 30(100) 30(100) 30(100)
  • 7. Table 3: Comparison of pre and post treatment itching in Clotrimazole group and 7 Sertaconazole group: Itching Clotrimazole group Sertaconazole group Grade Pre treatment patients Post treatment patients Pre treatment patients Post treatment patients No. (%) No. (%) No. (%) No. (%) 0 0(0.0) 9(30.0) 0(0.0) 23(76.7) 1 0(0.0) 20(66.7) 9(30.0) 7(23.30) 2 30( 100.0) 1(3.3) 20(66.7) 0(0.0) 3 0(0.0) 0(0.0) 1(3.3) 0(0.0) Total 30(100) 30(100) 30(100) 30(100) Table 4: Comparison of pre and post treatment margins in Clotrimazole group and Sertaconazole group Margins Clotrimazole group Sertaconazole group Grade Pre treatment patients Post treatment patients Pre treatment patients Post treatment patients No. (%) No. (%) No. (%) No. (%) 0 0(0.0) 7(23.3) 0(0.0) 2(6.7) 1 0(0.0) 23(76.6) 1(3.3) 28(93.3) 2 30( 100.0) 0(0.0) 0(0.0) 0(0.0) 3 0(0.0) 0(0.0) 0(0.0) 0(0.0) Total 30(100) 30(100) 30(100) 30(100) p<0.001 HS, Wilcoxon signed rank test
  • 8. TABLE 5: Comparison of pre and post treatment size in Clotrimazole group and Sertaconazole 8 group Size Clotrimazole group Sertaconazole group Grade Pre treatment patients Post treatment patients Pre treatment patients Post treatment patients No. (%) No. (%) No. (%) No. (%) 0 2(6.7) 13(43.3) 0(0.0) 15(50.0) 1 10(33.3) 8(26.7) 20(66.7) 15(50.0) 2 14(46.7) 6(20.0) 9(30.0) 0(0.0) 3 4(13.3) 3(10.0) 1(3.3) 0(0.0) Total 30(100) 30(100) 30(100) 30(100) p<0.001 HS, Wilcoxon signed rank test Table 6: Comparison of pre and post treatment KOH mounts investigation in Clotrimazole group and Sertaconazole group. KOH Clotrimazole group Sertaconazole group Grade Pre treatment patients Post treatment patients Pre treatment patients Post treatment patients No. (%) No. (%) No. (%) No. (%) 0 0(0.0) 29(96.7) 0(0.0) 30(100.0) 1 0(0.0) 0(0.0) 0(0.0) 0(0.0) 2 30(100.0) 1(3.3) 30(100.0) 0(0.0) 3 0(0.0) 0(0.0) 0(0.0) 0(0.0) Total 30(100) 30(100) 30(100.0) 30(100.0) P<0.001 HS, Wilcoxon signed rank test
  • 9. Table 7:Comparison of pre treatment values of both the Clotrimazole and Sertaconazole 9 groups Parameter Range Median Range Median Median difference P* value, sig ERYTHEMA 1-3 2 1-3 2 0 0.2 NS SCALING 1-3 2 1-3 2 0 0.06 NS ITCHING 1-3 2 1-3 2 0 0.21 NS MARGINS 1-3 2 1-3 2 0 0.31 NS SIZE 0-3 2 0-3 1 1 0.07 NS KOH MOUNT 0-2 2 0-2 2 0 1.0 NS *Mann Whitney U test Table 8: Comparison of post treatment values of both the Clotrimazole and Sertaconazolegroups CLOTRIMAZOLE GROUP SERTACONAZOLE GROUP Parameter Range Median Range Median Median difference P* value, sig ERYTHEMA 0-2 1 0-1 0 1 0.02 S SCALING 0-2 1 0-1 0 1 0.001 S ITCHING 0-1 1 0-1 0 1 <0.001 HS MARGINS 0-1 1 0-1 0 1 <0.001 HS SIZE 0-3 1 0-1 1 1 0.11 NS KOH MOUNT 0-2 0 0-2 0 0 0.31 NS *Mann Whitney U test
  • 10. Table 9: Comparison of pre and post treatment total scores in Clotrimazole and Sertaconazole 10 group: Mean difference Parameter CLOTRIMAZOLE GROUP SERPTACONAZOLE GROUP P* value, sig Mean 7.20 8.80 P<0.001 HS SD 1.69 1.52 *Student's unpaired t test DISCUSSION The antifungal properties of Sertaconazole have been evaluated in a few in-vitro studies. 10, 11 In one of these studies, isolates of T. Rubrum showed a higher sensitivity to Sertaconazole than to Bifonazole, Fluconazole And Cyclopyroxolamine but not to Amorolfine or Terbinafine. 12 In a comparative study of susceptibility against 250 clinical isolates of dermatophytes and Scopulariopsis Brevicaulis, Sertaconazole was shown to be one of the most effective among ten antifungal agents evaluated.13Sertaconazole showed a broad range of fungicidal activity in one study. 14 The pharmacokinetic data shows that, immediately following topical application of 100mg single dose 2% Sertaconazole cream on the skin of the back of 12 healthy volunteers, about 89% of the compound was recovered on the skin surface. 15 The clinical efficacy data shows that clinical cure rate and the mycological cure rate of 2% Sertaconazole cream twice daily was significantly greater than that of 2% miconazole cream twice daily in patients with a range of cutaneous mycoses. 16
  • 11. In the present study we have compared Sertaconazole and Clotrimazole topical cream among two groups of patients with comparable age. The pre-treatment values of both the groups in terms of erythema, scaling, itching, margins and size of the lesion and KOH mount were not significantly different (table 7). In order to compare the grading, the median grading in each of the parameters in each group was taken and after applying Mann Whitney U test, the p value was calculated which was insignificant.(table 7)This shows that both the Clotrimazole and Sertaconazole groups were comparable in all parameters before treatment. Fungal infections of the dermis may elicit a local inflammatory response that results in irritation and itching. The anti-inflammatory properties of Sertaconazole have been evaluated in both in-vitro and in-vivo animal studies. In human peripheral blood lymphocytes stimulated with phytohaemagglutinin, Sertaconazole significantly reduced the release of several proinflammatory cytokines compared with a range of other antifungal agents tested.17In the present study, the patients with grade 0 and 1 erythema in Clotrimazole group were 30% and 63.3% and in Sertaconazole group, the patients with grade 0 and 1 erythema were 96.7% and 0% after the treatment period (table 1). This shows that a significantly better reduction in erythema by Sertaconazole(p<0.02, table 1). This can again be attributed to anti-inflammatory property and better clinical efficacy with Sertaconazole. After the treatment period, in Clotrimazole group the patients with grade 0 and 1 size were 43.3% and 26.7% and in Sertaconazole group were 56.7% and 43.3 % (table 5). Though the p value was not significant (>0.11, Table 6), there was better result with Sertaconazole. The results of KOH test in both the groups were negative in post treatment period (table 6).The mean difference and the standard 11
  • 12. deviation of total scores for Clotrimazole are 7.20 and 1.69 and for Sertaconazole group are 8.80 and 1.52 respectively(Table 9). The p value is highly significant (p<0.001). The above results signify that Sertaconazole 2% cream is better than Clotrimazole 2% cream in treating Tinea corporis. Most azole drugs are fungistatic, which, although limits fungal cell growth, does not prevent the shedding of viable mycelial cells from the skin surface. Sertaconazole, however, has an additional fungicidal activity. In general, fungicidal drugs are preferred over fungistatic drugs for superficial dermatophyte infections because higher cure rates are achieved in shorter treatment times, thus increasing the likelihood of patient adherence and decreasing the incidence of recurrence.17One of the drawbacks of Sertaconazole may be the cost factor which may come down after some time. The limitations of this study are the small sample size and the efficacy of creams was not evaluated in other forms of dermatophytosis like Tinea cruris, Tinea capitis, and Tinea unguinum. Further studies are needed to evaluate the efficacy of Sertaconazole in these other forms of Tinea infections and in larger sample size. 12 CONCLUSION In the present study efficacy of 2% Sertaconazole cream was compared with 2% Clotrimazole cream applied topically for three weeks on the lesions of T. Corporis. At the end of 3 weeks Sertaconazole showed a significant reduction in erythema, scaling and other parameters compared to Clotrimazole cream. Hence, Sertaconazole has a better antifungal efficacy. ACKNOWLEDGEMENTS We would like to express our gratitude to Dr. H.R. CHANDRASEKHAR, M.D., former Principal, and Dr. S. B. MURUGESH, Professor and Head of Dermatology Department, J.J.M Medical College,
  • 13. Davangere, Karnataka for allowing the study and providing free samples of Clotrimazole cream. We are also thankful to Torrent Pharmaceutical Company Sales Representative Mr. BASAVARAJA M.S, for providing free samples of Sertaconazole cream. th ed. Edinburgh: Wiley Blackwell;2010. Vol 2.p.36.1-36.93. 13 REFERENCES 1. World Health Organization. Laboratory manual for diagnosis of fungal opportunistic infections in HIV/AIDS patients. Geneva: World Health Organization;2009. p.4-10. 2. Jain A, Jain S, Rawat S. Emerging fungal infections among children: A review on its clinical manifestations, diagnosis, and prevention. J Pharm Bio allied Sci. 2010;2:314–20 3. Hay RJ, Ashbee HR. Mycology. In: Rook’s textbook of dermatology. Burns T, Breathnach S, Cox N, Griffiths C editors.8 4. Wolff K, Goldsmith LA, Katz SI, Gilchrist BA, Pallar AS, Leffell DJ. Fitzpatricks dermatology in general medicine. 7th ed. New York: McGraw Hill; 2008. p. 1845-46. 5. Tripathi KD. Essentials of Medical pharmacology. 6thed. New Delhi: Jaypee Brothers Medical publishers (p) Ltd.; 2008. p.757-765. 6. Wolverton SE. Comprehensive dermatologic drug therapy. Philedelphia: WB Saunders company; 2001; 24: p. 501-503. 7. Borelli C, Klovekor G, Ernst TM, Bodeker RH, Korting HC et al, editors. Comparative study of 2% sertaconazole solution and cream formulations in patients with Tinea corporis, Tinea pedis interdigitalis, or a corresponding candidiasis. Am J Clin Dermatol 2007;8(6):371-378.
  • 14. 8. Croxtall DJ, Plosker LG. Sertaconazole- A review of its use in the management of superficial mycoses in dermatology and gynaecology. Drugs 2009;69(3):339-359. 9. Milne LJR. Fungi. In: Collee JG, Marmion BP, FraserAG, Simmons A editors. Practical th ed. Churchill Livingstone;1996.p.695-720. 14 Medical Microbiology.14 10. Palacin C, Sacristan A, Ortiz JA. Invitro activity of Sertaconazole. Arzneimittelforschung1992 Ma y;42( 5A):699-705. 11. Drouhet E, Dupont B. In vitro antifungal activity of Sertaconazole. Arzneimittelforschung 1992 May; 42(5A):705-10. 12. Carrillo-Munoz AJ, Quindos G, Del Valle O. In-vitro antifungal activity of Sertaconazole nitrate against recent isolates of Onychomycosis causative agents. J Chemother 2008 Aug; 20(4):521-3. 13. Carrillo-Munoz AJ, Guglietta A, Palacin C. In-vitro antifungal activity ofSertaconazole compared with nineother drugsagainst 250 clinical isolates of Dermatophytes and Scopulariopsis brevicaulis. Chemotherapy 2004 Dec;50(6): 308-13. 14. Martin-Mazuelos E, Aller AI, Morilla D. Antifungal activity of Sertaconazole in-vitro against clinical isolates of Candida spp. Chemotherapy1996, 30;42(2):112-7 15. Alomar C, Bassas S, Casas M. Multi-centre double-blind trial on the efficacy and safety of Sertaconazole 2% cream in comparison with Miconazole 2% cream on patients suffering from cutaneous mycoses. Arzneimittelforschung 1992 May;42(5A):767-73. 16. Liebel F, Lyte P, Garay M. Anti-inflammatory and anti-itch activity ofSertaconazole nitrate. Arch Dermatol Res 2006 Sep;298(4):191-9. 17. Kyle AA, Dahl MV. Topical therapy for fungal infections. Am J Clin Dermatol