The two-way sensitivity analysis was conducted on the two main input CHIR-99021 manufacturer drivers of the ICER estimate, i.e. the utility in the stable health state and the costs of three health states. The PSA attributed appropriate probability distributions to the input parameters. Results The ICER estimated from the model was –£2782 at the end of 1 year, which means the use of ethyl-EPA as an adjunct therapy for BD is more effective than placebo and

it reduces cost. The main factor contributing toward reduction in cost is the lower transitional probability to manic and depressive episodes for the patients taking ethyl-EPA. This means Inhibitors,research,lifescience,medical that fewer ethyl-EPA-treated patients experienced acute episodes as compared with the placebo group. Hence, service use (such as hospitalization) was lower in the ethyl-EPA group and consequently their treatment costs were lower. The additional drug cost of ethyl-EPA was small (£24) per cycle as compared with the reduction of service use elsewhere. In the Frangou and colleagues [Frangou et al. 2006] trial Inhibitors,research,lifescience,medical no inpatient episode was recorded among the patients allocated to ethyl-EPA adjunct treatment as compared Inhibitors,research,lifescience,medical with, on average, 3 days of inpatient treatment (daily cost of an inpatient episode of £210) in the placebo arm. The number of inpatient episodes in the case of the placebo group is in line with the RR (0.6) of acute episodes

estimated. Two patients in the placebo arm totalled 216 hours

of day centre contacts (hourly cost of day centre of £9), while no patients in the ethyl-EPA arm had day centre contacts. Lower scores of HRSD Inhibitors,research,lifescience,medical and Young Mania Rating Scale (YMRS) in the ethyl-EPA compared with placebo group at the week 12 assessment support Inhibitors,research,lifescience,medical better quality of life among patients receiving ethyl-EPA, which is estimated in the model as higher number of QALYs. Greater effectiveness and reduced cost contributed toward negative estimate of the ICER, which implies use of ethyl-EPA as an adjunct treatment for BD is a dominant treatment, falling in the dominant quadrant (II) of the cost-effectiveness plane. Although, the data used from the clinical trial covered a very short time period, the model was extended to 5-year time Mephenoxalone period, using a discount rate of 3.5% for costs and outcomes, the estimate of 5-year ICER was very close to the 1-year ICER estimate. Sensitivity analysis The tornado diagram in Figure 3 shows how the change (25% increase and 25% decrease) in the value of inputs affect the estimate of ICER. The diagram shows that the main input drivers of the ICER estimate are the utility in the stable health state and the costs of three health states. The tornado diagram also shows that the ICER estimate is negative despite a 25% increase or decrease in the values of most of the inputs. The one-way sensitivity analysis shows that the estimate of ICER was robust.

They were ready to transfer of this knowledge to the outside world only on the basis of substantial payment. Recent trend shows a decline in the number of traditional herbal healers in the tribal areas since the younger generation is not interested to continue this tradition. Hence, there is an urgent need to record and preserve all information on plants used

by Modulators Different tribal communities for various purposes before it is completely lost. Tribal herbal healers should also be encouraged by some means so that their knowledge is CHIR-99021 price sustained for future generations. In Kodagu district, the tribal populations living far away from urban area still rely on traditional herbal medicine for their primary health care needs. The unfortunate part is that due to forest fire and forest cutting for coffee and cardamom plantations, ginger cultivation, etc. many species are facing threat of extinction. There is immediate need for their conservation. selleck chemicals llc And also there is need for phytochemical analysis and pharmacological investigations of these important disappearing plants to strengthen the documentation of ethnic drugs. It would help in developing novel drug(s) to treat chronic diseases. All authors have none to declare. The authors are grateful to Dr. Halesh for help in the identification of some plants. Thanks are also due to the tribal people of Kodagu district, especially

Raju, Dobi, Thamma and Era who have provided the valuable information and co-operated during field work. “
“Prolonged antibiotic treatment is the main cause of fungal infections, especially candidiasis. Candida

albicans, causative agent of candidiasis is a yeast and one of the constituents of regular flora of the skin, gastro-intestinal tract, mouth, rectum and vagina. Although Candida is an endosymbiont of the human body, it can cause problems if there is an overgrowth, resulting in candidiasis. 1 Candidiasis usually occurs when there is an imbalance in the regular flora of the body, and in people who have compromised immune systems. Different factors can lead to Candidal overgrowth such as a person’s diet, immune suppression and prolonged antibiotic treatment, however, Ketanserin research findings support that the prolonged use of antibiotics can also play a major role in the development of candidiasis. Prolonged dose of antibiotics can lead to an imbalance in the essential gut flora, an imbalance that wipe out beneficial microflora and allows harmful bacteria, yeasts and parasites to overgrow in the stomach.2, 3, 4 and 5 Steroids and some cancer medications also weaken the immune system and can allow yeast to flourish. If this condition is not treated and controlled, the affected person can begin to suffer a slew of negative side effects such as oropharyngeal candidiasis, Intertrigo, Candida vulvovaginitis (Vaginitis), Systemic yeast infections (IDSA).

Clinical tests of this hypothesis are needed to assess its validity. If the immune activation that accompanies MS supports a potential role for inflammation in the pathogenesis of mood disorders,

then anti-inflammatory medications might be expected to ameliorate depression. Statins, a family of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, are used primarily to reduce atherogenesis and cardiovascular morbidity. Recently they have also been shown to have immunomodulatory properties that might be of benefit Inhibitors,research,lifescience,medical for the treatment of autoimmune disorders, and are currently being investigated in clinical trials for their potential use in treating MS.121 Inhibitors,research,lifescience,medical Previous studies have also found that statins may be of benefit in the treatment of depression. Young-Xu and colleagues studied patients from an outpatient cardiology clinic, and found that long-term use of statins appeared to be associated with a reduced incidence of anxiety,

depression, and hostility.122 Analysis from the 3-deazaneplanocin A supplier United Kingdom General Practice Research Database found that individuals currently on statins have a lower Inhibitors,research,lifescience,medical risk of developing depression.123 In a double-blind pilot study, subjects who took statins for 1 year were found to improve in ratings of depressive symptoms.124 A potential role of inflammation mediated by prostaglandin E2 (PGE2) in depression has recently been explored. As cyclo-oxygenase-2 (COX-2) inhibitors inhibit PGE2 production and the production of proinflammatory cytokines, there

are a growing number of investigations into a potential role for these medications for treating depression. Aspirin has been shown to dramatically Inhibitors,research,lifescience,medical accelerate the onset of action of a selective serotonin reuptake inhibitor (SSRI) in an animal model of depression.125 More persuasively, a double-blind placebo controlled trial in 40 patients with MDD demonstrated that addition of celecoxib had significant therapeutic Inhibitors,research,lifescience,medical effects on the action of the antidepressant reboxetine compared with treatment with reboxetine and a placebo.126 The potential interrelatedness of treatments for depression and their impact on inflammation is not suggested by vagus nerve stimulation (VNS). VNS therapy is an effective adjunctive treatment for chronic or recurrent treatment-resistant depression in adults. The mechanism of action of VNS and how it ameliorates depression is not known. A series of elegant studies by Tracey and colleagues have identified the cholinergic anti-inflammatory pathway as a neural, efferent vagus nerve-based mechanism that controls inflammation.127 Vagus nerve cholinergic signaling interacts with α-7nAchR on immune cells and inhibits the production of TNF and other proinflammatory cytokines and excessive inflammatory responses.

Reproductively suppressed subordinates do not have higher CORT levels than breeders and may have lower levels (Clarke and Faulkes, 1997 and Clarke and Faulkes, 2001). While it is not yet clear how stress relates to status in this species, inhibitors Social subordination must be considered in the context of how it affects the individuals involved. Notably, social defeat may be more

universally stressful than low status. Housing density affects rodent behavior, and both crowded and isolated social environments have been used as stressors in rodents. Crowding is a naturalistic stressor especially for social or gregarious species that relates to high population density and resource competition in the field. In house mice, several studies have shown that crowding can impair

reproductive function and may be part of population size regulation (Christian and Lemunyan, 1958 and Christian, selleck chemicals llc 1971). In the highly social, group-living rodent species the degu (Octadon degus), increased group size is associated with greater dispersal consistent with a “social competition” hypothesis ( Quirici et al., 2011). In the laboratory, crowding typically consists of large numbers of mice or rats (e.g. >6 rats/cage (Brown and Grunberg, 1995 and Reiss et al., 2007)) with ad libitum access to resources such as food and water. Crowding must be somewhat extreme to induce stressful outcomes, as group-housing (e.g. 4–6 rats or 12 mice in a sufficiently large SB203580 area) unless is often used as a key component of environmental enrichment ( Sztainberg and Chen, 2010 and Simpson and Kelly, 2011). Social crowding has been shown to impact many different

physiological outcomes in male mice, rats, and prairie voles. These include changes in organ weights, hormone secretion, HPA reactivity, pain sensitivity, telomere length, and cardiac outcomes (Gamallo et al., 1986, Gadek-Michalska and Bugajski, 2003, Kotrschal et al., 2007, Grippo et al., 2010, Tramullas et al., 2012 and Puzserova et al., 2013). Crowding of pregnant dams also produces changes in the offspring birth weight, pubertal timing, and reproductive behavior (e.g. Harvey and Chevins, 1987 and Ward et al., 1994) and may lead to lasting changes through a subsequent generation (Christian and Lemunyan, 1958). There appear to be important sex differences in the consequences of crowding, with one study in rats finding that crowding is a stressor for males but has the capacity to calm females (Brown and Grunberg, 1995). At the opposite extreme, solitary housing can be a potent stressor for social species. Social isolation is employed as a stressor in previously group-housed mice and rats (Heinrichs and Koob, 2006); in both species, extended (2–13 week) solitary housing produces an “isolation syndrome” particularly in females, consisting of hyperadrenocorticism, reduced body weight, altered blood composition, and enhanced pain responsiveness among other outcomes (Hatch et al., 1965 and Valzelli, 1973).

Although deficits in the MFG and caudate are tentative, given few studies specifically examining these regions relating to alerting, the ACC abnormality may constitute a fundamental deficit which is related to other

cognitive domains. Knowledge of deficits in alerting and executive control could be used to facilitate new adjunctive interventions for individuals with ASD, thus satisfying an important initiative to develop ASD-specific neurobehavioral domains. Acknowledgments We thank Michael I. Posner for making insightful comments, Jack M. Gorman Inhibitors,research,lifescience,medical for his kind help, and Cheuk Y. Tang and Kevin G. Guise for assistance with data collection. Conflict of Interest None declared.
Numerous neurotransmitter systems contribute to the normal development and function of Inhibitors,research,lifescience,medical the auditory check details sensory (cochlear) apparatus and the circuitry of the central nervous system. This includes members of

the excitatory ligand-activated nicotinic acetylcholine receptor family (nAChR; Albuquerque et al. 2009). The nAChR subunit family consists of 16 distinct subunits that in various pentameric combinations Inhibitors,research,lifescience,medical form ligand-activated ion channels that each exhibit uniquely specialized pharmacological and functional properties (Albuquerque et al. 2009). One of these is the homomeric alpha7 nAChR (α7) whose functional uniqueness is in part due to its expression by both neuronal and non-neuronal cells

in many tissues throughout the body and because it is responsive to multiple agonists (including acetylcholine and choline as well as nicotine). This results Inhibitors,research,lifescience,medical in its ability to modulate a diverse range of cellular functions including Inhibitors,research,lifescience,medical cell growth, cell survival, neurotransmission, and inflammation (Gahring and Rogers 2005; Levin et al. 2006; Albuquerque et al. 2009). Members of the nAChR family contribute to essentially all aspects of the auditory sensory system function and development (Morley and Happe 2000; Morley 2005). This includes widespread changes Oxygenase in expression during embryogenesis that optimizes their contribution to signal transduction, fine-tuning of sensory hair cells, and modulating central auditory circuit neurotransmission (Elgoyhen et al. 1994, 2001a; Happe and Morley 1998; Vetter et al. 1999, 2007; Morley and Happe 2000; Katz et al. 2004; Morley 2005). This functional diversity is in part accomplished through strict spatiotemporal control of different nAChR subunit expression, as has been extensively described for the nAChRs composed of either homomeric (α9) or heteromeric (α9 + α10) subunits (Elgoyhen et al. 1994; Vetter et al. 1999, 2007; Elgoyhen et al., 2001b; Murthy et al. 2009).

Acknowledgement We wish to acknowledge Mr Adeleke of the Pharmacognosy Department, Faculty

of Pharmacy, University of Lagos, Nigeria for the help with the preparation of the herbal decoction and support of this work. Conflict of Interest: None declared
Background: Ramadan fasting for pregnant women with diabetes remains controversial and underreported. The objective of this study was to determine the glycemic control in pregnant diabetic women on insulin who fasted BKM120 during Ramadan. Methods: This was a retrospective study carried out over a period of three years Inhibitors,research,lifescience,medical including pregnant diabetic women, who were on short-acting, intermediate-acting, or a combination of them, and opted to carry out Ramadan fasting. Glycemic control was assessed before, middle and after Ramadan fasting. Results: Thirty seven women opted to fast with 24 (64.9%) of them had type 2 diabetes mellitus and 83.8% of them required combined insulin (short- acting, intermediate-acting) therapy. The age of the participants was 32.13±4.68 years, and the age of their Inhibitors,research,lifescience,medical pregnancies was 25.60±7.12 weeks when the study was performed. The median Inhibitors,research,lifescience,medical number of days fasted was 25 days, and most of the women were able to fast for more than 15 days. There was no

difference between glycemic control of type 2 diabetes mellitus and gestational diabetes mellitus women prior to fasting. In the middle of Ramadan, serum fructosamine decreased in both groups. However, only serum HbA1c reduced in gestational diabetes mellitus after Ramadan. Conclusion: the findings indicate that pregnant diabetic women on insulin were able to fast during Ramadan and that their glycemic control was improved during fasting period. They may also suggest that instead of absolute ban on fasting for pregnant Inhibitors,research,lifescience,medical diabetic women more practical approach and close consultation with health care providers might be more helpful. Key Words: Fasting, insulin, diabetes, pregnancy, gestational diabetes Introduction Ramadan is a holy month for Muslims, in which healthy adult individuals are obliged to fast Inhibitors,research,lifescience,medical from dawn to sunset. Pregnant women are among those who are exempted from

fasting. Despite that, many pregnant Oxalosuccinic acid Muslim women fast,1 against the standard medical advice.2 Among these are pregnant women with diabetes, who are in need of insulin but perceive themselves to be fit to carry out the fasting. Several studies,3,4 conducted on healthy pregnant women during Ramadan have shown no detrimental effects or complications on them or their fetuses. These two studies, which compared fasting pregnant women with non fasting ones, showed lower serum levels of glucose and cholesterol with no evidence of ketonuria in fasting women. Moreover, there were no adverse effects on intrauterine fetal health. During the day when fasting is being carried out, food, drink or any oral intakes are not permitted. These contribute to an overall reduced caloric intake in most individuals.

It has evolved into newer US Food and Drug Administration (FDA)-approved formulations

including an oral immediate-release pill (OXY-IR), a once-daily oral preparation (OXY-ER), a transdermal patch (OXY-TDS), and a topical gel (OXY-OTG). No clinical head-to-head Selleck Ceritinib studies have been completed as yet comparing OXY-ER, OXY-TDS, and OXY-OTG; however, both OXY-ER and OXY-TDS have been compared with tolterodine ER (TOL-ER) Inhibitors,research,lifescience,medical and have demonstrated similar efficacy. In the Overactive Bladder: Performance of Extended Release Agents (OPERA) trial, OXY-ER, 10 mg, and TOL-ER, 4 mg, were compared, with both agents reporting similar decreases in urge incontinence reductions and incontinence episodes, whereas OXY-ER had a greater decrease in weekly micturition frequency (28.4 vs 25.2; P = .003) and overall dry rate (23% vs 16.8%; P = .03). OXY-IR, OXY-OTG, and placebo were evaluated in a short comparative study using cognitive

and psychomotor testing. OXY-IR demonstrated Inhibitors,research,lifescience,medical evidence of impairment on specific measures of recent memory versus placebo, whereas OXY-OTG and placebo were similar. This trial raises the question of whether the central nervous system (CNS) effects of oxybutynin could be Inhibitors,research,lifescience,medical related to the oxybutynin serum concentration and/or the metabolite N-desethyloxybutynin (DEO). Oxybutynin has been the most prescribed agent for the treatment of OAB. Initially limited by its tolerability and poor patient Inhibitors,research,lifescience,medical compliance, oxybutynin’s transformation into alternative delivery systems has improved its tolerability and maintained its effectiveness. The newer delivery systems maintain steady-state characteristics and avoid the presystemic metabolism of oxybutynin. OXY-IR, 10 mg, OXY-ER, 10 mg, OXY-TDS, and OXY-OTG appear Inhibitors,research,lifescience,medical to have similar efficacy based on available clinical information. OXY-IR and OXY-ER have the advantage of being FDA approved for use with pediatric patients, although the use of oxybutynin in the elderly, remains a concern. OXY-IR

was not studied in geriatric patients and has had the most reported problems with CNS, memory, and cognition side effects. Early data on transdermal formulations appear to demonstrate improved cognitive tolerability in the second elderly possibly related to the DEO concentration.
The medical treatment of benign prostatic hyperplasia (BPH) has its roots in the early 1970s. During this era, the first clinical trials investigating α-blockade1 and androgen deprivation therapy2 were reported for men with clinical BPH. Although these preliminary studies enrolled a small number of subjects and did not use validated self-administered questionnaires and uroflowmetry to assess symptom improvement and relief of bladder outlet obstruction (BOO), they did yield evidence suggesting clinical benefit.

11 Hopefully, it will help to use TDM optimally from a scientific, clinical, and economic point of view. Selected abbrewiations and acronyms CYP cytochrome P-450 GC gas chromatography HPLC high-performance liquid chromatography LOD limit of detection LOQ limit of quantification PM poor metabolizer SSRI selective serotonin reuptake inhibitor TDM therapeutic drug monitoring UM ultrarapid metabolizer Notes *This

review takes into consideration antidepressant agents currently available in Switzerland and Germany, and therefore does not claim to be exhaustive. This article is a modified version of an article published in the journal Pharmacopsychiatry Inhibitors,research,lifescience,medical in December 2004: Baumann P, Hiemke C, Ulrich S, et al. The AGNP-TDM expert group consensus guidelines: therapeutic drug monitoring in psychiatry. Pharmacopsychiatry. 2004;37:243-265. It is published here with the kind permission of the

publishers Georg FK228 price Thieme Verlag KG, Stuttgart, Germany.
Whatever the antidepressant drug prescribed, 30%1 to Inhibitors,research,lifescience,medical 50%2 of adult Inhibitors,research,lifescience,medical patients with major depression fail to respond to adequate first-line treatment, defined as a dose In the therapeutic range given for an adequate duration, ie, 4 to 6 weeks.3 In clinical practice, when a patient responds Insufficiently to an initial antidepressant dose, several options are available, such as temporizing, increasing the dose, switching to another antidepressant, or combining several drugs.4 A survey by Fredman et al5 of attendees at a psychopharmacology course showed that 80% or Inhibitors,research,lifescience,medical more Indicated that their first choice would be to raise the selective serotonin reuptake Inhibitor (SSRI) dose for a hypothetical patient with minimal response after 4 weeks, or partial response after 8 weeks, of adequate treatment, Inhibitors,research,lifescience,medical Ie, fluoxetine 20 mg/day, sertraline 100 mg/day, or paroxetine 20 mg/day. For a patient with no response

after 8 weeks of adequate SSRI treatment, a switch to a non-SSRI drug was the first and preferred strategy. Hirschfeld et al4 advocated switching, combination therapy, or augmentation therapy after 4 weeks for patients who fall to respond Levetiracetam at an adequate dosage of SSRI (Ie, <25% decrease In the Hamilton Rating Scale for Depression [HAMD] or Montgomery and Åsberg Depression Rating Scale [MADRS] score). For those patients who achieve a partial response on firstline therapy (ie, 25% to 50% decrease In HAMD or MADRS score), they proposed that treatment should be continued for 6 to 8 weeks at an adequate dose before considering a change In therapeutic management.4 An Important question Is whether the frequently applied strategy of Increasing the dose of antidepressant is justified. The Issue Is of fundamental and clinical relevance.

Newer biomarkers could evaluate treatment response in older adults in whom anxiety is most likely to have long-term adverse health or cognitive

consequences. These may include HPA axis functioning through cortisol sampling, or genome-wide expression analysis, a powerful high-throughput technology that provides a systems approach for examining complex clinical disease in terms of dynamic Selleckchem IPI145 changes in gene expression.221 Genome-wide expression analysis assays the current activity level of all transcripts known in humans. Thus, for example, a researcher can determine whether stress results in higher or lower levels of RNA transcripts in peripheral immunological cells.222 Such data, combined with bioinformatic Inhibitors,research,lifescience,medical techniques, allow researchers to infer the functioning of all of the intracellular pathways at a given point in time (ie, at baseline and then after a treatment), as well as their interactions.223,224 Inhibitors,research,lifescience,medical Additionally, as we previously noted, chronic stress hyperactivity (as seen in anxiety disorders) may cause accelerated aging; thus, telomere length measurement, during the

course of a treatment study, might provide a precise and quantitative estimate of benefits of treatment for health and cognition of older adults. Finally, novel neuroimaging markers might include neurogenesis, functional connectivity, and peripheral Inhibitors,research,lifescience,medical and central inflammation. In all, recent advances in technology in studies of anxiety could increase our precision for measurement, a need most pressing in geriatrics. What we do know: Inhibitors,research,lifescience,medical eight rules for managing anxiety disorders from a lifespan perspective

In this last section, we provide a blueprint for managing older (and equally so, younger) adults with anxiety disorders, based on empirical findings and our own clinical experience. 1. Assessment should Inhibitors,research,lifescience,medical measure severity and provide objective criteria for assessing response, and should assess comorbidity, prior treatment, cognitive status, and need for a medical workup Assessment of anxiety is often overlooked by mental health providers. A helpful introduction to the topic is to ask about stress; eg, “older adults often deal with stress; Phosphoprotein phosphatase how do you feel in times of stress?“ Patients who describe symptoms suggestive of anxiety or worry can then be further queried. Use nondirective questioning to determine the severity of anxiety symptoms, by: (i) level of distress (asking how much the anxiety symptoms bother the patient, what strategies they are trying in order to control or avoid it, and what somatic symptoms they are having); (ii) how much of their time it takes; and (iii) avoidance. Avoidance is a key component of all anxiety disorders yet often is not recognized. For example, older adults may rationalize changes in behavior patterns to perceived poor health or environmental limitations. Inquire about behavioral changes including activities given up or, conversely, intrusive overinvolvement with family members.

The methanolic extract of Piper sarmentosum also possesses a natural superoxide scavenger, naringenin.16 A recent study reported that it inhibited the 11β-HSD1 activity in the liver and adipose tissue of ovariectomized female rats.17 In addition, Piper sarmentosum was also found to reduce the bone resorption

marker pyridinoline, in glucocorticoid treated adrenalectomised rats.18 Both osteoblasts and osteoclasts exhibit the expression of 11β-HSD1, which is responsible for the local generation of glucocorticoids in bone. The aim of this study was to determine the effects of Piper sarmentosum extract on the bones of glucocorticoid treated adrenalectomized rats through Inhibitors,research,lifescience,medical the modulation of local 11β-HSD1 activity and expression in bone tissues. Materials and Methods Preparation of Piper sarmentosum Water Inhibitors,research,lifescience,medical Extract Fresh leaves of Piper sarmentosum were collected from the Ethnobotanic Garden, Forest check details Research Institute Malaysia (FRIM). They were identified and confirmed by a plant taxonomist from the Medicinal Plant Division, FRIM, and were given a voucher specimen number (FRI 45870). The extraction procedures were performed at the FRIM laboratory. Fresh Piper Inhibitors,research,lifescience,medical sarmentosum leaves were cleaned

with tap water and dried at room temperature before being chopped into small pieces. The leaves were then boiled in distilled water (90%, v/v) at 80°C for three hours. The water extract was then concentrated and dried into powder by freeze-drying. The powdered extract was stored at 4°C until further use. Animals and Treatment All procedures were carried out in accordance with the guidelines of the Universiti Kebangsaan Malaysia (UKM) Research and Animal Ethics Committee Inhibitors,research,lifescience,medical (UKMAEC) (No: ANT/2007/FARIHAH/14-NOV/201-NOV-2007-SEPT-2010) for animal research surgical procedures. Forty three-month-old male Sprague-Dawley rats weighing 220-250 grams were obtained from

the UKM Animal Breeding Centre. Animals, which were sick and underweight, were excluded from the study. The rats were divided into groups of eight rats and given Inhibitors,research,lifescience,medical following treatments: G1; the control group, which did not receive any treatment, G2; sham operated control group, which was given intramuscular (IM) olive oil as vehicle (0.05 ml/100 g), G3; adrenalectomized (adrx)group, which were given IM 3-mercaptopyruvate sulfurtransferase dexamethasone (120 µg/kg/day); G4: adrx group, which was given IM dexamethasone (120 µg/kg/day) and glycirrhizic acid (GCA, 120 mg/kg/day) by oral gavage, and G5: adrx group, which was given intramuscular dexamethasone (120 µg/kg/day) and water extract of Piper sarmentosum leaves (125 mg/kg/day) by oral gavage. Adrenalectomy was done two days after receiving the animals. The animals were first anaesthetized with Ketapex and Xylazil (Troy Laboratories, Australia). Dorsal midline and bilateral flank muscle incisions were then made, and the adrenal glands were identified and removed.