Journal of Pharmacy And Bioallied Sciences
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   Table of Contents - Current issue
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July-September 2015
Volume 7 | Issue 3
Page Nos. 161-244

Online since Monday, July 06, 2015

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REVIEW ARTICLES  

Clinical pharmacists: The major support to Indian healthcare system in near future p. 161
Prasanna R Deshpande, Raghuram Vantipalli, CH Chaitanya Lakshmi, E Jagadeswara Rao, Bishnu Regmi, Abdul Ahad, P Sharmila Nirojini
DOI:10.4103/0975-7406.160005  
Pharmacy practice is still in the initial stages of development in India, but launching of Doctor of Pharmacy (PharmD) study program has brought serious discussions about clinical pharmacy in the country. As the profession is in budding stage in the country, the patients, physicians, nurses, other healthcare providers, recruiters in pharmaceutical industries, prospective students, and their parents have numerous questions about this profession and study course. The objective of this article is to create awareness about clinical pharmacy services (CPS) and to introduce the role of clinical pharmacists (CPs). After reading this article, one will know about the usefulness of CPs in the Indian healthcare system against the current flaws in the system. The article describes the role of CPs in the hospitals, in research, in pharmaceutical/contract research companies, in community service and it also tells about the related myths and facts. Prospective job opportunities for CPs, present challenges and the possible solutions are elaborated as well. In conclusion, CPs are going to be the major support to the Indian healthcare system in near future; the reasons being (1) CPS are beneficial in many ways to improve healthcare; CPS have already proved their importance in western countries (2) India was never officially and efficiently exposed to CPS; so launching of CPS shall revolutionize the country's healthcare scenario.
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A review of injection and antibiotic use at primary health care (public and private) centers in Africa p. 175
Richard Ofori-Asenso, Akosua Adom Agyeman
DOI:10.4103/0975-7406.160008  
We conducted a review to study antibiotic and injections use at primary care centers (PHCs) within the World Health Organization African region. This was part of a larger study on prescribing indicators at PHCs within the region. We analyzed antibiotic and injection use reported in studies published between 1993 and June 2013, which were identified through searches conducted in PubMed, Scopus, Web of science, Africa-Wide NiPAD, Africa Journals Online, Google Scholar, and International Network for Rational Use of Drugs bibliography databases. Sub-group analysis was carried out for private and public centers. Data were retrieved from 18 studies in 6 countries involving 21,283 patient encounters across 338 PHCs. The percentage of patient encounters with antibiotics prescribed was 51.5% (IQR 41.1-63.3%). The percentage of patient encounters which resulted in the prescription of an injection was 36.8% (IQR 20.7-57.6%). Injection use rate at private facilities was 38% (IQR 19.1-42.7) while that of the public was 32.3% (IQR 20.6-57.6). Rate of antibiotic prescribing at public centers was 49.7% (IQR 51.1-75.7) and that of private facilities 57.6 (IQR 39.0-69.5).The percentage use of injections and antibiotics is high in Africa. The excessive use of antibiotics and injections are particularly more problematic in private than public facilities. Further research is needed to understand fully the underlying factors for the observed patterns and ways of improving medicines use.
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The use of psychotropic substances among students: The prevalence, factor association, and abuse p. 181
Che Fadhilah bt Mamat, Shazia Qasim Jamshed, Tarek El Syed, Tahir Mehmood Khan, Noordin Othman, Abdul Kareem Al-Shami, Syahrir Bin Zaini, Mohammad Jamshed Siddiqui
DOI:10.4103/0975-7406.160011  
This detailed review analyzed the previously published studies related to the prevalence of psychotropic substances use, associated factors, and the misuse of the psychotropics among students. A comprehensive literature search covering six databases was performed. References from published articles and reports were extracted. This helped in identifying the available information on the use of psychotropic drugs. A total of 16 articles were included in this review. There is an upsurge of using psychotropics with the preceding years. More students are exposed to the risk of using psychotropic substances due to the multiple factors like stress, increased academic workload, etc. The misuse is found to be common with prescribed psychotropic substances. Students need to be aware of the bad outcomes of using psychotropic substances. Participation of every stakeholder to curb this menace needs to be emphasized. More extensive studies are required to know about the increasing prevalence, factors, and misuse of psychotropics.
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Applications of regenerative medicine in organ transplantation p. 188
Aditya Jain, Ramta Bansal
DOI:10.4103/0975-7406.160013  
A worldwide shortage of organs for clinical implantation establishes the need to bring forward and test new technologies that will help in solving the problem. The concepts of regenerative medicine hold the potential for augmenting organ function or repairing damaged organ or allowing regeneration of deteriorated organs and tissue. Researchers are exploring possible regenerative medicine applications in organ transplantation so that coming together of the two fields can benefit each other. The present review discusses the strategies that are being implemented to regenerate or bio-engineer human organs for clinical purposes. It also highlights the limitations of the regenerative medicine that needs to be addressed to explore full potential of the field. A web-based research on MEDLINE was done using keywords "regenerative medicine," "tissue-engineering," "bio-engineered organs," "decellularized scaffold" and "three-dimensional printing." This review screened about 170 articles to get the desired knowledge update.
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ORIGINAL ARTICLES Top

Physiologically active hydrogel (in situ gel) of sparfloxacin and its evaluation for ocular retention using gamma scintigraphy p. 195
Himanshu Gupta, Aqil Malik, RK Khar, Asgar Ali, Aseem Bhatnagar, Gaurav Mittal
DOI:10.4103/0975-7406.160015  
Objective: Due to the structure and physiological barrier of eye, only 1% of instilled dose is available for action on the corneal surface. In this work, we developed and evaluated chitosan (pH sensitive) and gellan gum (ion sensitive) in situ gel of sparfloxacin to improve precorneal residence time. Materials and Methods: A protocol for radiolabeling of sparfloxacin with Tc-99m was optimized to study the ocular retention using gamma scintigraphy technique. Results: The clear formulation was developed. In vitro release showed a sustained and prolonged release compared to plain eye drop solution. Dynamic and static gamma scintigraphy showed better retention than plain eye drops. The ocular tolerance test (hen's egg test-chorioallantoic membrane test and infra-red study) showed that the formulation is nonirritant and can be used as ocular vehicle. Conclusion: Radiolabel protocol for sparfloxacin was successfully developed and evaluated on ocular retention studies of developed in situ gel. The developed in situ gel is non irritant and can go further with clinical evaluation.
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Nationwide survey on barriers for dental research in India p. 201
Kundendu Arya Bishen, Kumar Gaurav Chhabra, Shitalkumar Sagari, Puneet Gupta
DOI:10.4103/0975-7406.160017  
Objective: Research in the dental field is progressing at mightier speed worldwide, but an unfortunately representation of India at this platform is negligible. The present study was undertaken to unearth the barriers for dental research among dental professionals in Indian scenario. Materials and Methods: A cross-sectional questionnaire study was conducted on 1514 participant's (Master of Dental Surgery and Bachelor of Dental Surgery staff) and postgraduates in 40 dental colleges of India selected by multistage random sampling. The response rate was 75.7%. The survey was undertaken from July 2013 to December 2013. The survey instrument was 24-item, investigator developed, self-structured, close-ended, and self-administered questionnaire grouped into four categories that are, institutional/departmental support related barriers, financial/training support related barriers, time-related barriers, and general barriers. Results: Among all respondents 47.23% informed that they are administrative and educational work rather than research work as (P < 0.001). Overall 57.53% of study participants reported lack of administrative and technical support for research work as (P < 0.001). Overall 64.9% reported meager college funding was the barrier (P < 0.001). Overall 61.5% respondents reported lack of time to do research work due to clinical and teaching responsibilities (P < 0.001) was the barrier for research. Largely 80.25% agreed that, the lack of documentation and record maintenance are an obvious barrier for research (P < 0.001). Conclusions: Present study unearths certain barriers for research in an Indian scenario, which includes administrative overburden, lack of funds, and lack of documentation of the dental data. Governing authorities of dentistry in India have to make major interventions to make research non-intensive environment to research-friendly environment.
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Lifetime and 5 years risk of breast cancer and attributable risk factor according to Gail model in Iranian women p. 207
Abolfazl Mohammadbeigi, Narges Mohammadsalehi, Razieh Valizadeh, Zeinab Momtaheni, Mohsen Mokhtari, Hossein Ansari
DOI:10.4103/0975-7406.160020  
Introduction: Breast cancer is the most commonly diagnosed cancers in women worldwide and in Iran. It is expected to account for 29% of all new cancers in women at 2015. This study aimed to assess the 5 years and lifetime risk of breast cancer according to Gail model, and to evaluate the effect of other additional risk factors on the Gail risk. Materials and Methods: A cross sectional study conducted on 296 women aged more than 34-year-old in Qom, Center of Iran. Breast Cancer Risk Assessment Tool calculated the Gail risk for each subject. Data were analyzed by paired t-test, independent t-test, and analysis of variance in bivariate approach to evaluate the effect of each factor on Gail risk. Multiple linear regression models with stepwise method were used to predict the effect of each variable on the Gail risk. Results: The mean age of the participants was 47.8 ± 8.8-year-old and 47% have Fars ethnicity. The 5 years and lifetime risk was 0.37 ± 0.18 and 4.48 ± 0.925%, respectively. It was lower than the average risk in same race and age women (P < 0.001). Being single, positive family history of breast cancer, positive history of biopsy, and radiotherapy as well as using nonhormonal contraceptives were related to higher lifetime risk (P < 0.05). Moreover, a significant direct correlation observed between lifetime risk and body mass index, age of first live birth, and menarche age. While an inversely correlation observed between lifetimes risk of breast cancer and total month of breast feeding duration and age. Conclusion: Based on our results, the 5 years and lifetime risk of breast cancer according to Gail model was lower than the same race and age. Moreover, by comparison with national epidemiologic indicators about morbidity and mortality of breast cancer, it seems that the Gail model overestimate the risk of breast cancer in Iranian women.
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In-silico gene co-expression network analysis in Paracoccidioides brasiliensis with reference to haloacid dehalogenase superfamily hydrolase gene p. 212
Raghunath Satpathy, VB Konkimalla, Jagnyeswar Ratha
DOI:10.4103/0975-7406.160023  
Context: Paracoccidioides brasiliensis, a dimorphic fungus is the causative agent of paracoccidioidomycosis, a disease globally affecting millions of people. The haloacid dehalogenase (HAD) superfamily hydrolases enzyme in the fungi, in particular, is known to be responsible in the pathogenesis by adhering to the tissue. Hence, identification of novel drug targets is essential. Aims: In-silico based identification of co-expressed genes along with HAD superfamily hydrolase in P. brasiliensis during the morphogenesis from mycelium to yeast to identify possible genes as drug targets. Materials and Methods: In total, four datasets were retrieved from the NCBI-gene expression omnibus (GEO) database, each containing 4340 genes, followed by gene filtration expression of the data set. Further co-expression (CE) study was performed individually and then a combination these genes were visualized in the Cytoscape 2. 8.3. Statistical Analysis Used: Mean and standard deviation value of the HAD superfamily hydrolase gene was obtained from the expression data and this value was subsequently used for the CE calculation purpose by selecting specific correlation power and filtering threshold. Results: The 23 genes that were thus obtained are common with respect to the HAD superfamily hydrolase gene. A significant network was selected from the Cytoscape network visualization that contains total 7 genes out of which 5 genes, which do not have significant protein hits, obtained from gene annotation of the expressed sequence tags by BLAST X. For all the protein PSI-BLAST was performed against human genome to find the homology. Conclusions: The gene co-expression network was obtained with respect to HAD superfamily dehalogenase gene in P. Brasiliensis.
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Is Greulich and Pyle standards of skeletal maturation applicable for age estimation in South Indian Andhra children? p. 218
Rezwana Begum Mohammed, Dola Srinivasa Rao, Alampur Srinivas Goud, S Sailaja, Anshuj Ajay Rao Thetay, Meera Gopalakrishnan
DOI:10.4103/0975-7406.160031  
Introduction: Now-a-day age determination has gained importance for various forensic and legal reasons. Skeletal age (SA) of a test population can be estimated by comparing with established standards of Greulich and Pyle (G-P). As this atlas has been prepared using data from upper-class children born between 1917 and 1942 in the USA and the applicability of these standards to contemporary populations has yet to be tested on Andhra children living in India. Hence, this study was aimed to assess the reliability of bone age calculated by G-P atlas in estimation of age in selected population. Materials and Methods: A total of 660 children (330 girls, 330 boys) between ages 9 and 20 years were randomly selected from outpatient Department of Oral Medicine in GITAM Dental College, Andhra Pradesh. Digital hand-wrist radiographs were obtained and assessed for SA using G-P atlas and the difference between estimated SA and chronological age (CA) were compared with paired t-test and Wilcoxon signed rank test. Results: G-P method underestimated the SA by 0.23 ± 1.53 years for boys and overestimated SA by 0.02 ± 2 years in girls and mild underestimation was noted in the total sample of about 0.1 ± 1.78 years. Spearman rank test showed significant correlation between SA and CA (r = 0.86; P < 0.001). Conclusion: This study concluded that G-P standards were reliable in assessing age in South Indian Andhra children of age 9-20 years with unknown CA.
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Assessment of treatment interruption among pulmonary tuberculosis patients: A cross-sectional study p. 226
Satya Bhgath Gorityala, Uday Venkat Mateti, Venkateswarlu Konuru, Srinivas Martha
DOI:10.4103/0975-7406.160034  
Background: Multi-drug resistant tuberculosis (TB) is a rising peril of the TB control in India caused mostly by incomplete treatment. Aim: The aim was to assess the treatment interruption among pulmonary TB (PTB) patients. Materials and Methods: A cross-sectional study was carried out for a period of 9 months among PTB patients. Patients admitted with active pulmonary Koch's and history of anti-TB treatment (ATT) for 1-month or more from any source and who returns to treatment after not taking ATT consecutively for 2 months or more were included in the study. The data were collected from the patients or their caretakers to obtain the source of treatment given previously before default, number of treatment interruptions, phase and reasons for treatment interruption treatment. Results: A total of 107 defaulters were identified during the study period. In the present study, 62.6% of the patients interrupted treatment only once, 55.34% of the patient's early continuation (3-4 months) treatment, and 47.66% of the patient's only one reason for the treatment interruptions during the course of the treatment. The most common reason for the treatment interruptions were felt well with TB treatment (29.53%) followed by side effects (16.06%), lack of money (8.29%), and other reasons. Conclusion: The study revealed that most of the defaulters were in the age group between 35 and 60 years, male gender, illiterates, daily wage labor, and married. The treatment interruptions were minimized by putting the efforts to improve direct supervision; pretreatment counseling and retrieve treatment interrupters were recommended.
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Electronic solutions for combating counterfeit drugs p. 230
R Hemalatha, A Srinivasa Rao
DOI:10.4103/0975-7406.160035  
Introduction: The problem of counterfeiting of drugs is assuming alarming proportions and is getting difficult to combat due to its trans-national character. It is undermining the faith of people on health care system. Therefore, there is a need to adopt zero tolerance approach to combat the problem. The Way Forward: There are many solutions available which are being adopted in piece meal manner by individual manufacturers. However, for wholesalers and resellers it is getting difficult to maintain multiple solutions. Therefore, there is a need to adopt a unified solution preferably with the help of the government. Conclusions: This paper discusses the available solutions, their shortcomings and proposes a comprehensive solution where at each level in the supply chain the authenticity is verified preferable linking it with Unique identification.
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Combinational effect of resveratrol and atorvastatin on isoproterenol-induced cardiac hypertrophy in rats p. 233
Songjukta Chakraborty, Mukta Pujani, Syed Ehtaishamul Haque
DOI:10.4103/0975-7406.160037  
Introduction: Resveratrol is a natural polyphenol present mainly in grapes. It has been shown to offer strong cardio protection in animal models due to its ability to correct lipid peroxidation and maintain antioxidants level. Atorvastatin, a HMG-CoA reductase inhibitor, lowers cholesterol level and is commonly prescribed to heart patients. Our aim in this study was to see the combination effect of these two drugs against Isoproterenol-induced cardiac hypertrophy in rats. Materials and Methods: Wister Albino rats were treated with resveratrol (20 mg/kg/day, p.o), atorvastatin (20 mg/kg/day, p.o) and in combination (resveratrol [10 mg/kg/day, p.o] + atorvastatin [10 mg/kg/day, p.o]) for a period of 25 days and from 15 th till 25 th day Isoproterenol (5 mg/kg/day, s.c) was co-administered to rats to induce cardiac hypertrophy. Results: A significant increase in creatine kinase, lactate dehydrogenase, aspartate transaminase and lipid peroxidation with the significant decrease in reduced glutathione, superoxide dismutase and catalase were observed in Isoproterenol treated rats. Resveratrol, atorvastatin and their combination significantly reversed the effect. The histopathological studies and myocardial infarct size evaluation also confirmed the protection. Conclusion: Comparing the data we came to this conclusion that atorvastatin although showed the protection along all the parameters, the extent of protection offered by resveratrol alone and in combination were more effective. Hence, it can be concluded that resveratrol, an herbal nutritional supplement, alone and in combination is better against cardiac hypertrophy.
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LETTER Top

Perspective: Does personalized medicine hold the future for medicine? p. 239
Akosua Adom Agyeman, Richard Ofori-Asenso
DOI:10.4103/0975-7406.160040  
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