Journal of Pharmacy And Bioallied Sciences
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   Table of Contents - Current issue
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October-December 2019
Volume 11 | Issue 4
Page Nos. 299-376

Online since Tuesday, September 24, 2019

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REVIEW ARTICLES  

A review of pharmacist-led interventions on diabetes outcomes: An observational analysis to explore diabetes care opportunities for pharmacists p. 299
Muhammad Z Iqbal, Amer Hayat Khan, Muhammad S Iqbal, Syed Azhar Syed Sulaiman
DOI:10.4103/jpbs.JPBS_138_19  
A strict and adherence treatment is required by the patient with diabetes mellitus and it demands a proper self-medication by the patient. Pharmacists are involved in providing self-management support to the patients. This review evaluates the interventions of pharmacist for patients to improve self-management with diabetes mellitus and also to improve the clinical outcomes of diabetes mellitus. A comprehensive literature search was performed by using different keywords “pharmacist-led intervention,” “diabetes,” “effect of pharmacist on outcome of diabetes,” and “self-management of diabetes” with the help of various electronic databases such as PubMed, Science Direct, Embase, Web of Science, and the Cochrane Library from the beginning of the database through September 2018. The primary outcome was glycated hemoglobin (HbA1c), whereas the secondary outcomes were blood glucose level, blood pressure (BP) measure, body mass index, lipids, adherence to medication, and quality of life. Twenty-five studies comprising 2997 diabetic patients were included in the analysis. Pharmacist-led intervention was involved in all included studies in the form of education on diabetes and its complications, medication adherence, lifestyle, and education about self-management skills. Pharmacist-led interventions are able to reduce HbA1c levels with a mean of 0.75%. Most studies do not expose the material and methods used in pharmacist-led intervention. The variation in the reduction of HbA1c, fasting blood sugar, BP, and lipid profile was due to the lack of this standardization. The included studies indicated that pharmacist-led interventions in diabetes mellitus can significantly improve the outcomes of diabetes mellitus and its complication later on. Hence, these long-term improvements in outcomes added more value of pharmacists in health-care system of the world.
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Osteoporosis among patients with chronic obstructive pulmonary disease: Systematic review and meta-analysis of prevalence, severity, and therapeutic outcomes p. 310
Ahmad Naoras Bitar, Syed Azhar Syed Sulaiman, Irfhan Ali Hyder Ali, Irfanullah Khan, Amer Hayat Khan
DOI:10.4103/jpbs.JPBS_126_19  
Chronic obstructive pulmonary disease (COPD) can be associated with systemic inflammatory trademarks and can coexist with other chronic debilitating diseases such as osteoporosis, which is considered among the most serious comorbidities of COPD. In this review, we aimed at finding answers for the following questions and tried to encapsulate the available literature: (1) how prevalent is osteoporosis among patients with COPD? (2) What are severity patterns of osteoporosis in case of COPD? (3) What are the therapeutic outcomes for patients with osteoporotic COPD? The total number of patients with COPD from all studies was 3815, majority of which were male (2658) representing 69.67% of patients. The mean ± standard deviation for percentage of forced expiratory volume in 1s (FEV1%) was 55.43 ± 14.62%, body mass index for almost 91.29% of patients was 24.4 ± 4.45 kg/m2, whereas fat-free mass index (FFMI) was 17 ± 0.93 kg/m2 for 17.66%. The percentage of patients with COPD having osteoporosis varied in the analyzed studies from 14% up to 66.6%. The mean prevalence of reported osteopenia from 14 studies (n = 2107) was 39.91%, whereas for osteoporosis, the mean prevalence was 37.62% for all included studies. Osteoporosis was highly prevalent among patients with COPD. It is reasonable to call for osteoporosis screening in patients with COPD who are above 65 years, in advanced stages, with BMI lower than 21 kg/m2 or with FFMI lower than 16 kg/m2 for males and 15 kg/m2 for females. There is a lack of research investigating severity and treatments of osteoporosis in patients with COPD.
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Probiotics: A potential immunotherapeutic approach for the treatment of schizophrenia p. 321
Sandeep Grover, Amol Patil, Anit Kaur, Gaurav Garg
DOI:10.4103/jpbs.JPBS_47_19  
Probiotics are in use for physiological boosting, health supplement, and for treatment since historical time. Recently, the to-and-fro pathways linking the gut with the brain, explaining the indirect communication via modulation of immune function and levels of various neurotransmitters, have been discovered, but how precisely these modulations alter the levels of neurotransmitters contributing to the cognitive and other symptom improvements in patients with schizophrenia remains a new arena of research for psychiatry and psychology professionals. The germ-free mice experiments have been the game changer in the mechanistic exploration. The antimicrobial usage alters the local gut flora and hence is associated with psychiatric side effects that strengthen the association further. The changes in the genetics of these bacteria with different types of diet and its correlation with neurotransmitters production capacity and the psyche of the individual are indeed an emerging field for schizophrenia research. Redressal of issues such as manufacturing, the shelf life of probiotics, and stability of probiotics in the gut milieu, in the presence of food, secretions, and exact volume needed for particular age group will help in refining the dose duration of probiotic therapy. Clinical trials are underway for evaluating safety and efficacy in schizophrenia. The gut microorganism transplant and pharmacovigilance of probiotics are important areas yet to be addressed accurately. This paper elucidates the pathways, clinical studies, availability of probiotics in the Indian market with their composition, regulatory issues in India about the probiotic use, and future of probiotic research in schizophrenia.
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ORIGINAL ARTICLES Top

A prospective study on hospitalization due to drug-related problems in a tertiary care hospital p. 328
Venkateswarlu Konuru, Bodanam Naveena, Edulakanti Sneha Reddy, Bandela Charles Vivek, Gyadari Shravani
DOI:10.4103/jpbs.JPBS_35_18  
Introduction: Drug-related problem (DRP) is any undesirable event experienced by the patient, which is suspected to involve drug therapy and interferes with a desired patient outcome. Most of these DRPs are avoidable with little vigilant effort. DRP admissions need high attention as DRP-related admissions on an average accounted for 8.36%, of which 50% are avoidable. The aim of the study was to identify the risk factors associated with DRPs in tertiary care hospital. Materials and Methods: One year prospective observational study was conducted in the departments of general medicine, dermatology, pediatrics, and gastroenterology of a tertiary care teaching hospital. A total of 148 cases, where a correlation between past medication history and current complaints was established, were included in the study. Exclusion criteria of the study were no correlation between past medication history and current complaints, social habits causing hospitalization, and herbal medication use history. Results and Discussion: In this study, nonadherence (50.94%) and adverse drug reaction (ADR) (38.36%) were predominant among the identified DRPs. Children and geriatrics showed the higher incidence of nonadherence to the prescribed therapy. ADRs were the DRP with the higher incidence among adults followed by nonadherence to the prescribed therapy. Lack of knowledge about the disease, its complications, and possible adverse reactions with self-medication was identified to be the high incidence risk factor. Higher incidence of DRPs was observed in patients having a past medical history of cardiovascular system and central nervous system diseases, which require long-term management. Conclusion: In this study, nonadherence to prescribed therapy was found to be the DRP causing hospitalization at a higher incidence. The most commonly involved risk factors were lack of knowledge about the disease, need of adherence to the therapy as prescribed, and outcomes of the treatment provided.
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Community Pharmacist’s Knowledge, Attitude, and Practices towards Vitamin Supplements in Al-Khobar Region, Saudi Arabia: A Descriptive Cross-Sectional Study p. 333
Sherihan A Ghosn, Brian Addison, Mohammad D Ali
DOI:10.4103/jpbs.JPBS_99_19  
Aims and Objectives: To foster a podium for assessing and evaluating knowledge, attitudes, and professional practices of Saudi community pharmacists in counseling patients regarding the safe usage of dietary supplements. Materials and Methods: A cross-sectional descriptive study was conducted between January 2017 and April 2017. Collection of data was carried out by using a set of 44 semi-structured self-administrated questionnaires. Study was conducted among community pharmacies in Al-Khobar Region, Saudi Arabia, with target sample of 250 pharmacists. Results: A total of 102 pharmacists contributed in this study. The mean average score of the participants in subjective assessment of knowledge was 62.45%. Half of the participants (51.96%) achieved good and excellent score in objective assessment regarding knowledge of vitamin, 66.67% of the respondents thought that pharmacists should be knowledgeable regarding vitamin supplements, and 81.37% declared that they inform the patients about possible adverse effects by the use of dietary supplements. Conclusion: The study revealed a positive attitude of community pharmacists in Al-Khobar Region on their role in patients’ counseling about the safe usage of vitamins as dietary supplements. However, their level of knowledge about vitamin supplements needs to be improved to meet consumer’s needs regarding usage of dietary supplements.
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Tecoma stans: Alkaloid profile and antimicrobial activity p. 341
Riham Omar Bakr, Marwa Abdelaziz Ali Fayed, Mohammad Alaraby Salem, Ahmed Samir Hussein
DOI:10.4103/jpbs.JPBS_79_19  
Aim: Tecoma stans (L.) Kunth is a promising species in the trumpet creeper family Bignoniaceae. This study aimed at showing the antibacterial and antifungal potentials of T. stans methanolic leaf extract (TSME) correlated to its phytoconstituents. Materials and Methods: The antimicrobial potential of TSME was evaluated using agar diffusion method. The main alkaloids were separated on silica gel column and identified using nuclear magnetic resonance spectral analysis. Molecular docking was performed for the isolated compounds against MurD ligase, penicillin-binding protein, and dihydropteroate synthase enzyme to rationalize the observed antibacterial effect. Results and Discussion: TSME showed significant antibacterial effect against all tested microorganisms with comparable minimum inhibitory concentration (MIC) to the ampicillin and gentamicin with MIC values ranging between 0.98 and 1.95 µg/mL, in addition to a promising antifungal effect when compared to amphotericin with MIC values 3.9 and 15.63 µg/mL for Aspergillus flavus and Candida albicans, respectively. Several alkaloids were separated, purified, and identified as tecostanine, 4-OH tecomanine, 5-hydroxyskytanthine, and tecomanine, which were previously isolated from T. stans. The docking study showed that the alkaloids bind in a similar fashion to the co-crystallized ligands of the crystal structures of MurD ligase. The binding poses and scores in the case of penicillin-binding protein and dihydropteroate synthase did not match the co-crystallized ligands in their crystal structures. The in silico results suggest an antibacterial mechanism that involves the inhibition of MurD ligase. Conclusion: T. stans alkaloids could represent the basic skeleton for a powerful antimicrobial agent.
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Risk factors associated with trastuzumab-induced cardiotoxicity in patients with human epidermal growth factor receptor 2-positive breast cancer p. 348
Wesam Abdel-Razaq, Mohammed Alzahrani, Majed Al Yami, Faisal Almugibl, Mohammed Almotham, Razan Alregaibah
DOI:10.4103/jpbs.JPBS_276_18  
Context: Although trastuzumab is a highly effective and selective targeted therapy for human epidermal growth factor receptor 2 (HER2)-positive breast cancer, the drug-induced cardiotoxicity may confine its usefulness in patients. Aim: To explore risk factors associated with the development of cardiotoxicity in patients with HER2-positive breast cancer. Settings and Design: A retrospective review of medical records and chart review for all patients with breast cancer treated with trastuzumab was conducted at King Abdulaziz Medical City and King Abdullah Specialized Children Hospital in Riyadh, Kingdom of Saudi Arabia, between October 2015 and February 2018. Patients with declined left ventricular ejection fraction, either with or without cardiac symptoms, were recognized as those with cardiotoxicity due to trastuzumab administration. Results: A total of 146 patients were included in the study with an average age of 52.7 (standard deviation = 12.2) years. Thirty-two (21.9%) patients developed cardiotoxicity. However, only 24 (16.4%) were symptomatic with an apparent heart failure but it did not necessitate interruption of trastuzumab therapy. The majority of patients had prior underlying cardiovascular diseases. This study identified unilateral tumor site (62.5%), breast surgery (37.5%), and concomitant taxane chemotherapy (62.5%) as the main risk factors associated with significant increase in cardiotoxicity in patients with breast cancer (with P values of 0.0269, 0.0482, and 0.0225, respectively). Conclusion: The majority of patients (more than 90%) developed cardiotoxicity after completion of chemotherapy. However, recruiting a larger sample size should be warranted to confirm or negate these findings.
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Tamarindus indica fruit: Pharmacognostical standardization, detection of contaminant, and in vitro antioxidant activity p. 355
Mohd Amir, Niyaz Ahmad, Md Sarfaroz, Wasim Ahmad, Sayeed Ahmad, Mohd Mujeeb, Faheem Hyder Pottoo
DOI:10.4103/jpbs.JPBS_46_19  
Objective: The main objective of the current study was to perform pharmacognostical, physiochemical analysis and in vitro antioxidant activity of Tamarindus indica Linn. (Family: Fabaceae) fruit. Materials and Methods: The present study deals with pharmacognostical characters as identification parameters of the fruit, which were subjected to macro- and microscopical studies. Physiochemical analysis was performed as per World Health Organization–recommended parameters. Toxicological parameters such as heavy metals, aflatoxins, and pesticide residue and presence of microbial count were analyzed. This study also deals with the thin layer chromatography/high performance thin layer chromatography fingerprinting and antioxidant activity. Results: The microscopy study revealed the presence of epidermis, vascular bundles, parenchyma cells, mucilage fiber, starch grain, and nonlignified fibers. Physiochemical parameters such as loss on drying, moisture content, ash value, and extractive value were also determined. Heavy metal, aflatoxin, total microbial load, and pesticide residues were found to be variable but under the permissible limits. Conclusion: It is critical to analyze these parameters in each crude herbal drug before further processing to ensure their safety and efficacy for better approval at the international podium. This study revealed precise identification for the meticulous crude drug which will be valuable in detection and manage to adulterations of the raw material.
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Pathophysiology of the risk factors associated with osteoporosis and their correlation to the T-score value in patients with osteopenia and osteoporosis in the United Arab Emirates p. 364
Nihal A Ibrahim, Nessrin Nabil, Sana Ghaleb
DOI:10.4103/jpbs.JPBS_4_19  
Introduction: Osteoporosis is a growing major health problem with medical, social, and economic burden. The pathogenesis of osteoporosis involves excessive bone resorption by osteoclasts and decreased new bone formation by osteoblasts. Early diagnosis is the key to minimize the impact of osteoporosis on patients. Dual-energy X-ray absorptiometry at the hip or spine is the main standard test for measuring bone mineral density, and according to the World Health Organization, the T-score value of –2.5 or less determines osteoporosis. Aim: In this work, we aimed to study the risk factors associated with osteoporosis among a population sample of osteoporotic and controls in the United Arab Emirates (UAE) and relate them to the T-score value. Material and Methods: Two hundred male and female participants were recruited in the study. A questionnaire was used and data were correlated with the T-score value of the participants. Results: Results showed a positive correlation between the T-score value of the patients with osteoporosis and their calcium intake, exercise duration, and the age at menopause of female patients, whereas a negative correlation was evident between the T-score value and both caffeine and nicotine consumption. Results also revealed that patients with osteoporosis have significantly low body mass index, low calcium intake, and shorter duration of exposure to the sun than the control group. Conclusion: In conclusion, more intervention should be directed toward changing the modifiable risk factors in patients with osteoporosis and more studies should be directed toward osteoporosis in the UAE.
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SHORT COMMUNICATION Top

Isolation and characterization of four terpenoidal compounds with potential antimicrobial activity from Tarconanthus camphorantus L. (Asteraceae) p. 373
Wadah Osman, Mohammad Ibrahim, Mohammed Adam, Ramzi Mothana, Mona Mohammed, Iman Abdoon, Omer Basudan, Elrashied Garelnab, Hayat Mohamed, Bashier Osman, Sayeed Ahmad
DOI:10.4103/jpbs.JPBS_249_18  
Objectives: The objective of this study is to describe the isolation, characterization, and antimicrobial activity of isolated compounds from Tarconanthus camphorantus.Materials and Methods: Bioactive compounds such as trifloculoside, parthenolide (sesquiterpene lactones), lupeol, and erythrodiol (pentacyclic triterpens) were isolated from n-hexane extract of T. camphoratus, and their antimicrobial activity against Candida albicans, Escherichia coli, Psuedomonas aeruginosa, Bacillus subtilis, Staphylococcus aureus, and Mycobacterium smegmatis was evaluated. The compounds were characterized using chromatographic and spectroscopic techniques. Results: Trifloculoside, lupeol, and erythrodiol are being reported for the first time from T. camphoratus. The isolated compounds sesquiterpens and lupeol exhibited prodigious antimicrobial activity against B. subtilis and S. aureus with minimum inhibitory concentration values in the range of 25–1000 µg/mL but no activity was observed against other tested organisms, and erythrodiol showed no antimicrobial activity against any of the tested organisms. Conclusion: The findings of this study revealed that the new compounds trifloculoside, parthenolide, and lupeol isolated from T. camphoratus exhibited effective antimicrobial potential. It was inferred that T. camphoratus can be effectively used in traditional medicine.
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