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   Table of Contents - Current issue
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October-December 2020
Volume 12 | Issue 4
Page Nos. 369-507

Online since Thursday, October 8, 2020

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REVIEW ARTICLES  

A narrative review of antimicrobial stewardship interventions within in-patient settings and resultant patient outcomes p. 369
Ovais Ullah Shirazi, Norny Syafinaz Ab Rahman, Che Suraya Zin
DOI:10.4103/JPBS.JPBS_311_19  
The overuse of antibiotics has led to various healthcare problems such as the emergence of resistance in infectious microbes and mortality due to antibiotic resistant healthcare associated infections (HAIs). An antimicrobial stewardship (AMS) program is the set of interventions used worldwide to enhance the rational use of antibiotics especially for the hospitalized patients. This review aimed to describe the characteristics of the implemented AMS programs in various hospitals of the world mainly focusing on the interventions and patients outcomes. The literature about AMS program was searched through various databases such as PubMed, Google Scholar, Science Direct, Cochran Library, Ovid (Medline), Web of Science and Scopus. In this review the literature pertaining to the AMS programs for hospitalized patients is sorted on the basis of various interventions that are categorized as formulary restriction (pre-authorization), guideline development, clinical pathway development, educative interventions and prospective audit. Moreover a clear emphasis is laid on the patient outcomes obtained as a result of these interventions namely the infection control, drop in readmission rate, mortality control, resistance control and the control of an overall cost of antibiotic treatment obtained mainly by curbing the overuse of antibiotics within the hospital wards. AMS program is an efficient strategy of pharmacovigilance to rationalize the antimicrobial practice for hospitalized patients as it prevents the misuse of antibiotics, which ultimately retards the health threatening effects of various antibiotics.
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Eplerenone: The multifaceted drug in cardiovascular pharmacology p. 381
Akshyaya Pradhan, Shaweta Vohra, Rishi Sethi
DOI:10.4103/JPBS.JPBS_338_19  
Conventionally, rennin–angiotensin–aldosterone system (RAAS) inhibition has focused on angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers and angiotensin receptor-neprilysin inhibitors (ARNI) are the latest addition to this armamentarium. However, mineralocorticoid receptor antagonists (MRAs) also constitute an integral part of this anti-RAAS brigade, which are perceived more often as diuretics and are often under prescribed in heart failure (HF) despite being universally advocated by all major guidelines. Apart from HF, they have also shown promise in the management of hypertension, post-myocardial infarction, and hyperaldosteronism. Eplerenone, Food and Drug Administration (FDA) approved in 2002, is an acceptable alternative to spironolactone due to its sparing androgenic effects. In two big pivotal trials in heart failure (EMPHASIS -HF) and post-myocardial infarction (EPHESUS), the drug has firmly shown a reduction in adverse cardiovascular events. It has an established place in the management of resistant hypertension too. In this article, we will discuss the role of RAAS and its pathophysiology, pitfalls of spironolactone, which led to success of its congener, eplerenone, major studies conducted on eplerenone, current role of eplerenone, and comparison of the two MRAs.
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ORIGINAL ARTICLES Top

Potential confounders and a modified Framingham risk score for the prediction of pregnancy-related medical conditions occurrence among pregnant women: A retrospective study from Baghdad, Iraq p. 391
Anmar AL-TAIE, Nadia H Mohammed, Zahraa Albasry
DOI:10.4103/JPBS.JPBS_109_19  
Background: The incidence of pregnancy-related medical conditions relied on a set of potential factors that could be available even before the term of pregnancy and may be associated with poor outcomes later in life. This study aimed to investigate the association between some potential predictive factors related to maternal, gestational, and clinical parameters and the incidence of pregnancy-related medical conditions in a sample of Iraqi pregnant women. Materials and Methods: A retrospective, observational, single-center study was carried out on 92 pregnant women during their routine visit to the obstetric clinic in a certain distinct of Baghdad province, Iraq. Demographic, gestational, and clinical records of the participants were collected and analyzed to detect the predictive factors for pregnancy-related medical conditions. Results: 56.5% of the participants were at a gestational age of 25–37 weeks. 32.6% complained of pregnancy-related medical conditions, mainly gestational hypertension and diabetes mellitus. Pregnant women with pregnancy-related medical conditions were significantly correlated with a family history (P < 0.0001), previous gestational medical conditions (P < 0.001), diastolic blood pressure (P = 0.0011), different lipid panels (P = 0.0001), and maternal blood phenotype O (P = 0.0001). Conclusion: Some predictive factors related to maternal, gestational, and health characteristics are correlated with the incidence of pregnancy-related medical conditions. Interventions to adjust and recognize these confounders are essentials even before pregnancy which could improve maternal health and reduce the overall risk of pregnancy-related medical conditions.
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Relationship between stages of change and glycemic control in patients with type 2 diabetes mellitus in a primary health-care setting p. 400
Yara Arafat, Mohamed Izham Mohamed Ibrahim, Ahmed Awaisu, Yaw Owusu
DOI:10.4103/JPBS.JPBS_156_20  
Introduction: Advanced stages of change (SOC) are usually associated with lower glycated hemoglobin (HbA1c) scores in patients with type 2 diabetes mellitus (T2DM). Additionally, these patients’ adherence to antidiabetic medications is crucial to achieve controlled HbA1c scores. The purpose of this study was to determine the relationship between SOC and HbA1c as well as between medication adherence and HbA1c in patients with T2DM in a primary health-care setting in Qatar. Materials and Methods: A cross-sectional observational study was conducted in patients with T2DM at the noncommunicable diseases clinics at Mesaimeer Healthcare Center and West Bay Health Care Center. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8), whereas a two-item SOC questionnaire was used to measure the SOC. HbA1c values were obtained from the electronic database at the clinic. Spearman rank correlations were performed, with the significance level set at α < 0.05. Results: A total of 387 patients were included in the analysis. More than 75% of them reported that they were in the maintenance stage, and 35.4% of them had a controlled diabetes status. There was no significant correlation between SOC and HbA1c or between medication adherence and HbA1c. Conclusions: There was no relationship between SOC and HbA1c or between medication adherence and HbA1c in patients with T2DM, indicating that in this study, self-reported measures are not associated with the HbA1c scores of patients.
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Development and validation of doxorubicin hydrochloride and doxorubicinol quantification method in dried blood spot by liquid chromatography–tandem mass spectrometry p. 406
Yahdiana Harahap, Herman Suryadi, Aldhi Anarta
DOI:10.4103/JPBS.JPBS_167_20  
Dried blood spot as biosampling method offers a less invasive and easier procedure. This study aimed to develop the validated analytical method of doxorubicin hydrochloride and doxorubicinol simultaneously in dried blood spot with hexamethylphosphoramide as the internal standard. A total of 30 μL blood was spotted on DBS paper and dried for 3 hours before it was extracted by protein precipitation method using water and methanol. The separation was performed on column Acquity UHPLC BEH C-18 (2.1 × 100 mm; 1.7 μm), with 0.15 mL/min flow rate and using 0.1% acetic acid and acetonitrile as mobile phase in gradient elution for 7 min. Quantification analysis was performed by a triple quadrupole mass spectrometry with electrospray ionization (ESI) in positive ion mode. The multiple reaction monitoring (MRM) was set at m/z 544.22 > 397.06 for doxorubicin hydrochloride; m/z 546.22 > 361.05 for doxorubicinol; and m/z 180.03 > 135.16 for hexamethylphosphoramide. The lower limit of quantitation was 10 ng/mL for doxorubicin and 4 ng/mL for doxorubicinol. Concentration range acquired was 10–200 ng/mL for doxorubicin and 4–100 ng/mL for doxorubicinol. The precision and accuracy were within acceptable criteria of <15%. Dried blood spot samples acquired was stable for at least 30 days before analysis. This method fulfilled the validation requirement refers to Bioanalytical Method Validation Guideline of European Medicines Agency 2011 and US Food and Drug Administration 2018.
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The impact of a pharmacist-led warfarin educational video in a Saudi setting p. 413
Sireen Abdul Rahim Shilbayeh
DOI:10.4103/JPBS.JPBS_188_20  
Context: Internationally, various warfarin education strategies have been described in the medical literature and delivered by a variety of health-care providers. However, none of these were tested in a Saudi setting. Aim: The aim of this study was to assess the impact of pharmacist interventions via an educational video on improving patient knowledge of and satisfaction with warfarin therapy and the international normalized ratio (INR). Setting and Design: This study adopted a prospective pre- and posttest design and enrolled 91 patients from an anticoagulant clinic at King Khaled University Hospital in Riyadh, Saudi Arabia, between September 2017 and February 2018. Materials and Methods: All patients completed the Anticoagulation Knowledge Assessment (AKA) and Anti-Clot Treatment Satisfaction (ACTS) scales. Subsequently, the patients watched a 10-min educational video containing basic information regarding warfarin and were given relevant informative booklets. The patients were reassessed after a mean follow-up period of approximately 52 days. Results: In total, 85 patients completed the study. The impact of the intervention on patient knowledge was highly significant (mean difference = 17.7%, 95% confidence interval (CI) = 21.75–13.58, P < 0.000). In addition, the patients showed significant increases in their ACTS benefits subscale scores (mean difference = 0.73, 95% CI = 1.22–0.24, P = 0.004). Despite being long-term warfarin users, the patients’ INRs had a greater tendency to be within the target range after the intervention (56.63% ± 35% vs. 64.72% ± 35% of the time; mean difference, 8.1 percentage points; effect size = 0.23). However, there was no significant effect on patients’ perceptions of the warfarin burden. Conclusion: This study provided evidence that a pharmacist-led audiovisual intervention via an educational video coupled with an informational booklet effectively improved patients’ knowledge retention and satisfaction with warfarin therapy benefits. Longer studies are needed to determine the impact of this intervention on patients’ perceptions of warfarin burdens and their INRs.
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Drug prescribing patterns in pediatric urinary tract infections: A retrospective drug utilization analysis in an urban tertiary care hospital p. 423
Srinidhi Govindarajan, Preethi J Shenoy
DOI:10.4103/JPBS.JPBS_235_19  
Introduction: A constant update of antibiotic sensitivity of pathogens of the area, country, or institution helps in interventions that would improve the prescribing pattern and rational use of drugs in children. This study aimed to assess prescribing trends for urinary tract infection (UTI), a common distressful pediatric infection in a tertiary care teaching hospital. Materials and Methods: This study was a descriptive, retrospective, cross-sectional, and record-based analysis including pediatric patients aged <18 years of either gender diagnosed with UTI. The case record files retrieved from medical records department based on the International Classification of Diseases, 10th Revision (ICD-10) disease coding were analyzed for demographics, and details of drugs including dose and route of administration, frequency, and duration of treatment with antimicrobial used and other concurrent drugs were recorded. Results: Of 42 patients included in the study, 14 (33.3%) were males and 28 (66.67%) were females. Third-generation cephalosporins were the most commonly used antibiotics (71.4%) followed by aminoglycosides (35.7%), amoxicillin clavulanate (11.9%), fluoroquinolones (7.1%), and miscellaneous (doxycycline, metronidazole, and nitrofurantoin) (9.5%). Ceftriaxone among the cephalosporins and amikacin among the aminoglycosides were the most commonly used drugs. Intravenous route was the most commonly used route of administration followed by patients who received by both intravenous and oral routes. The average duration of therapy was 4.43 ± 1.9 days. Conclusion: This study concludes that third-generation cephalosporin is used as first-line drugs irrespective of the causative agent for UTI which should ideally be reserved for complicated UTIs. Moreover, existing guidelines also indicate that the duration of antimicrobial therapy should be seven to 14 days. These results highlight the necessity for a remedial education program within the health care system designed to improve pharmacotherapy of UTI.
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Development and validation of a questionnaire on knowledge, attitude, and perception towards allergic reactions of paracetamol p. 428
Nur Amalina Dellemin, Zalina Zahari, Mohamed Azmi Ahmad Hassali, Shaharuddin Abdul Rashid
DOI:10.4103/JPBS.JPBS_247_19  
Introduction: National Pharmaceutical Regulatory Agency, Ministry of Health Malaysia has received 1018 adverse drug reaction reports related to paracetamol with 1972 adverse events from the year 2000 to February 2015. Serious skin reactions including Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis, and acute generalized exanthematous pustulosis may develop as a result of allergic reactions of paracetamol. This study aimed to develop and validate a questionnaire regarding Knowledge, Attitude, and Perception towards Allergic Reactions of Paracetamol (KAP-ARP) among the general population. Materials and Methods: Content and face validity of the KAP-ARP were determined by four experts and 20 respondents, respectively. A questionnaire with 36 items, consisting of 16 Knowledge, 9 Attitude, and 11 Perception items, was distributed to 177 respondents. Exploratory factor analysis (EFA) was performed for construct validity. Cronbach’s alpha was used to determine the reliability of the questionnaire. Results: EFA constructed 13 Knowledge, 8 Attitude, and 8 Perception items. The final KAP-ARP questionnaire is reliable based on its internal consistency reliability (Knowledge: α = 0.78; Attitude: α = 0.63; Perception: α = 0.70). Conclusion: A valid and reliable questionnaire that is useful for measuring KAP-ARP among the general population has been developed.
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Knowledge of the use of herbal medicines among community pharmacists and reporting their adverse drug reactions p. 436
Mehak Tahir, Dinesh Kumar Upadhyay, Muhammad Zahid Iqbal, Sawri Rajan, Muhammad Shahid Iqbal, Ahmed A Albassam
DOI:10.4103/JPBS.JPBS_263_20  
Introduction: Community pharmacist’s knowledge about the uses of herbal medicines and its adverse drug reactions reporting can contribute in better therapeutic outcomes and patient safety. Objectives: To evaluate community pharmacists’ knowledge about the use of herbal medicines and its adverse drug reactions reporting in Kedah state, Malaysia. Methods: A cross-sectional, questionnaire-based study was conducted among 103 pharmacists from 74 different community pharmacies to assess their knowledge about the use of herbal medicines and its adverse drug reaction reporting by using a pre-validate knowledge questionnaire consisting of 12 questions related to it. The pharmacists’ responses were measured at a 3-point Likert scale (Poor=1, Moderate=2, and Good=3) and data was entered in SPSS version 22. The minimum and maximum possible scores for knowledge questionnaires were 12 and 36 respectively. Quantitative data was analyzed by using One Way ANOVA and Paired t-test whereas Chi-square and Fisher exact test were used for qualitative data analysis. A p-value of less than 0.05 was considered statistically significant for all the analyses. Results: About 92% of the pharmacist had good knowledge regarding the use of herbal medicines and its adverse drug reaction reporting with a mean knowledge score of 32.88±3.16. One-way ANOVA determined a significant difference of employment setting (p<0.043) and years of experience (<0.008) with mean knowledge scores of Pharmacists. Pharmacists’ knowledge was significantly associated with their years of experience with the Chi-square test. Conclusion: Pharmacists exhibit good knowledge regarding the use of herbal medicines and its adverse drug reaction reporting. However, with an increasing trend of herbal medicine use and its adverse drug reaction reporting it recalls the empowerment of experienced pharmacists with training programs in this area for better clinical outcomes.
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Translation of the Revised Dyadic Adjustment Scale (RDAS) into the Malay language and its psychometric qualities among healthy married Malay women p. 444
Nurhazwani Hamid, Rosediani Muhamad, Yee Cheng Kueh, Zalina Zahari, Nurhayati Mohamad Nor, Nurzulaikha Abdullah, Mung Seong Wong, Siti Aishah Meor Zul Keflií Auni, Zheng Feei Ma, Yeong Yeh Lee
DOI:10.4103/JPBS.JPBS_265_19  
Background: In Malaysia, the problem of marital distress is fast becoming an important public health concern. A major shortcoming is inadequate marital evaluation. There are, however, very few localized instruments for married women in Malaysia. The objective of this study was to translate the original version of the Revised Dyadic Adjustment Scale (RDAS) and to evaluate for its psychometric properties. Multiple aspects of validity and reliability were also assessed. Materials and Methods: The questionnaire was first translated into the Malay language (RDAS-M). In this cross-sectional study, healthy married Malay women in Kota Bharu, Kelantan, were recruited from January to April 2018. Participants were asked to complete the RDAS-M that consists of three domains, that is, dyadic consensus, dyadic satisfaction, and dyadic cohesion with a total of 14 items. The concept, content, and construct validity using exploratory factor analysis (EFA) and reliability of the RDAS-M were assessed. Results: Of the 164 recruited participants, 150 consented to participate. The mean age of the participants was 34.1 years (standard deviation [SD], 9.5 years), ranging from 20 to 57 years. All 14 items were considered comprehensible by more than 95% of the subjects. Based on EFA, total variance extracted was 69.08%, and the original three factors were retained. The Malay version of the RDAS was valid based on factor loadings for dyadic consensus, dyadic satisfaction, and dyadic cohesion, which ranged from 0.64 to 0.80, 0.79 to 0.98, and 0.37 to 0.78, respectively. The internal consistency was good with coefficient α of 0.87 for dyadic consensus, 0.93 for dyadic satisfaction, and 0.78 for dyadic cohesion. Conclusions: The Malay version of the RDAS is easy to understand, and is a reliable and valid instrument for married women. It is also comparable with the original version of the RDAS in terms of structure and psychometric properties.
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Bacteria causing urinary tract infections and its antibiotic susceptibility pattern at tertiary hospital in Al-Baha region, Saudi Arabia: A retrospective study p. 449
Mohammed Abdullah Alzahrani, Mohamed Salah Ali, Sirajudheen Anwar
DOI:10.4103/JPBS.JPBS_294_19  
Context: Clinicians face one of the most common bacterial infections in developing countries that is urinary tract infection (UTI). Current knowledge on antimicrobial susceptibility pattern is essential for selecting appropriate therapy. Aims: In this study, we investigated the various bacteria causing UTI and determined the sensitivity and resistance of antibiotics pattern against most prevalent uropathogens isolated from patients at tertiary hospital, Al-Baha, Saudi Arabia. Settings and Design: This was a retrospective study of urine culture conducted in King Fahad Hospital at Al-Baha in Saudi Arabia. Materials and Methods: Laboratory reports and patient medical files of both inpatient and outpatient were collected between June 2017 and May 2018, targeting both male and female of age above 18 years of age, who had been treated for UTI. Results: A total of 349 patients’ urine report was studied to identify the uropathogens. Escherichia coli was the main etiologic agent in community and hospital-acquired infections. The majority of the bacteria was isolated from female (60%), whereas the remaining (40%) was from male. The most common isolates were E. coli, Klebsiella pneumoniae, Enterococcus faecalis, E. coli Extended spectrum beta-lactamases, Pseudomonas, and K. pneumoniae ESBL (these represented 37.82%, 19.20%, 10.89%, 10.32%, 6.59%, and 3.72%, of isolate, respectively). UTI due to E. coli was at a higher rate during summer than during winter. This study showed that ciprofloxacin (20.29%) and cefuroxime (16.14%) are most prescribed medications, followed by ceftriaxone (12.96%) and then tazocin (8.80%). Imipenem, meropenem, amikacin, vancomycin, tigecycline, linezolid, and colistin were highly sensitive for most types of bacteria, but gram-negative bacteria were highly resistant to ampicillin. Gram-positive bacteria showed highly resistance to cefoxitin. Conclusion: The microbial culture and sensitivity of the isolates from urine samples should be carried out as a routine before starting the antimicrobial therapy. Current knowledge of the antibiotic sensitivity/resistance patterns of uropathogens at a particular geographical region is a guiding factor for choosing an appropriate empirical antimicrobial treatment rather than following universal guidelines.
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Effects of pegagan (Centella asiatica L.) ethanolic extract SNEDDS (self-nanoemulsifying drug delivery systems) on the development of zebrafish (Danio rerio) Embryos p. 457
Farida Hayati, Lutfi Chabib, Silmi Fauzi IT, Rizki Awaluddin, Sumayya , Wan Syarifah Faizah, Moh Hamzah Mohd Nasir, TS Nipun
DOI:10.4103/JPBS.JPBS_297_19  
Introduction: Pegagan is a traditional medicinal plant with three major bioactive properties, triterpenoid, steroids, and saponin. It has the properties of antioxidant, antistress, and wound healing. Pegagan extract is prepared in self-nanoemulsifying drug delivery systems (SNEDDS) to overcome the problem of low water-solubility level. Objectives: This study aimed to observe the effect of pegagan ethanolic extract SNEDDS on the development of zebrafish embryos. Materials and Methods: This study used 12 sets of zebrafish embryos presented in five sets of extract SNEDDS with different concentrations, that is, 20, 10, 5, 2.5, and 1.25 μg, five sets of SNEDDS without extract with different concentrations, that is, 20, 10, 5, 2.5, and 1.25 μg, a set of positive control (3.4-DCA 4 mg/L) with one control set (diluted with water), and a negative control (SNEDDS without extract). The procedure was conducted for 96 h with observations every 24 h. The parameters observed were embryonic coagulation, formation of somites, detachment of tail bud from the yolk, and abnormality of embryoResults: The results showed that in 96 h the 20ppm concentration caused 100% mortality. Embryo abnormality appeared as coagulation of embryo, somite malformation, and abnormal tail. Discussion: There is a correlation between the concentration of SNEDDS and the incidence of embryo coagulation. The malformation in the group of pegagan extract SNEDDS is characterized by cardiac edema, somite malformation, and abnormal tail. Conclusion: Pegagan ethanolic extract SNEDDS of 20ppm can inhibit the development of zebrafish embryos.
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Taxonomic characterizations of soil Streptomyces cavourensis DW102 and its activity against fungal pathogens p. 462
Gouse Basha Sheik, Aroob Abdullah Alhumaidy, Ali Ismail Ali Abdel Raheim, Zeyad Abdullah Alzeyadi, Mohammed Ibrahim AlGhonaim
DOI:10.4103/JPBS.JPBS_304_20  
Background: Streptomyces spp. are soil bacteria that have commercial value from which numerous secondary metabolites such as antifungal compounds have been derived. There is growing concern that antifungal resistance is on the rise, and soil Streptomyces from various geographical places might produce novel antifungal molecules. The aim of this study was to characterize and identify the actinomycetes strain namely Streptomyces isolate DW102, and to evaluate its antimicrobial activity against nosocomial fungal pathogens. Materials and Methods: Streptomyces isolate DW102 was identified based on morphological, cultural, physiological, and biochemical properties, together with 16S rRNA sequence. Its antifungal activity was determined by agar well-diffusion assays. Results: The isolate DW102 phenotypic and molecular characterization was identified as Streptomyces cavourensis DW102 and sequencing results were deposited in GenBank under accession number MK508855. Furthermore, the fermented broth of Streptomyces isolate DW102 inhibited the growth of Aspergillus niger and Candida albicans in vitro. Conclusions: Phenotypic, molecular, and phylogenetic analysis of DW102 identified the strain to be S. cavourensis. The antifungal assay showed that DW102 fermentation broth was active against both C. albicans and A. niger in vitro. Further studies are required to use the Streptomyces isolate DW102 as a promising source for the development of antifungal drugs.
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Association of visceral adiposity index, lipid profile, and serum leptin with glucose intolerance risks in Iraqi obese patients: A cross-sectional study p. 468
Wael Waleed Mustafa, Samer Shukur Moahammed, Wathiq Mohammed Al-Jewari, Hussein Saad Abdulrahman, Saad Abdulrahman Hussain
DOI:10.4103/JPBS.JPBS_324_19  
Aims: The aim of this study was to evaluate the possibility of using visceral adiposity index (VAI), serum leptin, and lipid profile as indicators of impaired glucose tolerance in Iraqi obese patients. Subjects and Methods: A cross-sectional study was performed in Iraqi obese patients of both sexes. Body mass index (BMI), waist circumference, hip circumference, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), VAI, waist-to-hip ratio (WHR), serum leptin, and 2-h glucose tolerance test (2-h GT) were determined and compared with those of healthy non-obese control group. A correlation analysis was performed to determine the strength of association between the studied markers. Data were adjusted to determine gender differences in this regard. Statistical Analysis: Kolmogorov–Smirnov, Shapiro–Wilk analyses, Mann–Whitney U test, and unpaired t test were used for the two-group comparisons once applicable. Pearson’s and Spearman’s correlation analyses were used to measure the relationship levels between the studied variables. Results: A total of 144 obese patients were included; the mean age was 37.11 ± 8.2 years and 92 (63.9%) were females. Compared with non-obese subjects, the participants had significantly higher levels of BMI, WC, WHR, VAI, TG, leptin, and 2-h GTObese male subjects had significantly higher values of body weight, WC, HC, VAI, and TG compared with obese females. Elevated 2-h GT was significantly associated with VAI (r = 0.291, P = 0.0004), TG (r = 0.319, P = 0.0001), and LDL-C/HDL-C ratio (r = 0.435, P < 0.0001) in the obese patients only. Conclusions: The results provide evidence that VAI, TG, and LDL-C/HDL-C ratio can be suggested as potential markers for the risk assessment of impaired glucose tolerance in Iraqi obese patients.
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Pharmaceuticals poisoning: Reported by the National Poison Centre in Malaysia between 2010 and 2015 p. 475
Iqdam Abdulmaged Alwan, Ammar Ihsan Awadh, Balamurugan Tangiisuran, Halilol Rahman Mohamed Khan, Noorfatimah Yahaya, Mohamed Isa Majid
DOI:10.4103/JPBS.JPBS_340_19  
Background and Purpose: The wide availability of medications has led to an increased exposure of humans to the possibility of poisoning. An unavoidable effect due to the availability of these medications has also led to a rising increment in the number of poisoning cases. All drugs, especially when administered in large doses or overextended periods, can initiate a toxic condition. Therefore, the objective of this study was to examine nationwide, the patterns attributed to poisoning, and to describe the sociodemographic, and geographic distribution of poisoning, by identifying the category of substances implicated in these cases. Data Sources and Methods: A retrospective study based on telephone calls reported on poisoning caused by pharmaceutical products undertaken by the National Poisoning Centre (NPC) in Penang (Malaysia) was used as the basis of this study covering the period between 2010 and 2015. The study included the mode and type of poisoning, exposure routes as well as the incidence locations. Results: A total of 10,998 cases were examined, finding that females represented 5,899 cases (53.6%) being intoxicated more frequently compared to the number of males, 3,839 (34.9%). The age group of poisoning cases ranged between 20 and 29 years representing 2,579 (23.4%) of reported cases. The common mode of poisoning was attributed to suicide 5,203 (47.3%) from among the 10,998 cases and the highest poisoning agents reported were from the psychiatric group of pharmaceutical products of 2,287 (21%). Conclusion and Implications: These findings indicate a rising trend of suicidal poisoning attempts between 2013 and 2015, which emphasizes the need for more stringent and effective enforcement protocols to limit the rising incidence of poisoning. As such, analyzing the trends in poisoning in a particular zone periodically could help health policy-makers to develop management policies and prevention strategies.
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Intentions of and barriers to carrying out medical research among clinical pharmacy students: A cross-sectional study in the eastern region of Saudi Arabia p. 482
Huda A Alqadi, Amal K AbuAlhommos
DOI:10.4103/JPBS.JPBS_341_19  
Aims: This study was aimed at exploring the intentions of clinical pharmacy students to be involved in clinical research, and to identify the perceived and existing barriers to conducting research activities in the Eastern region of Saudi Arabia. Settings and Design: This was a cross-sectional questionnaire survey. Materials and Methods: This study was conducted between February and March 2019, in the Eastern region of Saudi Arabia, using clinical pharmacy students at the two universities that offer a pharmacy program there (King Faisal University and Imam Abdulrahman bin Faisal University). An electronic questionnaire tool was adapted to explore the intentions of and barriers to carry out medical research among the students. Statistical Analysis: Descriptive statistics are presented as frequencies and percentages. A χ2 test was used to explore any statistically significant difference between the student demographics and the intentions and barriers regarding medical research. P ≤ 0.05 was considered statistically significant. Results: Only 35.1% (n = 33) of the participating clinical pharmacy students had previous research experience. Of these, the majority encountered barriers to medical research (81.8%, n = 27). The most commonly reported barriers were a lack of funding, a lack of support from the college for research activities, and difficulties in coordination between the research team. Around 36.2% (n = 34) of the participants were currently involved in research activities, with a majority of them (67.6%, n = 23) spending an average of 5 h or less per week for research. Conclusion: Our study highlights that the intention among clinical pharmacy students to carry out medical research was poor. Educational institutions are advised to provide more financial and logistic support to their medical researchers.
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Comparison between branded and generic furosemide 40 mg tablets using thermal gravimetric analysis and Fourier transform infrared spectroscopy Highly accessed article p. 489
Mosab Arafat, Khairi M Fahelelbom, Muhammad K Sarfraz, Mohammad F Bostanudin, Qurat-ul-Ain Sharif, Anna Esmaeil, Othman A AL Hanbali, Salahdein Aburuz
DOI:10.4103/JPBS.JPBS_365_19  
Background and Purpose: There has been a long-standing belief that generic drugs are of lower value in comparison to their branded name counterparts. They are in particular under scrutiny due to their low market price. Even though the reduction in costs is largely based on skipping expensive preclinical studies and clinical trials for generic drugs, the purity and quality of the raw materials in the production of generic drugs is debatable. Thus, the objective of the study was to analyze and assess the quality comparability of generic furosemide 40 mg (FSD) tablets to branded product available in the market. Materials and Methods: Quality control tests, in vitro drug release assessments, and thermal analysis investigations for both analog products of FSD were performed. Various physical parameters related to the tablet quality, such as hardness, weight variation, and friability tests, were examined. In vitro drug release behavior evaluations were conducted according to United States Pharmacopeia (USP) specifications and guidelines, whereas thermal analysis was carried out using thermal gravimetric analysis (TGA), and tablets were further evaluated by Fourier transform infrared (FTIR) spectroscopy. Results: The results indicated a significant variation between the two products in terms of hardness, weight variation, and friability. This could be correlated to variation appeared in thermal and spectroscopic spectra between the two products using TGA and FTIR. Drug release of FSD was slightly different between both products following incubation in different pH media (1.2, 3.0, and 6.5; 120 min), however, this was in accordance with USP dissolution requirements as < 80% of drug release was obtained within the first 30 min from each product. Conclusion: This study is a useful example for the independent investigations using thermal and spectroscopic analysis to confirm potential hidden variations between generic and branded products that could not be obtained by the bioequivalence studies.
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Adherence to antiepileptic drugs among patients attending the neuro spinal hospital in the united arab emirates p. 499
Enas S Abd Wahab, Muaed Al Omar, Moawia M A M Altabakha
DOI:10.4103/JPBS.JPBS_367_19  
Background: Adherence to antiepileptic drugs (AEDs) is an integral component of epilepsy management. There are no previous data in the United Arab Emirates (UAE). Objectives: The aim of this study was to assess the prevalence of AED adherence among patients attending the Neuro Spinal Hospital in UAE and to identify the predictors of nonadherence. Materials and Methods: A cross-sectional study was conducted between April 2018 and May 2019, and included consecutive patients with epileptic who were receiving AEDs for at least 6 months. A validated interviewer-administered questionnaire was used. Adherence was assessed by four-item Morisky’s Medication Adherence Scale with a score between 0 and 4. Patients were considered adherent or nonadherent for a score of zero, or 1 and more, respectively. Chi-square test, binary, and multiple logistic regression analysis were used. Results: The study included 315 respondents, 70.8% (n = 223) were adherent, the rest were nonadherent. The most common factor affecting adherence was forgetfulness. Lower education level and having a seizure within the last 6 months were significant risk of nonadherence (odds ratio [OR] 95% confidence interval [CI] = 2.6 (1.2–5.8) and 2.5 (1.3–5.2), respectively), whereas levetiracetam intake reduces the risk of nonadherence (OR: 0.5 [0.2–0.9]). Conclusions: The prevalence of AED adherence was 70.8%. Education level and having a seizure in the last 6 months were significant predictors of nonadherence, whereas levetiracetam intake reduces the risk of nonadherence.
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