Open Access Original Research Article

Health Care Provider Hormonal Recommendations for Treatment of Menstrual Cycle-related Problems - A Vignette-based Study

Rui Chen, Fatemeh Bejaei, Shan Yi, Tabassum Vali, Jerilynn C. Prior

Journal of Pharmaceutical Research International, Page 1-12
DOI: 10.9734/BJPR/2016/22046

Background: Combined hormonal contraceptives (CHC) are recommended for “non-contraceptive benefits” for menstrual cycle-related problems. But no evidence-based consensus exists. Our purpose was to assess the clinical choices of health care providers (HCP: pharmacists, physicians, nurses) for menstrual cycle-related scenarios.

Methods: A 1-page questionnaire was provided to continuing professional education attendees at events across Canada. They suggested treatments for four common clinical scenarios each involving a different menstrual cycle-related problem. Each case was followed by five to six choices. All potential options included CHC and cyclic progesterone (P4) or medroxyprogesterone (MPA); HCP could choose multiple options.

Results: CHC was recommended by 84% of HCP for at least one of four scenarios; 64% chose cyclic P4/MPA at least once. For teenage menorrhagia, 63% chose CHC, 23% cyclic P4/MPA and only 31% ibuprofen. For the 35 year-old smoker with polycystic ovary syndrome (PCOS), 55% discontinued CHC, but 22% suggested switching to higher-dose anti-androgen CHC; 23% chose cyclic MPA, 32% spironolactone and 14% metformin. For a premenopausal fragility fracture, 34% recommended CHC and only 5% cyclic MPA; 17% chose a contraindicated aminobisphosphonate. For perimenopausal VMS, 10% chose CHC, 34% cyclic P4, 21% cyclic MPA.

Conclusion: There are significant variations among HCP disciplines for treatment of menstrual cycle-related problems. Contraindications and disadvantages of CHC-based therapies in these scenarios seem to not be recognized by HCP. Evidences for progesterone-based therapies have not been translated into current clinical practice. Few HCP suggested evidence-based non-hormonal treatments. Efforts are needed to translate research-based, physiological menstrual cycle treatments into safe and effective clinical practice.

Open Access Original Research Article

Treatment Persistence Associated with Typical versus Atypical Antipsychotics among Out-patients with Schizophrenia

Increase Ibukun Adeosun

Journal of Pharmaceutical Research International, Page 1-8
DOI: 10.9734/BJPR/2016/23826

Aim: The chronic nature of schizophrenia usually demands uninterrupted treatment in order to maintain optimal clinical and functional outcomes. It has been speculated that patients receiving atypical antipsychotics may persist longer in treatment than those receiving typical antipsychotics because of the lower risk of inducing extra-pyramidal symptoms. This study aimed to compare treatment persistence among patients with schizophrenia receiving atypical versus typical antipsychotics after discharge from a psychiatric hospital in Lagos, south-west Nigeria.

Study Design and Methodology: A retrospective cohort study design. Clinical records of 162 patients with schizophrenia admitted to a public psychiatric hospital were extracted to determine their persistence with treatment over a period of one year after their discharge to out-patient clinic.  Treatment persistence (time to all cause treatment discontinuation) was determined using the Kaplan-Meier Survival analyses. The log rank test compared persistence in treatment between patients receiving atypical versus typical antipsychotic medications.

Results: Only 27.1% persisted in treatment for six months, while 19.1% persisted for one year. The mean time to all cause treatment discontinuation was 17.3 (±1.5) weeks (95% C.I= 14.4-20.3). The mean duration of treatment persistence for patients receiving typical antipsychotics was 16.7 (±2.7) weeks (95% C.I= 11.5-22.0), and 17.7 (±1.8) weeks (95% C.I= 14.2-21.2) for patients receiving atypical antipsychotics. There was no significant difference in treatment persistence between the two groups (p=0.762).  

Conclusion: There is a poor rate of persistence in treatment among patients with schizophrenia, regardless of the class of antipsychotics received. Considering the negative consequences of non-persistence in treatment including increased risk of relapse, re-hospitalisation and suicide, there is a dire need for interventions to facilitate treatment persistence in schizophrenia.

Open Access Original Research Article

Effects of High-concentratıon Oxygen Inhalation during Cesarean Section with Spinal Anesthesia on Lipid Peroxidation, Oxidant and Antioxidant Systems

E. Kaya, N. Kayacan, B. Karsli, H. Akbaş, F. Davran

Journal of Pharmaceutical Research International, Page 1-10
DOI: 10.9734/BJPR/2016/24129

Objective: The benefit of supplemental oxygen during elective Cesarean section under regional anesthesia is controversial.

Methodology: In this study, parturients were randomized two groups, to breathe either room air (air group, inspired oxygen fraction 21%) or oxygen at a flow rate of 6 L.min-1 (oxygen group, inspired oxygen fraction 40%) by nasal cannula. At delivery, a segment of umbilical cord was isolated using double clamps before the infant’s first breath and umblical vein blood samples were obtained. After then, 5th min of oxytocin infusion, a sample of maternal blood was obtained for analysis. The remainder of the sample was centrifuged at 4400 rpm for 4 min and the plasma was stored at -70°C for subsequent batch analysis for 8- isoprostane, TOS, TAC. Oxidation Stress Index (OSI) was assessed as the percentage ratio of TOS level to TAC level.

Results: There were significant differences in maternal oxygenation but not neonatal oxygenation in supplemental oxygen group. The parameters indicating lipid peroxidation (8-isoprostane concentration) and oxidative stress (TOS, TAC, OSI) in maternal and umblical blood  were higher in FiO2 supplementation group but this increase was not significant.

Conclusions: Although supplemental oxygen increased maternal oxygenation, fetal oxygenation did not changed. Breathing supplemental oxygen did not increased the parameters indicating lipid peroxidation and oxidative stress in maternal and umbilical cord blood in healthy women having elective cesarean section under spinal anesthesia.

Consequently, breathing supplemental oxygen does not have a significant effect on neonatal well-being and is unnecessary in healthy women undergoing elective Cesarean section under spinal anaesthesia.

Open Access Original Research Article

Thyrotoxic Evaluation and Lipid Peroxidation in Wistar Albino Rats Exposed to Vitellaria paradoxa Stem Bark

Taofeeq Oduola, Abdulahi A. Ngaski, Hussein Mahe, Abdurrasheed O. Muhammed, Moses O. Akiibinu, Ayooye S. Ajayi

Journal of Pharmaceutical Research International, Page 1-7
DOI: 10.9734/BJPR/2016/24257

Background: Vitellaria paradoxa stem bark is used by villagers because of its antimicrobial activity for treating skin diseases and wound infections in some parts of Nigeria without considering its safety.

Aim: The aim of the study was to determine the effect of ingestion of Vitellaria paradoxa stem bark on thyroid hormones and lipid peroxidation in Wistar albino rats.

Place and Duration of Study: The study was undertaken at the Department of Chemical Pathology, Faculty of Medical Laboratory Sciences, Usmanu Danfodiyo University, Sokoto.

Methods: The oral acute toxicity of the extract (LD50) was determined in 30 Wistar rats divided into 6 groups of 5 rats per group. Group 1 was the control and received normal saline. Different doses of 5, 50, 300, 2000, and 5000 mg/kg were administered once to the study groups (2, 3, 4, 5 and 6) respectively. A sub-chronic toxicity study was then carried out in 30 Wistar rats, divided into six groups of 5 rats per group. Group 1 served as control and was given normal saline and standard rat pellets. The remaining 5 groups  were administered different doses of 50, 100, 200, 300 and 400 mg/kg Vitellaria paradoxa stem bark extract daily respectively for 30 days. Thyroid function test (T3, T4 and TSH) was carried out by the use of enzyme linked immunosorbent assay (ELISA), malondialdehyde (MDA) and total antioxidant status (TAS) determined by spectrophotometric techniques.

Results: No mortality was recorded in the rats after 24 hours and up to 14 days post-oral treatment, an indication that LD50 of the extract is greater than 5000 mg/kg. In the sub-chronic toxicity study, T3, T4 and TSH values of animals that received higher doses were significantly decreased (p<0.05) than the control groups. MDA values were significantly lower (p<0.05) in treated animals than the control group but there was no significant difference (p>0.05) in the values of TAS.

Conclusion: T3 and T4 play important roles in metabolism, growth and development among others, consumption of Vitellaria paradoxa may have harmful effect in the long term users. Hence, T3 and T4 should be monitored in Vitellaria paradoxa consumers so as to prevent induction of hypothyroidism. However, it may still be of clinical benefit in the treatment of hyperthyroidism. Consumers may not develop oxidative stress induced diseases because of reduced values of MDA in the treated animals.

Open Access Original Research Article

Adsorption – Desorption and Theoretical Study of Propranolol Hydrochloride Drug on Chitosan and Cellulose Acetate Surfaces

Duaa J. Ali, Reem A. Al-Bayati, Ramzie R. Alani

Journal of Pharmaceutical Research International, Page 1-8
DOI: 10.9734/BJPR/2016/24083

The research is concerned with the study of adsorption of propranolol hydrochloride drug on the surface of chitosan and cellulose acetate polymers.

Adsorption isotherms of propranolol hydrochloride on the two surfaces used from aqueous solution were specified. These adsorption isotherms were seen to be in agreement with Freundlish adsorption isotherm. Temperature, pH, and ionic strength parameters were studied which affected the adsorption process of the drug and desorption of the drug from the surface was studied to determine the efficiency of the surfaces as drug carrier. Chitosan and cellulose acetate were used as a model adsorbent in the experiments. Hyperchem 8.08 program was conducted using semiempirical (PM3, AM1) method to compare between experimental and theoretical results, both results were pointed to cellulose acetate as better absorbent for the drug.

Open Access Original Research Article

Effect of Chelidonium majus on Metabolic Abnormalities Induced by HAART in Mice

A. L. P. P. Soares, N. A. Steiner, R. P. Regla, M. Spack Jr, A. R. T. Pupulin

Journal of Pharmaceutical Research International, Page 1-8
DOI: 10.9734/BJPR/2016/24445

Aims: Extracts of Chelidonium majus, extensively used in traditional systems of medicine, have been tested for their possible anti-tumor, hepato-protective and anti-genotoxic effects, to investigate their potential in cancer therapy. Although the highly active antiretroviral therapy (HAART) has changed the natural history of HIV infection, several adverse events may limit its efficacy. Antiretroviral drugs are associated with increased risk of severe hepatotoxicity. These complications increase morbidity and mortality significantly. Current study evaluated the effect of Chelidonium majus on metabolic alterations induced in mice subjected to HAART.

Methodology: Four-weeks old male Swiss Webster mice, weighing approximately 28-30 g, provided by the Central Animal Laboratory of the State University of Maringá, were used in the experiments. The drug in the form of mother tincture was prepared with the juice of the root of C. majus, mixed in equal parts of grain alcohol (P.A.) and comprised 12 animals per experimental group: (I) animals treated with HAART diluted in 1.2 mL water gavage/day, (II) animals treated with HAART diluted in 1.2 mL water gavage/day + C. majus diluted 1x1012 in water 1.0 mL, daily added once to the drinking water (1:10 mL) available ad libitum, (III) non-treated animals (control group) received 1.2 mL water by gavage/day. The experimental groups were treated for 15 days. Overall clinical evaluation was performed and serum cholesterol, triglycerides, hepatic enzymes (AST and ALT) were assessed by specific methods. Results were analyzed with GraphPad Prism by Student´s t test.

Results: Results demonstrate lower weight gain, 30% less (p=0.004) in the group treated with HAART, whereas the group treated with HAART and C. majus had the same weight gain of control group. The evaluation of metabolic parameters showed a significant difference on levels of plasma triglycerides in animals treated with HAART + C. majus (19.6% less). ALT parameter was 23.7% lower in patients treated with C. majus when compared to group treated only with HAART. AST decreased by 65.2% in the group treated with C. majus, with the same levels of control.

Conclusion: C. majus, diluted 1x1012, improved metabolic changes induced by HAART in mice.

Open Access Original Research Article

Studies on the Removal of Amoxicillin by Single Walled Carbon Nanotubes

Davoud Balarak, Yousef Mahdavi, Afshin Maleki, Hiua Daraei, Shahram Sadeghi

Journal of Pharmaceutical Research International, Page 1-9
DOI: 10.9734/BJPR/2016/24150

The research was conducted to determine effectiveness of CNTs as sorbents for removal of AMO from aqueous solution and to analyze the impact of various parameters including adsorbent dosage, initial Amoxicillin concentration, contact time and temperature on the adsorption capacity of CNTs. The percentage of AMO removal decreased with increase in initial concentration. Adsorption equilibrium of AMO removal was observed after 45 min of contact time. Maximum AMO removal efficiency was obtained to be 99.1% and best results were achieved in contact time of 45 min, adsorbent dosage of 0.3 g/l, initial AMO concentration of 200 mg/l and temperature equal with 323 K. Equilibrium data were fitted to Langmuir and Freundlich isotherms, and their constants were determined. Using the linear correlation coefficients showed that the Langmuir isotherm best fits the AMO adsorption data on SWCNTs. The experimental data were fitted into the following kinetic models: pseudo-first-order, pseudo-second-order, and the intraparticle diffusion model. It was observed that the pseudo-second-order kinetic model described the adsorption process better than any other kinetic models. All results found concluded that SWCNTs could be effectively employed as an effective new adsorbent for the removal of Antibiotics from aqueous solutions.