Open Access Case Study

General Anaesthesia for Cesarean Section in a Parturient with Long QT Syndrome: A Case Report and a Review of Literature

Nurten Kayacan, Bilge Karsli, Ulku Karatas Ince

Journal of Pharmaceutical Research International, Page 1-7
DOI: 10.9734/BJPR/2017/31699

Long QT syndrome patients are at high risk of developing ventricular arrhythmia and cardiac arrest, so that the anesthetic technique used for these patients must avoid anything that will induce an arrhythmia such as tachycardia, hypotension or increased catecholamine release by pain or stress.

A 28 -yr-old  woman was scheduled for an elective, repeat cesarean section at 36 weeks gestation. She was diagnosed  long QT syndrome at age 22 and an automatic implantable cardiac defibrillator (AICD) was implanted. During her pregnancy, parturient was hospitalized at 35 weeks gestation  because of fetal bradycardia and obstetrician scheduled cesarean section at 36 weeks gestation. Before induction of anaesthesia, esmolol was started for prevention of ventricular dysrhythmia during laryngoscopy and tracheal intubation. After preoxygenation, anaesthesia was induced with fentanyl 100mcg,  propofol 200mg, rocuronium 100mg and trachea was intubated at 45th seconds. Esmolol infusion rate was reduced gradually to parturient’s haemodynamic parameters during surgery and was stopped at end of the surgery. At 4th minutes of the surgery, fetus was deliveried but there is no heart rate and breathing of baby. Following cardiac compression for 45 seconds, heart rate and breathing of baby returned. Anaesthesia was maintained with 1 MAC sevoflurane and 100 mcg fentanyl. Parturient’s blood pressure and heart rate remained within normal limits during surgery.

Consequently, if parturient does not accept regional anaesthesia, in case of an emergency cesarean section, general anaesthesia can be safely used with optimized preoperative evaluation, close monitoring and carefully anaesthetic management.

Open Access Original Research Article

Evaluation of Effect of Insurance Coverage on Sale Volume and Price of Entered Drugs in Insurance List in 2012 in Iran

Mohammadreza Amirsadri, Farimah Rahimi, Seyyed Hesamoddin Sharifnia, Niloofar Zehtab

Journal of Pharmaceutical Research International, Page 1-6
DOI: 10.9734/BJPR/2017/31882

Background: Drug industry is considered as the second profitable industry in the world and plays an important role in global economy. The sharp annual growth in drug expenditures imposes heavy loads on the health insurance organizations as a major part of these costs are covered by these companies. Covering a drug by health insurance companies not only reduces the out of pocket costs of patients, but also increases probability of prescribing the covered drug by physicians. Consequently this generally ends to an increase in pharmaceutical sales volume. This enables the health insurance companies to negotiate a lower price with pharmaceutical companies.

Methods: In this study, the effect of insurance coverage of a list of drugs in Iran on increase of their sale volume as well as the reduction in their price has been evaluated. The SPSS software used to assess the trend of numerical, monetary sales and price of the insured drugs compared to non-insured medicines in a cross-sectional study. Paired tests (Student t test and Wilcoxon test) with a significance level of 0.05<P were used to analyze data in the current study.

Results: The achieved results showed that although the sale volume of the  insured drugs were increased during the investigated period, this was the same for non-insured drugs as well, However, the prices of investigated insured drugs  were reduced following covering by insurance companies while this was not the case for non-insured drugs.

Conclusion: The results of this research can be used by policy-makers to have a better understanding of drug policies in Iran and by insurance organizations in order to evaluate consequences of adding drugs to their coverage list.

Open Access Original Research Article

Patient Controlled-epidural Analgesia with or without a Background Infusion for Labour Analgesia

Figen Önder, Nurten Kayacan, Bilge Karsli, Zekiye Bigat

Journal of Pharmaceutical Research International, Page 1-8
DOI: 10.9734/BJPR/2017/31717

The popularity of Patient-Controlled Epidural Analgesia (PCEA) has increased in the treatment of labour pain.

50 ASA I primaparous or multiparous parturients who had requested epidural analgesia were enrolled in this prospective study. Group I (demand-only PCEA) received a PCEA regimen without background infusion, 6-mL demand bolus, 10-min lockout interval, Group II (PCEA-CBI) received a similar PCEA regimen with continuous background infusion of 6 mL/h. The epidural solution consisted of 0.1% levobupivacaine with fentanyl 2 microg/mL. Primary outcomes investigated were  efficacy of epidural analgesia using VAPS and the number of PCEA demand, the number of delivered PCEA boluses and total consumption of local anaesthetic and patient’s satisfaction.

Baseline VAPS scores of the patients were similar.  At no time throughout labour there was a significant difference in the mean VAPS scores between groups. VAPS scores decreased significantly within first 15 min. following epidural analgesia and all parturients had low pain scores (VAPS<3) during the overall  study period. The number of PCEA demand and the number of PCEA delivery dose were higher in demand-only PCEA group. All of this differences were not significant statistically. However, the mean total amount of local anesthetic  and opioid solution administered during the overall study period was less in parturients receiving demand-only PCEA group but there was no statistical difference. Maternal satisfaction values were high and similar between study groups.

PCEA plus CBI is not essential to achieve a good analgesia for labour and delivery. The use of demand-only PCEA with 6mL bolus and 10 minutes can relief of labour pain and improve the comfort of parturients and their satisfaction during labour with less drug consumption.

Open Access Original Research Article

In vitro Evaluation of Antidiabetic and Anti-Inflammatory Activity of Ethanolic and Methanolic Extracts of Ceropegia juncea

M. Saraswathy, K. Kalimuthu, V. Chinnadurai, Y. Sharmila Juliet

Journal of Pharmaceutical Research International, Page 1-9
DOI: 10.9734/BJPR/2017/32020

Antidiabetic and anti-inflammatory activity of ethanol and methanol extracts of in vivo and in vitro plants of Ceropegia juncea were evaluated by in vitro methods. Antidiabetic activity was studied using α-amylase inhibitory assay and α-Glycosidase inhibitory assay. In vitro anti-inflammatory activity was evaluated using albumin denaturation assay and membrane stabilization assay. Results showed that the in vivo and in vitro plant ethanol and methanol extracts exhibited significant activity with α-amylase inhibitory assay and α-Glycosidase inhibitory activity with IC50 values of 434.75±1.40, 578.16±0.09, 555.9±0.28, 748.35±0.58 µg/ml and 752.94±0.82, 797.17±1.02, 877.09±0.74 and 959.86±0.26 µg/ml respectively. The extracts also showed in vitro anti-inflammatory activity by inhibiting the heat induced albumin denaturation and human red blood cell membrane (HRBC) stabilization with the IC50 values of 376±1.21, 372±0.92, 396±0.84, 344±01.08 µg/ml and 376±0.89, 910±1.06, 760±0.56, 810±0.12 µg/ml respectively. Thus, the both in vivo and in vitro plants of C. juncea could potentially be rich sources of natural antidiabetic and anti-inflammatory medicine. From the results, it is concluded that the metabolites present in vitro plant is almost similar to that of in vivo plant. So, in vitro plants can be used for medicinal purpose instead of in vivo plants.

Open Access Original Research Article

Impact of Socioeconomic and Risk Factors on Cardiovascular Diseases among People in Bangladesh: A Cross-sectional Health Survey

Md. Uzzal Haque, Most. Sumonara Khatun, S. M. Abdul Barik, Md. Rafiul Islam, Md. Nazmul Islam, Md. Rashidul Islam

Journal of Pharmaceutical Research International, Page 1-8
DOI: 10.9734/BJPR/2017/32024

Aims: The burden of non-communicable diseases especially cardiovascular diseases (CVDs) are rising rapidly in the developing countries particularly in Bangladesh. Therefore, the present study was undertaken to assess the impact of socioeconomic and risk factors affecting cardiovascular diseases among people in Bangladesh.

Study Design: We conducted this study with standard structured questionnaires following WHO STEPS Surveillance Manual.

Place and Duration of Study: Department of cardiology, ward number 32, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from July  to December 2015.

Methodology: We enrolled 650 patients randomly (469 men, 181 women; age range 11 to 70 years) with cardiac complications. Data were collected via interview of the patients/guardians and medical records using WHO-NCD STEP wise approach questionnaires. Descriptive statistics was applied to analyze the data.

Results: In this study we found that the prevalence of CVDs was more among rural people (61.5%) than urban residence (38.5%). Majority of participants (74.6%) came from lower socio-economic class, patients of age 50-60 years (30%) had greater risk than others, male (72.1%) had greater risk of suffering from CVDs than female (27.9%), families with low income (10000-20000 taka) 44.3%, family members (4-5) 46.8%, high cholesterol diet 75.2%, hypertension 79.1%, patients with no physical exercise 45.7% were commonly suffering from cardiovascular diseases.

Conclusion: Our present study showed that CVDs risk factors such as habit of salt intake during meals in the table, high cholesterol diet, smoking, hypertension, heredity, obesity, diabetes & no physical exercise was persistent among the study populations. Therefore social awareness should be developed among people of Bangladesh especially in rural community through educational programs & by mass media.