Open Access Case Study

Neonatal Effects after Selective Serotonin Reuptake Inhibitors and Benzodiazepines Administration during Pregnancy

Georgios Eleftheriou, Fiocchi Roberto, Butera Raffaella, Giampreti Andrea, Mangili Giovanna, Molinaro Delfina

Journal of Pharmaceutical Research International, Page 1-8
DOI: 10.9734/JPRI/2017/34620

Aims: To evaluate whether the co-administration of benzodiazepines (BDZ) and selective serotonin and serotonin/norepinephrine reuptake inhibitors (SSRI/SNRI) during pregnancy is associated with an increased risk of abstinence symptoms in the newborns.

Methods: Twenty six neonates exposed in utero to SSRI/SNRI were studied. The presence of symptoms possibly due to neonatal abstinence syndrome, BDZ exposure, weight, age at birth and duration of hospitalization were recorded. Blood levels of SSRI/SNRI and BDZ were measured in all neonates.

Results: Neonatal blood levels of SSRI/SNRI were within or below normal adult therapeutic range in 21 newborns (81%). Thirteen newborns (50%) were symptomatic. Neonates born from mothers receiving co-administration of SSRI/SNRI and BDZ had a higher risk of developing symptoms as compared to those whose mother was not receiving BDZ (9/13, 69% versus 4/13, 31%, p ≤ 0.05). At birth, symptomatic newborns displayed a significatively lower weight and gestational age than asymptomatic neonates (2609 ± 301 vs 3112 ± 310 g, and 36 ± 1 vs 39 ± 1 week, respectively, p < 0.001). No relationship was found between symptoms and neonatal blood levels of either SSRI/SNRI or BDZ.

Conclusions: Our results suggest that the co-administration of SSRI/SNRI and benzodiazepines during pregnancy may be associated with an increased risk of neonatal symptoms. However, these symptoms are not related to blood levels and may be attributed to prematurity leading to a longer hospital stay.

Open Access Short Research Article

Public Knowledge and Awareness about Gout: A Cross-sectional Study in Qatar

Intithar Mohammed M. Alshammari, Md. Ali Mujtaba

Journal of Pharmaceutical Research International, Page 1-11
DOI: 10.9734/JPRI/2017/34375

Background: The prevalence of hyperuricemia and gout had shown an increasing trend all over the world including in developing countries. The patients may receive very little education on the dietary and lifestyle factors associated with gout. 

Objective of the Study: Assess knowledge and awareness about gout disease and determine prevalence of gout in Qatar.

Methodology: A prospective cross-sectional study had been done on Qatari people in the period from December 2016 to March 2017. The Inclusion criteria were selected to be (i) Qatari (ii) older than sixteen years (iii) living in Qatar and (iv) agree to answer the questionnaire after mentioning the main objective of it. The data was collected from 447 Qatari by using a self-administered online questionnaire in Arabic language specially designed for the research purpose. All data were entered to the computer program MS EXCEL 2007 and frequency, percentage calculated for all the items in the questionnaire with representation for the answers by either pie chart or bar chart.

Results: Among the 447 subjects 52% were males, 62% aged between sixteen to thirty six years. 38% are university graduate. The average knowledge regarding etiology, predisposing factors, complications and diagnosis of gout were 30%, average knowledge regarding diet consumption related to gout is approximately 30%, average knowledge regarding signs and symptoms of gout was 31% and the overall mean for participants knowledge and awareness were 31%. Overall the participants who reported to have gout were only thirty-six (8%) among them 33% know the normal range of uric acid in blood, 61% informed by their physician or pharmacist about the medication to be taken during the acute attack and 64% informed by physician or pharmacist about the types of foods that should be avoided.

Conclusion: In conclusion, this study found low awareness and knowledge regarding gout among Qatari people. More attention is needed on patient education on gout and self-management training.

Open Access Original Research Article

Prophylactic and Protective Activity of Crude and Methanolic Extract of Punica granatum Peel against Gentamicin Induced Nephrotoxicity

Mobasher Ahmad, Rizwana Wazir, Rukhsana Anwar, Sairah Hafeez Kamran, Afroze Mobasher, Usman Akhtar

Journal of Pharmaceutical Research International, Page 1-7
DOI: 10.9734/JPRI/2017/34616

The aim of the current study was to investigate the nephroprotective effect of Punica granatum peel (pomegranate) against gentamicin induced nephrotoxicity. The crude pomegranate peel (600 mg/kg) and methanolic pomegranate extract (600 mg/kg) for 7 days showed significant (p<0.05) reduction in serum creatinine, urea, uric acid, serum electrolytes, alkaline phosphatase and total anti-oxidant activity as compared to gentamicin (2.5 mg/kg for 7 days) treated group. There was non-significant (p>0.05) increase in serum electrolytes, creatinine, urea, uric acid, alkaline phosphatase, total anti-oxidant activity in prophylactic group receiving 600 mg/kg of methanolic pomegranate extract for 5 days followed by the administration of gentamicin (2.5 mg/kg) for 7 days as compared to normal group. The result obtained demonstrates that pomegranate peel crude and methanolic extract are potent nephroprotective agents and prophylactic use prevents nephrotoxicity induced by gentamicin by decreasing oxidative stress in kidney.

Open Access Original Research Article

Evaluation of an Undocumented Polyherbal (Faradin®) Used for the Treatment of Sickle Cell Disease in West Africa. Part II: Antibacterial Activity and Synergism

Moji C. Adeyeye, Daniel A. Gbadero, Lawrence O. Farayola, Vicky McKinley, Nikolaos Olalere, Zachary Erlichman, Dami Alabi, Tobi Amosun

Journal of Pharmaceutical Research International, Page 1-11
DOI: 10.9734/JPRI/2017/33606

Aim: This study focused on evaluation of the anti-bacterial effects and synergism of Faradin®), a polyherbal complementary alternative medicine (CAM) and anti-sickling agent. It is used for treatment of sickle cell disease (SCD) and co-morbidities (such as infection and inflammation) in some West African countries. It is made up of Zanthoxylum zanthoxyloides, Alnus glutinosa and Alchornea cordofolia, designated, not in order as F, M, and V.

Methods: Antibacterial susceptibility effects were studied using various weight: weight (w/w) ratios (10:1-1.25:1) of Faradin (or single component extract, F, M and V):water and compared to standard controls - erythromycin and penicillin (5mg/ml). Gram (-) Pseudomonas aeruginosa and E. coli, and gram (+) Enterococcus faecalis, Staphylococcus aureus and Streptococcus pneumonia microorganisms were utilized. Well diffusion method was used with pre-prepared Mueller-Hinton agar plates for all species except S. pneumonia, for which sheep blood agar plates were employed. Synergism or Fractional Inhibitory Concentration Index (FICI) between Faradin and the antibiotics was calculated using modified minimum inhibitory concentration (MIC) for each microorganism [that was derived using lower concentrations (10:1 – 0.078:1 v/v ratios) in addition to the range used for the susceptibility study], FIC for Faradin, and each antibiotic. FICI of ≤ 0 = synergy, 0.5-1.0 = additive effect; > 1.0 = intermediate effect and values > 4 are suggestive of antagonism.

Results: Faradin, F or M extract had a dose-dependent antibacterial effect, with more antibacterial activity against gram (+) bacteria than gram (-) bacteria.  Gram (+) S. aureus showed greatest susceptibility followed by S. pneumoniae (MICs of 1 and 8 mg/ml respectively). The V extract showed no antibacterial activity. Greater than 4.0 FICI values were obtained, except for P. aeruginosa, indicative of antagonism between Faradin and the antibiotic controls, and possibly different mechanism of antibacterial action. P. aeruginosa had FICI of 0.88, indicative of additive effect.

Conclusions: Polyherbal Faradin showed antibacterial action to certain microorganisms and could be potentially effective against co-morbid infections in sickle cell patients while functioning as an anti-sickling agent.

Open Access Original Research Article

Usability of Medicine Package Inserts for Chronic Diseases: A Survey of the Pharmaceutical Market in Jos, Nigeria

B. N. Joseph, U. O. Asiegbu, B. M. Aya, M. N. Nyam, D. M. Umar, N. S. Jimam, M. L. P. Dapar

Journal of Pharmaceutical Research International, Page 1-10
DOI: 10.9734/JPRI/2017/34603

Background: The burden of illness is increasingly tending towards chronic diseases while medication adherence is often unsatisfactory. The patient information leaflet is one model that has the prospect to improve medication adherence. Improving the readability and content based validity of medication information has great educational potential to influence adherence to medicines.

Objectives: This study assessed the readability and content based validity of patient information leaflets. It compared the readability and the content based validity of foreign and indigenous based patient medicine inserts.

Methods: The study was conducted in two tertiary hospitals in Jos, Plateau State, Nigeria. The study was a cross-sectional design. Sixty six leaflets for chronic diseases were randomly selected.

Results: The mean Flesch readability ease was 23.17, the Flesch-kincaid grade level was 13.7 and mean word count was 1219.89. The average font size and line spacing were 1.13 and 1.15 respectively. Only 3% of the leaflets had pictogram. All the leaflets had information on generic name of the drug and indication for use. Nigeria indigenous leaflets recorded an average Flesch readability ease of 18.39 compared to foreign leaflets which had 25.43 (p-value = 0.070). Flesch Kincaid grade level for indigenous and foreign leaflets were 14.46 and 13.30 respectively (p-value = 0.075). The Nigeria pharmaceutical leaflets had a mean font size of 1.12 while the foreign leaflets had 1.13. The line spacing for Nigeria leaflets was 1.11 compared to the foreign leaflets which recorded 1.17. The foreign pharmaceutical companies were more likely to indicate information on pregnancy/lactation (p-value = 0.002), paediatric/geriatric (p-value = 0-007), shelf-life (p-value = 0.033) and handling of machine while on medication (p-value = 0.038).   

Conclusion: These findings exposed the inadequacy and failure of the Nigeria’s drug policies to coordinate and ensure best practices in the pharmaceutical sector. Our findings demonstrated that the readability and content validity of the indigenous patient information leaflets were poor. However, the foreign leaflets compared statistically better in terms of content validity.