Open Access Original Research Article

Impact of Introducing Clinical Pharmacy Services in A Respiratory Diseases Clinic: A Report from North Cyprus

Abdikarim Mohamed Abdi, Finn Rasmussen, Rumeysa Demirdamar

Journal of Pharmaceutical Research International, Page 1-15
DOI: 10.9734/jpri/2019/v29i630253

Aims: The Implementation of Clinical Pharmacy Services (CPS) in hospitals is currently gaining attention in an effort to rationalize drug use in many developing countries. This study aims to introduce and evaluate ward-based CPS in a Respiratory Diseases clinic in North Cyprus and assess its efficacy and physician's perceptions toward the services.

Study Design:  A prospective interventional study.

Place and Duration of Study: The study was carried out in the respiratory clinic from 01 December 2013, to 30 January 2014 at Near East University Hospital, in Nicosia, North Cyprus.

Methodology: Clinical Pharmacy Services (CPS) were introduced and documented over the study period of 60 days in a tertiary university hospital. DTPs and Interventions were documented and classified using DTP classification tool obtained from previous studies, and later evaluated by an independent clinical committee for their feasibility. Physician’s attitudes and perceptions were evaluated before for and after introducing CPS's using a questionnaire tool.

Results: 82.35% of the targeted physician's sample have responded to baseline survey, (n=17) majority (92%) did not have any previous interaction with clinical pharmacists, they generally well perceived and had high expectations to pharmaceutical care services in general. This further enhanced the post-implementation of CPS. 118 interventions were carried during the program, 86.6% accepted and regarded as clinically relevant. Interventions mostly related to cardiovascular agents. Add/ change/stop medications were the most common type of interventions (21%). Most common resultant outcome was to avoid adverse effects or toxicities. The intervention was significantly related to the number of drugs used (r=0,487; p=0,006), the rate of acceptance significantly was higher to services compared to DRP interventions (p<0.005).

Conclusion: The introduction of CPS's lead to clinically relevant and highly accepted optimization of medicine use in different wards and clinics including respiratory diseases clinic in the case of this study, it was relatively well perceived by physicians, but also could be more valued if more optimized and practiced by talented proactive clinical pharmacists within a multidisciplinary team.

Open Access Original Research Article

What is the Relationship among Patients' Position and Intra-abdominal Pressure and Mean Arterial Pressure?

Yusef Haghighi Moghaddam, Elnaz Hosseinnejhad, Mohammad Amin Valizade Hasanloei, Javad Rasouli

Journal of Pharmaceutical Research International, Page 1-8
DOI: 10.9734/jpri/2019/v29i630254

Background: The prevalence of intra-abdominal hypertension in ICU patients is about 50% and can be affected by changing the position of the patients. This study aimed to investigate the relationship between changing patient positions in bed with intra-abdominal pressure and mean arterial pressure among mechanically ventilated patients in ICU.

Methods: This study was a clinical trial conducted on 68 patients admitted in intensive care units of Imam Khomeini hospital of Urmia city, Iran. The patients were selected through convenience sampling based on the inclusion criteria. In this study, the effects of changes in five positions (0, 15, 30, 45, left and right lateral position with 30 degrees) on the mean arterial pressure was evaluated. Statistical tests such as chi square and repeated measures ANOVA were used as well. All analyzes were performed using SPSS 21.

Results: In this study, there were 24 men (35.3%) and 44 women (64.7%). The mean age, weight and height of patients were 70.35±16.98 years, 75.76±9.77 kg and 168.82±8.14 cm, respectively. There was no significant difference regarding intra-abdominal pressure by gender (p<0.05). There was a significant difference regarding intra-abdominal pressure between first, second, fourth and fifth measurements (p<0.001). There was a significant difference regarding mean arterial pressure between first, second, third, fourth and fifth measurements (p<0.001). Significant differences were observed between the fifth and fourth mean arterial pressure measurements as well (p<0.001).

Conclusion: According to the results of this study, the changing of patient's body position from supine to higher positions lead to the increase of intra-abdominal pressure.

Open Access Original Research Article

Multiple Sclerosis and Evaluation of Vitamin D Effect

Zahra Eslamifar, Behnaz Deihim, Reza Ghaffaripour

Journal of Pharmaceutical Research International, Page 1-15
DOI: 10.9734/jpri/2019/v29i630255

Multiple sclerosis is an autoimmune disease of the central nervous system with symptoms of neurodegenerative diseases. The symptoms vary depending on damage location. Some of the symptoms include cognitive disorders, anxiety and depression, visual impairment, respiratory, speech and swallowing disorders, muscle spasm and fatigue.

Due to the lack of a definitive treatment method, various therapeutic approaches are proposed to control the disease. Drugs are classified into attack control drugs, complication control drugs and disease-modifying drugs. Vitamin D is a hormone-like steroidal compound with immune modulatory and anti-inflammatory properties. Vitamin D deficiency is associated with a variety of inflammatory, neurologic and autoimmune diseases.

Many studies on patients as well as experimental autoimmune encephalomyelitis studies have shown that the administration of vitamin D reduces inflammation in inflammatory diseases of the central nervous system. As argued, vitamin D level was significantly lower in MS compared to healthy subjects as controls.  Also, a higher level of vitamin D is reported in relapsing-remitting MS patients compared to patients with progressive MS. It is observed that higher serum levels of vitamin D can reduce the severity of symptoms, progress, and also delays the relapses. Few studies considered vitamin D to be ineffective in stopping or inhibition the disease. Despite the controversies concerning the role of vitamin D in MS progress, there is a lot of interest in further research in this regard with the hope of reaching a common ground. Therefore, frequent reviews of past and recent studies are essential to achieve the same results.

Open Access Review Article

Metabolism, Toxicity, Detoxification, Occurrence, Intake and Legislations of Fumonisins - A Review

Ahmad Farhadi, Hossein Nowrozi, Reza Kachuei

Journal of Pharmaceutical Research International, Page 1-35
DOI: 10.9734/jpri/2019/v29i630252

Fumonisins are a group of mycotoxins generated by the Fusarium spp. in foods and feeds. More than 15 isomers of Fumonisin are recognized, and the B series of Fumonisins is the primary and referral isomer of Fumonisin. Fumonisin B can cause leukoencephalomalacia in rabbits and horses and porcine pulmonary edema in swine. Fumonisin B is also nephrotoxic, hepatotoxic, immunotoxic and carcinogenic. It blocks sphingolipid biosynthesis (and hinders the synthesis of ceramide) by a noticeable resemblance to sphingosine and sphinganine. This paper provides a review of the toxicity, occurrence, and mechanism of carcinogenicity, hepatotoxicity, nephrotoxicity as well as immunotoxicity of Fumonisins, which are primarily found on a variety of food and feed in Africa, America, Europe, Asia, and Oceania. In this paper, current information on contamination of feeds and foods by Fumonisins around the world is summarized. Because of economic losses induced by Fumonisins and their harmful effects on animal and human health, various procedures to detoxify infected feeds and foods have been illustrated in this review, including biological, physical, and chemical processes. Additionally, we discuss dietary intakes and maximum limits of Fumonisins in some countries.

Open Access Review Article

A Review of GENETIC Polymorphism of GSTs (Glutathione –s Transferase) Genes in Breast Cancer

Mohammad Shokrzadeh, Nematollah Ahangar, Abbas Mohammadpour, Golpar Golmohammadzadeh

Journal of Pharmaceutical Research International, Page 1-12
DOI: 10.9734/jpri/2019/v29i630256

In this review article, several researchesabout genetic polymorphisms of Glutation –s transferase (GST) enzymes that may have an etiological role in breast cancer have been reviewed. Breast carcinoma is the most frequent malignancy in women and represents the second leading cause of cancer death among women and accounts for about one-fourth of female cancer cases all over the world. GSTs are a family of Phase II detoxification enzymes that catalyze the conjugation of glutathione (GSH) to a wide variety of xenobiotic The incorporation of glutathione increases the molecule’s water solubility. This detoxification ability to become Glutathione S-transferases play an important role in drug, carcinogen, and reactive oxygen species detoxication and act both as peroxidases and as catalysts of glutathione transfer to hydrophobic electrophiles.It is evaluated in Iran and other countries that the annual incidence of cancer in the world will increase to 25 million in 2030, of which more than 70 percent occurs in developing countries.It is the second cause of death among Iranian women and one million new cases diagnosed worldwide every year.