Open Access Short Research Article

Treatment of Grade 3 Fatty Liver by the Principles of Persian Medicine: A Case Report

Alireza Niknafs, Seied Amirhossein Latifi, Mehdi Salehi

Journal of Pharmaceutical Research International, Page 8-13
DOI: 10.9734/jpri/2020/v32i4531086

Introduction: Nowadays, societies have witnessed a rapid increase of Fatty Liver, which is one of the most common liver diseases worldwide, due to some changes in lifestyle and the increased obesity and metabolic syndrome.

Case presentation: in this study, the patient under research was a 41-year-old woman who was diagnosed with grade 3 fatty liver caused by the absence of a healthy diet and lifestyle. She was successfully treated using the methods of Traditional Iranian Medicine.

Discussion: Classical medicine is not able to develop a certain treatment for this disease yet. Therefore, this article has mainly concentrated on the therapeutic effects of medicinal herbs on the liver.

Conclusion: Delays in the diagnosis and treatment of fatty livermay lead to irreversibility or liver Cirrhosis, which cannot be treated using any method, but by liver transplants. However, the principles of PM (Persian Medicine) can be useful as useful in the prevention and treatment of this disease.

Open Access Original Research Article

The Outcome of Infants with Acute Lymphoblastic Leukemia Treated with Interfant-99 Protocol

Gholamreza Bahoush, Pourya Salajegheh

Journal of Pharmaceutical Research International, Page 1-7
DOI: 10.9734/jpri/2020/v32i4531085

Objective: The Outcome of Infants with Acute Lymphoblastic Leukemia Treated with Interfant-99 Protocol

Materials and Methods: In this retrospective analytical study, all newly diagnosed infants with ALL who were treated with Interfant-99 protocol from 2004 to 2014 in Ali-Asghar Children's Hospital in Tehran were included. Demographic data including age at diagnosis, sex, initial WBC, Hb and platelet count, flow cytometric diagnosis, cytogenetic findings, follow-up duration, and their outcome was extracted from patients' medical records. All the above data were analyzed by SPSS 23 software.

Results: 11 infants with ALL (5 girls and 6 boys) were included in the study. Mean and median age at diagnosis of all enrolled patients were 7.20 (std. deviation = 1.78; range = 3.57-9.37) and 7.90 months, respectively. 5 of the 11 patients had t (4; 11) and all of them were Pro-B ALL. The mean initial WBC in patients with this translocation was significantly higher than the others (193400 vs. 49166), and this difference was statistically significant (P = 0.004) despite the small number of patients under study. None of the patients had CNS involvement or mediastinal mass at diagnosis. Three patients relapsed, two of whom had isolated CNS relapse. Finally, one of them recovered completely as chemotherapy continued, another suffered a bone marrow relapse and eventually died, and a third suffered a bone marrow relapse and died about 10 months after relapse. The median follow-up of all patients was 53.83-mo. The estimated 5-yr overall survival of patients was 68.60% ± 15.10, and their Estimated 5-yr event-free survival was 21.20%±45.70. Infection was the most common complication during treatment that was manageable.

Conclusion: The Interfant-99 protocol appeared to improve the outcome of infants with ALL even with t (4; 11), with manageable complications. However, its implementation in developing countries has problems due to the small number of rooms suitable for heavy chemotherapy, and the dose of drugs that should be modified. It is worth noting that proving this requires a comprehensive prospective study with an appropriate sample size.

Open Access Original Research Article

Survival and Biomarkers of COVID-19 Patients Treated with Remdesivir and Favipiravir in ICU during the Peak of Pandemic: A Single Center Study in Bangladesh

M. Nasir, R. A. Perveen, M. Murshed, R. Nazneen, K. A. Talha

Journal of Pharmaceutical Research International, Page 14-22
DOI: 10.9734/jpri/2020/v32i4531088

Since the first detection of a cluster of COVID-19 patients in China in late 2019, it becomes a global concern due to its transmissibility and ability to progress patients in severe respiratory failure and acute respiratory distress syndrome, which need intensive care unit support for a long time. We observed the repurposing use of remdesivir and favipiravir whether considered as a therapeutic option or not through survival rate and changes in biomarker during 10-day treatment stay in ICU.

The retrospective observational study in a tertiary care hospital dedicated to COVID-19 at Dhaka, Bangladesh was done at the peak of COVID-19 pandemic in Bangladesh. The mortality rate, length of ICU stays and eight prognostic biomarkers of patients treated with remdesivir and favipiravir was observed as one of the first ever reported experience in Bangladesh.

Among the critically ill patients in ICU, 26 (44.8%) died and 32 (55.2%) were cured during the study period and highest mean duration of stay in ICU was observed (14.33 days and 18.13 days) in FPV-treated patients. Mean of means for all biomarkers CRP (26.0) and d-Dimer (2.64) was recorded higher in favipiravir treated patients in death cases, but NLR, d-NLR, platelet, PLR was much higher in remdesivir treated patient of both death and improved cases. Though overall outcome variables between death and improved cases were not statistically significant (p<0.39)

The severity of disease progression in critically ill COVID-19 patients in ICU depends on comorbidities and hyper-responsive inflammatory or immunological biomarkers to predict. Though the emergency use authorization and repurposing use of different antivirals are still on trial, but remdesivir and favipiravir revealed not much hope in improving prognostic biomarkers, survival rate and disease progression at the peak of pandemic in Bangladesh.

Open Access Original Research Article

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Basic Life Support among First Year Undergraduate Nursing Students

D. Ravivarman, K. Kamala

Journal of Pharmaceutical Research International, Page 30-36
DOI: 10.9734/jpri/2020/v32i4531090

Introduction: Early initiation of Basic life support (BLS) with Cardiopulmonary resuscitation (CPR) is an important contributory factor in the survival of Cardiac arrest. Effective and timely CPR reduces the likelihood of death following sudden cardiac arrest. Adequate knowledge and skills regarding BLS and appropriate application of the same is an essential requisite for nursing students.

Aim: To assess the effectiveness of structured teaching programme on knowledge regarding Basic life support among first year undergraduate Nursing students.

Materials and Methods: Quantitative pre experimental research design was adopted for this present study. First year 59 undergraduate Nursing students were chosen by Purposive sampling technique. The data were collected by using demographic proforma and self structured knowledge questionnaire.

Results: Pre-test and post- test knowledge scores revealed that during pre-test, the mean score 8.6±3.07 (SD) which is 43% of the total mean score, whereas in post-test, the mean score was 15.13 ± 2.26(SD) which is 75.65% of the total mean score depicting difference of 32.65% increase in mean percentage of score. The calculated‘t’ value 24.89 which is higher than the P<0.05, stated that highly significant difference between the pre-test and post-test. It proved that the structured teaching programme was highly effective to improve the student’s knowledge.

Open Access Original Research Article

Management of Distal 1/3rd Closed Forearm Fractures in Children above Elbow Plaster Cast versus Below Elbow Plaster Cast

Abbas Memon, Amir Zaffar Abro, Shakeel Ahmed Memon, Irshad Ahmed Bhutto, Ashfaq Hussain Mirjat, Siraj Ahmed Butt

Journal of Pharmaceutical Research International, Page 37-46
DOI: 10.9734/jpri/2020/v32i4531091

Objective: To determine if below-elbow casts are as effective as above-elbow casts in the treatment of the distal third closed forearm fractures in children.

Materials and Methods: This was a prospective comparative study and was conducted at orthopaedic department of Liaquat University of Medical and Health Sciences (LUMHS). Children 4 to 12 years of age who presented to, distal 1/3rd fractures of the forearm were randomized in order to manage with either an above-elbow or below-elbow cast after closed reduction under fluoroscopic guidance. Radiographic analysis was done for angulation and displacement at the injury time, following reduction, and at subsequent intervals of follow-up. At the fracture level, the cast index for evaluating the cast moulding quality was assessed from the post-reduction radiographs. Variations between post-reduction and final values for displacement and angulation, the range of motion of elbow, forearm and wrists and cast indices between the two groups were compared.

Results: Of total 50 study subjects, 26 underwent above-elbow cast and 24 subjects underwent below-elbow cast techniques. Mean age of above-elbow cast group patients was 9.42 year and the mean age in of below-elbow cast group patients was 9.13 years. 15 male and 11 female patients were present in above-elbow cast group; 14 male and 10 female patients were present in below-elbow cast group. The mean cast index of above-elbow cast group was 0.71 and the mean cast index of below-elbow cast was 0.70. In terms of patient demographics, injury mechanism, characteristics of initial fracture, cast index or shift in displacement and angulation during treatment, no significant variances were observed between both groups. In above-elbow cast group, the mean elbow arc of motion on cast removal at six weeks was only 78° compared to 141.6° in below-elbow cast group. There was a significant decline in arc of motion of elbow joint in above-elbow cast group compared to below-elbow cast group in six weeks which became normal at final follow-up in three months. The complication rates in both the groups were similar.

Conclusion: Below-elbow cast is the safe reliable and cost-effective method of cast immobilization in distal third forearm fractures in the children of 4 to 12 years of age.

Open Access Original Research Article

Frequency of Low Bone Mineral Density (BMD) in Patients with Liver Cirrhosis

Ihsanullah Rajar, Nasrullah Aamer, Narindar Kumar, Prem Kumar, Kapeel Raja, Muhammad Akram Bajwa

Journal of Pharmaceutical Research International, Page 47-52
DOI: 10.9734/jpri/2020/v32i4531092

Objective: The objective of this study was to evaluate the low bone mineral density (BMD) in patients with liver cirrhosis.

Methodology: This cross sectional study on 151 Liver cirrhotic patients was conducted at Liaquat

University Hospital Hyderabad/Jamshoro. This study duration was 6 months, July 2015 to December 2015. The Assessment of bone mineral density (BMD) for each relevant patient was done using ultrasound impedance Dual Energy X-ray Absorptiometry  (DEXA) by senior pathologist having ≥05 years of experience, across the calcaneum, at lumbar spine  (LS) and femur neck (FN),  were computed by using computer supported device. The BMD was expressed in terms of T score. The WHO standard value was utilized to define the low BMD / osteoporosis is T score -1.5.

Results: The mean age of subjects was 31.32±6.18 years. Out of all, 62.9% were males whereas 37.1% were females. About 21% patients had low/abnormal bone mineral density (BMD). Among these, 17.9% had bone mineral density (BMD) of -1.5 to -2.5 and 4% had BMD of <-2.5. Rest of 78.1% patients had a normal (>-1.5) bone mineral density (BMD). Majority of patients, 63.6% had a CTP grade B of liver cirrhosis, whereas 22.5% had A grade and 13.9% had C grade of liver cirrhosis.

Conclusion: Conclusively, the risk of low bone mineral density (BMD) was evidently high for patients with hepatic cirrhosis. Male gender and age above 30 years were found at greater risk and CTP grade B of cirrhosis was most common.

Open Access Original Research Article

Survival Analysis of Cancer Patients at Teaching Hospitals in Ethiopia

Gemechu Bekana Fufa

Journal of Pharmaceutical Research International, Page 53-63
DOI: 10.9734/jpri/2020/v32i4531093

Survival analysis today is widely implemented in the fields of medical and biological sciences. The basic principle behind the survival analysis implies to a statistical approach designed to take into account the amount of time utilized for a study period, or the study of time between entry into observation and a subsequent event. The event of interest pertains to death and the analysis consists of following the subject until death. This study aims to analysis the survival status of cancer patients, to identify the main cancer in women at study area and to determine the survival time of women with cancer after undergoing certain treatments in the selected teaching hospital(s).  A random sample of 460 cancer patients was selected using purposive sampling from the study area, in 2016 to 2018. Parametric and non-parametric models, Logistic regression models, Statistical distributions and tests methods of data analysis were used in this study. The demographic information: age, educational level, treatments, economic level, marital status and stages of cancer were included and Comparisons were made among major cancers in patients. The findings of the study suggest that among major types of cancer in patients, breast cancer was the highly affecting the females in the study area. There are 62.15 % survival and 37.35 % of not survived patients in the data and the majority of patients (about 88 %) are diagnosed when they are in stages 1 and 2 and very few (about 8 %) of them are diagnosed in advanced stage of cancer. It also reveals that the average tumor sizes are significantly different for all ages and stages. By grouping ages into groups of 5, I also stratified the number of patients diagnosed with cancer in different stages and the diagnoses at different stages were different.  Finally, Results of survival time shows that the surviving of cancer patient were different at different ages and treatments level.

Open Access Original Research Article

Drug Prescription Pattern of Psychotropic Drugs Used for the Management of Schizophrenia in a Tertiary Care Speciality Hospital in South Kerala

Dhanya Dharman, S. Parimala Krishnan, K. G. Ravikumar

Journal of Pharmaceutical Research International, Page 64-77
DOI: 10.9734/jpri/2020/v32i4531094

An individual affected by psychotic illness is usually a burden to both the society as well as their family in terms of non-productivity. The WHO recognized the significance of mental health and defined it as “a state of complete physical, mental and social well-being”.A psychiatric or psychotropic medication refers to a psychoactive substance administered to exert an effect on the chemical makeup of the brain and nervous system. A hospital based cross sectional observational study was undertaken in the Mental Health Centre, Trivandrum. All psychiatric drugs prescribed was collected with the help of data collection form and anaysed with Excel and SPSS. The study data indicated that highest percentage of drugs used was coming under the classification antipsychotice agents (63.25%), followed by antianxietic agents (21.25%), antiepileptic agents (9.34%), antimania agents (3.07%) and antidepressants (3.07%). Highly prescribed antipsychotic agent was Risperidone (12.93%) followed by haloperidol (11.40%), Promethazine (10.50%).This study was conducted in a govt hospital, so all medicine was free of cost. Due to the poor financial quality of life of psychiatric patients , prescribers were forced to write the hospital avilable medicine to the patients. The main limitation of this study was, it is only a single centered sudy so the result was very limited. So multicentered study is recommended to get a better result to find out the prescribing pattern and pattern of schizophrenia in kerala.

Open Access Original Research Article

A Novel Evidence of Immunological and Molecular Detection of Brucella Species in Camels

Kavitha Manivannan, Malathi Ramasamy, Hanaa Ahmed

Journal of Pharmaceutical Research International, Page 78-87
DOI: 10.9734/jpri/2020/v32i4531095

Objectives: Brucellosis is a zoonosis with severe complications for both humans and animals. In this work, we intended to examine the Brucella infection in dromedary camels in Qatar by using different analysis.

Materials and Methods: A total of 203 samples of dromedary camels were randomly collected from the nearby farms in Qatar. Real-time PCR for the genus specific Brucella cell surface salt extractable bcsp31 kDa protein gene were performed on DNA extracted from camel samples. Rose Bengal and rivenol tests were performed to detect the Brucella species. The milk samples were collected from the camels and utilized for the milk ring test.

Results: The outcomes of RT-PCR analysis illustrate the presence of Brucella spp. in 170 samples (83.74%) out of 203 samples. The findings of immunological assays also proved the presence of Brucella spp. such as Rose Bengal (67.14%), ELISA (71.42%), and precipitation assay (65.71) in both serum and blood samples of the dromedary camels, which were collected from the Qatar.

Conclusions: In conclusion, it was clear that the incidence of the brucellosis in camels is significantly rising in Qatar region and there is a need to control the spread of the disease from camels to camels as well as from camels to humans.

Open Access Review Article

Genetic Arguments for the Prevention of Severe Forms of COVID-19 through Moderate-Intensity Exercise

Bogdan-Alexandru Hagiu

Journal of Pharmaceutical Research International, Page 23-29
DOI: 10.9734/jpri/2020/v32i4531089

Many severe forms of COVID-19 have genetic causes, with variants providing information and thus supporting the hypothesis that moderate-intensity exercise would have a prophylactic role. In the case of genetic abnormalities related to the induction and amplification of type I interferons, in addition to curative administration of interferon, moderate intensity exercise could be used prophylactically. The same exercises inhibit the p38 MAPK pathway, being evaluated by clinical trials the drug inhibition of that pathway. In high physically active subjects, intermediate CCR2 monocyte decreased in response to moderate intensity exercise, and Cenicriviroc, an antagonist of the chemokine CCR5/CCR2b receptor, has been proposed for therapy. Exercise prevents the increased expression of Tyk2, and for COVID-19 therapy, corresponding to the defect of this gene, kinase inhibitors or Baricitinib have been proposed. The critical analysis of the data presented in the paper shows that for the prophylaxis of severe forms of COVID-19, moderate intensity exercises could be used.