Open Access Original Research Article

In-hospital Outcomes of Primary Percutaneous Coronary Intervention in Patients Presenting with acute ST Elevation Myocardial Infarction in a Tertiary Care Hospital in Karachi

Arshad Ali Shah, Syed Dilbahar Ali Shah, Amara Zafar, Ghulam Abbas Shaikh, Muhammad Aslam, Suresh Kumar, Abdul Majid, Maheen Khan, Hareem Syed, Muhammad Sami Khan, Mohammad Nawaz Lashari, Dileep Kumar

Journal of Pharmaceutical Research International, Page 1-8
DOI: 10.9734/jpri/2022/v34i30A36061

Background: Although primary percutaneous coronary intervention (PPCI) is now frequently performed in Pakistan, there is little data available regarding its outcomes in tertiary care hospitals of Pakistan. This study was designed to determine the outcomes, and assess the factors influencing these outcomes of PPCI.

Methods: It is a retrospective study conducted on the data of patients who presented to the department of Cardiology, Dr. Ruth K.M. Pfau Civil Hospital Karachi from October 2017 to March 2019 with acute ST-elevation myocardial infarction (STEMI) and underwent PPCI. A total of 115 patients were included in this study.

Results: Out of the 115 patients, 111 had a successful PPCI. The total mortality was 2.6% (3 deaths). One of the patients was reported to have a stent thrombosis. No emergency coronary artery by-pass graft (CABG) was performed and none of the patients had a stroke or any major bleeding. An accelerated idioventricular rhythm (AIVR) was noted in 23 (20%) of the patients. Pre-procedure 87% of the patients had thrombolysis in myocardial infarction (TIMI) grade 0 and only 11.3% were having TIMI flow grade 1. Post procedure a vast majority of the patients (97%) achieved TIMI flow grade 3.

Conclusions: Our study reports a very high success rate of PPCI which is consistent with the data reported from the Western countries. A major limitation of our study was the relatively small sample size. A larger sample size would have better predicted outcomes considering this is one of the few such studies in this region. Further studies with larger sample size and long-term follow up outcomes are recommended.

Open Access Original Research Article

Antifungal Activity of Echinops echinatus and Fagonia cretica from Cholistan Desert-Pakistan

Faheem Hadi, Annum Khawer, Amna Riaz, Anaab Basharat, Muhammad Habib-E-Ajmi, Tahir Maqbool, Muhammad Rafiq, Muhammad Sarwar, Tahir Muhammad, Memoona Zahra

Journal of Pharmaceutical Research International, Page 9-17
DOI: 10.9734/jpri/2022/v34i30A36062

Background: Fungal infections are getting worse due to their resistance against available antibiotics and have always remain a problem. Homoeopathic mother tinctures are part of therapy in clinical patients with less side effects and much efficient against pathogenic infections.

Methodology: Echinops echinatus and Fagonia cretica plant mother tinctures were performed and used to evaluate the anti-fungal potential of these plants against potentially pathogenic fungal species like Candida albicans, Aspergillus ustus, Aspergillus niger and Aspergillus flavus by agar disc diffusion method. Three doses were used (0.25 ml, 0.5 ml and 1 ml volume per disc) and zone of inhibition was observed in millimetres and compared with positive control Fluconazole (2 mg/ml) which is commercially available.

Results: The results indicated efficacy of both mother tinctures showed remakarble activity against pathogens with zone of inhibition ranging 17.33 – 30.33 mm.

Conclusion: Current work indicated anti-infective potential of plants which can be added in therapy of infections in future after confirmation in in-vivo models.


Open Access Original Research Article

Study on Frequency of Placenta Previa and Morbidly Adherent Placenta in Patients with Previous Cesarean Sections

Hina Amanullah, Nida Zaki, Amna Aslam, Nahil Shams

Journal of Pharmaceutical Research International, Page 36-41
DOI: 10.9734/jpri/2022/v34i30A36066

Objective: To determine the frequency of different positions of placenta previa and morbidly adherent placenta in women who had previous multiple cesarean section reporting at Department of Gynecology and Obstetrics, Isra University Hospital.

Patients and Method: This cross sectional was done at department of Gyne/Obs and department of Radiology ISRA University Hospital Hyderabad during one year. An informed consent was taken from pregnant women during antenatal diagnosed to have placenta previa or morbidly adherent placenta on ultrasound with history of previous C-section. The clinical / abdominal examination was done and proformas were filled, the location of placenta previa and morbid adherence was confirmed during C-section and observations were recorded for results. Data was collected via study proforma and analysis of data was done by using SPSS version 26.

Results: The mean of the patients was 29.31+5.17years. Most of the study participating women 87(87%) gave the history of Cesarean sections during previous deliveries, while only 13(13%) women had history of NVDs (normal vaginal deliveries) and Cesarean sections both. Out of all 33% patients observed with placenta previa and morbidly adherent placenta in women who had previous multiple cesarean section, particularly the previa I to IV 22.0%, placenta accreta 4%, placenta percreta 4% and least common type was placenta increta 3%. Incidence of the placenta previa and morbidly adherent placenta in women who had previous multiple cesarean section was statistically insignificant according number of c-sections (p-0.39).

Conclusion: As per study conclusion the placenta previa and morbidly adherent placenta was observed to be the highly frequent among women who had previous multiple cesarean section. There was no effect observed of the number of caesarean sections performed, implying that one previous caesarean may have caused placenta previa and morbidly adherent placenta.

Open Access Original Research Article

Prevalence of Early Childhood Caries in Thiruvallur District: A Cross Sectional Hospital Based Study

Prerna Jain

Journal of Pharmaceutical Research International, Page 42-46
DOI: 10.9734/jpri/2022/v34i30A36067

Oral health is an essential and important component that is involved in the total health and well-being of an individual. It affects various aspects of a person's health status such as the quality of life including self-esteem, ability to masticate, speak and various other levels of routine activities. The aim of this study was to determine the prevalence of early childhood caries in a particular district since the obtained results can serve as a guide in assessing the current practice as well as planning of additional education about early childhood caries. This prospective study was done among children in Saveetha dental college from June 2019 to December 2019.  A total sample size of 181 patients were included as part of the study which consisted of both male and female participants. The inclusion criteria for the study was that the child should be within the age group of 3-6 years of age, and should be from Thiruvallur district . A total of 181 children were studied as part of the present study of 3-6 years of age out of which 92 (50.8%) candidates were males and 89 (49.2%) candidates were females. In the age groups of 3-4 years, 4-5 years and 5-6 years the number of candidates that were examined were 70 ( 38.6%), 54 ( 29.8%) and 57 (31.4%) respectively. As a conclusive aspect it is important to take care of oral health and appropriate policies are to be adopted and incorporated for the betterment of the society.

Open Access Original Research Article

Frequency of Coronary Artery Anomalies Undergoing Coronary Interventions Patients at Tertiary Hospital

Vengus Manzoor, Sabir Hussain, Wajid Hussain, Araj Jamil, Laraib Shaikh, Bilal Ahmed

Journal of Pharmaceutical Research International, Page 47-54
DOI: 10.9734/jpri/2022/v34i30A36068

Aims: This study aims to identify the frequency of Coronary Artery Anomalies (CAA) in coronary intervention receiving patients at tertiary care hospital.

Sample: To obtain the sample size of the study i.e., 228 were selected at a Confidence level of 95%.

Study Design: Cross-sectional study.

Place and Duration of Study: This Descriptive cross-sectional study was conducted at Tertiary care hospital - National Institute of Cardiovascular Disease, Sindh-Karachi. Six months after the approval from IRB-NICVD (April 2018 – October 2018).

Methodology: Nonprobability consecutive sampling was used to collect the study data. All Patients of either gender from age 18 to 60 years of age undergoing Primary Coronary Intervention (PCI)/ coronary artery angiography because of substernal chest pain were included.

Results: Total 228 sample population was enrolled in the study, among which 88 (38.6%) were females and 140 (61.4%) were males. CAA was found in the coronary arteries of patients with abnormal aortic valves with a frequency of 1.3 percent. The most often occurring anomaly in our analysis is the separation of the origins of Left Anterior Descending Artery (LAD) and Left Circumflex Artery (LCx) from the Left Coronary Artery (LCA). The Circumflex Artery resulting from Right Coronary Sinus (RCS)/ Right Coronary Artery (RCA) was the second most often seen anomaly in our analysis, accounting for 22.78 percent of all anomalies. The RCA caused by LCS was the next abnormality, with a 7.59 percent frequency. In three cases, the left major coronary artery was derived from RCS, accounting for 3.8 percent of abnormalities.

Conclusion: Among patients receiving diagnostic coronary angiography, we discovered a 0.9 percent incidence of coronary artery abnormalities. In our research, the prevalence of coronary artery abnormalities was 7% among patients who had coronary procedures. The drawback of our research is that we only included individuals who had had coronary angiograms rather than a random sample of the different cardiac tertiary care hospitals.

Open Access Original Research Article

Tablets in Capsule as Strategy to Improve Adherence in Patients Cardiovascular Disease

M. A. Peña, F. Roger, G. Torrado

Journal of Pharmaceutical Research International, Page 55-64
DOI: 10.9734/jpri/2022/v34i30A36069

Aims: The main objective of this work has been the development of delayed-release hard capsule containing mini-tablets of two-platelet antiaggregant, acetylsalicylic acid and clopidogrel, for the treatment of patients suffering from acute coronary syndrome at risk of gastrointestinal bleeding, therefore jointly is administered an inhibitor of gastric acid secretion, the ranitidine.

Study Design: Design of mini-tablets into a capsule for the treatment of acute coronary syndrome.

Methodology: For the galenic preparation of the three mini-tablets, an in-depth study of the choice of excipients and the most appropriate manufacturing methodology was carried out. Once the suitability of the mixture for use in direct compression was determined, which is the selected technological method, as it is the most profitable and involves less time, the mini-tablets were prepared and their physical characterization. Tablet appearance and physical characteristics such as dimensions, thickness, mass, resistance to crushing, friability, disintegration time and content uniformity met the requirements established according to pharmacopoeia to ensure the quality of the tablets.

Results: The final formulation consists of the grouping of mini-tablets of three drugs in a delayed-release hard capsule ("tablets-in-capsule") for the treatment of patients suffering from acute coronary syndrome at risk of gastrointestinal bleeding. All tablets show resistance to crushing, disintegration, and friability features that strictly meet pharmacopoeia requirements.

Conclusion: Adherence to treatment is increased because the concomitant administration of three active ingredients is unified in a single pharmaceutical dosage form.

Open Access Original Research Article

Determining the Role of Immunohistochemical Expression of CK20 in Grading Urothelial Carcinoma

Faiqa Mubeen, Sana Ullah Khan, Nasima Iqbal, Shahid Parvez Shaikh, Ghazal Irfan, Muhammad Khan

Journal of Pharmaceutical Research International, Page 65-72
DOI: 10.9734/jpri/2022/v34i30A36070

Background: The cytoskeleton-associated intermediate filaments, CK20 belong to epithelial subgroups and it has a controlled expression in gastrointestinal marked cells and in the urinary tract. During embryogenesis, cytokeratin is the first intermediate filament type and they provide facilitation in maintaining the integrity and mechanical stability of cells. It is identified with regard to neoplastic urothelial cells there is a strong and diffuse cytoplasmic immunoreactivity for CK20 that involve all three layers of the urothelium. Therefore, the aim of the study was to determine the role of the immunohistochemical expression of CK20 in the grading of urothelial carcinoma.

Methodology: It was a retrospective cross-sectional study that was conducted at the Department of Histopathology, Lady Reading Hospital, Peshawar, Pathology department, Sheikh Zayed medical college and Hospital, Rahimyar Khan and Khyber Medical college and Khyber Teaching Hospital, Peshawar from March 2021 till September 2021.  Ninety-seven, (97) Paraffin-embedded blocks of urothelial carcinoma along with records of these patients, which were collected over three years from January 2018 till December 2020, were retrieved from the archives of the Histopathology departments of these hospitals.  These blocks were cut and stained with Hematoxylin Eosin and CK20 antibodies. Expression of CK20 was noted by two consultant pathologists. Positive expression was considered when cytoplasmic immunohistology expression of CK20 was seen in deep layers of the urothelium or diffused strong cytoplasmic staining of urothelial cells beyond the superficial cells was found. Negative expression was defined as CK 20 staining restricted to the superficial cells or Negative expression was defined as CK 20 staining restricted to superficial “Umbrella” cells of urothelium.

Results: Out of 97 patients, the minimum age was 20 years and maximum age was found to be 90 years with mean + standard deviation of 64 +11 years. There were 86 (88.6%) male patients and 11 (11.3) female patients. Low grade urothelial carcinoma was seen in 49(51 %) patients while 48 (49%) cases displayed high grade morphology. CK20 was found positive in 74 (76.3%) patients. Among positive cases, 43 cases were high grade and 31 cases were low grade urothelial carcinomas.

Conclusion: CK20 Positivity was seen in 76.3% of the patients with papillary urothelial carcinoma. CK20 is an important immunohistochemical marker for early diagnosis and grading of urothelial carcinomas. Positive Immunohistochemistry staining of the urothelial carcinomas were found in high-grade as well as low-grade urothelial carcinomas but in comparison, 43 cases of high-grade urothelial carcinomas had exhibited positive immunohistochemistry staining for CK 20 and 31 cases of low-grade urothelial carcinomas had exhibited positive staining for CK20 which would indicate that perhaps immunohistochemistry staining features of urothelial carcinoma would tend not to completely differentiate between high-grade and low-grade urothelial carcinomas.

Open Access Original Research Article

Effects of Probiotic Supplemented diet on Growth Performance of Silkworm Bombyx mori and Improved Characteristics of Cocoon and Silk

S. P. Anisha̍, N. Yasmin, Sree Vaisnava Devi

Journal of Pharmaceutical Research International, Page 73-78
DOI: 10.9734/jpri/2022/v34i30A36271

Aims: The present work is to investigate the effect of probiotic namely normagut on the biochemical and commercial characteristics of silkworm, B. mori.

Study Design: Normagut treated mulberry leaves were supplemented at three different concentrations: 1%, 2% and 3%. It was fed to B. mori larvae and biochemical parameters were analyzed.

Place and Duration of Study: Experiments were performed at Muslim Arts College, Tamilnadu, India between June 2019 and May 2020.

Methodology: The feeding supplementation started from first day of third instar to last day of fifth instar for every 24 h. The research was performed with control and experimental groups of 3 replications of 30 larvae each.

Results: In our study, 2% concentration of probiotic normagut was very effective and maximum of fat body protein (31.18 µg/mg), glycogen (20.21 µg/mg) and lipid (255.31 µg/mg) was observed. Maximum of haemolymph protein (58.12 µg/ml), trehalose (365.06 µg/ml) and of lipid (41.06 µg/ml), free amino acid (34.32 µg/ml), protein (64.43 µg/mg ) and 15.27 µg/mg of lipid was recorded in silk gland of B. mori (p<0.001). The economic traits of larval weight (3869.23 mg), cocoon weight (2131.36 mg), shell weight (463.13 mg), shell ratio (21.72%) and filament length (912.24 m) was recorded in 2% normagut treated group.

Conclusion: The probiotics enhanced the commercial characteristics of cocoon and silk.

Open Access Review Article

Role of Medicinal Mushroom Lentinula edodes in Nutrition, Nutraceutics and Ethnopharmacology

Zeemal Seemab Amin, Saba Abbas, Arooj Munir, Mian Mubeen Ali Qadri, Muhammad Raza, Muhammad Danish, Sabir Khan, Beshray Hafey, Muhammad Kamran Hanif, Hafiz Kashif

Journal of Pharmaceutical Research International, Page 18-35
DOI: 10.9734/jpri/2022/v34i30A36065

Lentinula edodes (shiitake mushroom) is the medicinal macro-fungus popular in Japan and China. It is the second most well- known edible fungus in the global market after Agaricus  bisporus Because of presence of dietary fibers, vitamins, proteins, minerals and carbohydrates, shiitake mushroom have significant nutritional worth. It is commonly cultivated in winter season and known as “elixir of life”. Bioactive compounds such as polysaccharides, amino acid derivatives, sterols, glycoproteins, chitin and sulfurous compounds are all extracted from shiitake mushrooms. Some of these are lentinans, eritadenine and KS-2-α- mannan peptide etc. Shiitake mushroom is used therapeutically to cure cancers, cardiovascular disorders, viral and fungal infections, hepatitis, hypertension and hepatic disorders. Shiitake mushroom have also grown in popularity as a result of their unusual and well-liked flavor.