Open Access Case Report

Novel Technique in Late Stage Avascular Necrosis of Lunate: Tendon Interposition and Ligament Reconstruction with ECRL Tendon– A Case Report

Sarvang Desai, Apurva Patel, Malkesh Shah

Journal of Pharmaceutical Research International, Page 11-15
DOI: 10.9734/jpri/2022/v34i39B36241

Aim: To evaluate clinical and functional results of extensor carpi radialis longus tendon ball interposition for treatment of late stage avascular necrosis of lunate (kienbock’s disease).

Materials and Methods: Patient with stage 4 kienbock’s disease was treated with excision of lunate and ecrl tendon interposition to fill the cavity of the excised lunate bone. Tendon was split. One half was left in situ and the other was used to fill the cavity by passing it to the scaphoid and triquetrum. This also helps to maintain intercarpal stability. Functions were assessed using grip strength, range of movement of wrist, quick dash and visual analogue score. Radiological examination was performed to assess carpal height ratio and progression of arthritis.

Results: Long and bulky ecrl tendon acts as a spacer to fill the excised lunate. it also provides scapho lunate and lunate triquetral ligament reconstruction for inter carpal stability.

Conclusion: ECRL tendon used for interposition with reconstruction seems to be an effective treatment modality for late stage of kienbock’s disease.

Open Access Short Research Article

Platelet Transfusion and Tranexamic Acid in the Treatment of Bleeding in Dengue Fever

Jamshed Saddique, Madeeha Ghaffar, Muhammad Raffey Shabbir, Azeem Khalid, Asad Ur Rehman, Muhammad Osama, Abdullah Adil

Journal of Pharmaceutical Research International, Page 58-65
DOI: 10.9734/jpri/2022/v34i39B36248

Objective: We conducted this study to investigate the effectiveness of platelet transfusion and/or intravenous tranexamic acid in the treatment of clinical bleeding in patients with dengue fever at a tertiary care hospital during a large outbreak (August and November, 2011) of dengue fever in Lahore, Pakistan.

Methods: We reviewed data of patients with clinical bleeding and confirmed dengue fever at Jinnah Hospital Lahore, Pakistan. Based on the treatment, patients were classified into four groups: Baseline characteristics of patients and site and grade of bleeding were documented. A comparison of time to cessation of bleeding across four groups was made.

Results: Out of 100 selected patients with clinical bleeding, 65 were male and median age was 28 years (range 13-80). There were 47 patients in group A, 12 in group B, 9 in group C, and 32 in group D. 75 patients had bleeding from a single site while 24 patients had bleeding from 2 different sites and 1 patient had bleeding from 3 sites. Median time from the initiation of treatment till the cessation of bleeding was not significantly difference across four groups (p value = 0.724, Kruskal-Wallis test). Adverse effects included abdominal pain in group A and pruritus in group A and C.

Conclusion: Platelet transfusion and/or tranexamic acid do not provide significant benefit over standard of care treatment in patients with clinical bleeding in dengue fever and may be associated with adverse outcome.

Open Access Original Research Article

A Cross-sectional Comparative Study to Observe the Obstetric Complication Associated with Extreme (<18 - >35) Maternal Age

Nazia Azam Yousfani, Mehwish Zafar, Faisal Irshad, Rasheed Ahmed Soomro, Azra Ahmed, Fareeda Wagan

Journal of Pharmaceutical Research International, Page 1-10,
DOI: 10.9734/jpri/2022/v34i39B36239

Aim: To assess the frequency and association of obstetric complications in extreme of maternal ages.

Methods: A cross-sectional comparative study was conducted at a tertiary care hospital of district Nawabshah, Sindh and Suleman Roshan Medical College during the period April 2019- May 2020. The data regarding adverse obstetric outcomes of all teenage (<18 years) compared with the reference group of (19-22 years) and women of (>35 years) were compared with reference (31-34 years of age) delivering at the facility. The frequencies, percentages were derived as part of descriptive statistics, chi-square was used for parametric testing with 0.05 level of significance and odds ratio were applied to compare the risk of extreme age groups with their respective reference groups.

Results: A total of 104 participants were recruited in this study among 16.3% accounted for teenage (<18 years) and 34.6% accounted for advanced maternal age (> 35 years). Multivariate association between maternal age groups and the adverse obstetric variables were taken into account. Elevated rates for all adverse obstetric outcomes were observed between the variables among extreme-age mothers compared to reference group. The differences were statistically significant with p-value of 0.001 respectively. The chi-square test was found to be insignificant for other factors such as socio demographics, obstetric history and mode of delivery. Odds ratio was calculated to measure the risk associated with extreme age. Those women who were <18 years of age attributed 3.2 odds of developing fetal complications and 3.9 odds of developing maternal complication whereas women >35 years of age attributed 3.7 odds of developing fetal and odds 10.7 developing maternal complications.

Conclusion: Women in extreme age group were at a higher risk for developing adverse fetal and maternal obstetric complications as compared to their reference group.

Open Access Original Research Article

Outcomes and Predictors of Non-Responsiveness in Treatment of Naïve and Non-Cirrhotic Patients with HCV Genotype 3 Infection – A Third World Perspective

Saima Mehboob, Noor Mohammad, Amer Abbas, Syed Hassan Danish

Journal of Pharmaceutical Research International, Page 16-21
DOI: 10.9734/jpri/2022/v34i39B36242

Objective: To assess the clinical outcome in treatment naïve and non-cirrhotic patients with HCV genotype 3 infection after treatment with Sofosbuvir with declastasvir and valpatasvir (in case of non-responsiveness).

Methods: Study included 263 participants. The inclusion criteria were HCV genotype 3 infection confirmed through PCR, age above 18 years, treatment naïve and non-cirrhotic. HCV PCR below the threshold of quantification at 12th week of treatment was defined as SVR12 (sustained virological response). The patients were started on a fixed dose generic combination of declastasvir 60 mg and Sofosbuvir 400 mg and PCR was performed at 12, 24 and 48 weeks. PCR positive patients at 24 weeks were given valpatasvir with Sofosbuvir.

Results: There were 162 males and 101 females. PCR performed at 12 weeks showed that 251 patients (95.4%) became PCR negative and 12 (4.56%) remained positive. Repeat PCR of these 12 patients started on valpatasvir and Sofosbuvir at 48 weekswas negative. The treatment was well tolerated by all.Probability of positive HCV PCR at 12 weeks decreases by 0.73 with one unit increase in the hemoglobin, whereas one unit increase in TLC reduces the probability of HCV PCR at 12 weeks, positive by 0.001.

Conclusion: The combination of Sofosbuvir and declastasvir is a cheap and effective treatment strategy for treatment naïve and non-cirrhotic HCV genotype 3 infections. Those not responding will achieve PCR negativity with a 6 month therapy of Sofosbuvir and valpatasvir combination. A high hemoglobin level and high total leucocyte count are predictors of good treatment response.

Open Access Original Research Article

Diagnostic Accuracy of Susceptibility Weighted Magnetic Resonance Imaging for Glioblastoma Diagnosis

Mahnaz Baloch, Abid Ali Sahito, Mohsin Hussain, Asma Jatoi, Nazia Azeem, Zeeshan Ahmed Shah

Journal of Pharmaceutical Research International, Page 22-27
DOI: 10.9734/jpri/2022/v34i39B36243

Objective: To determine the ddiagnostic accuracy of susceptibility weighted magnetic resonance imaging (SW-MRI) for glioblastoma diagnosis by taking biopsy as gold standard.

Material and Methods: This cross-sectional study was done at department of Radiology, Jinnah Postgraduate Medical Center (JPMC), Karachi from June to December 2017. Total 114 cases with focal neurological deficit, seizures, stroke and CT scan findings of a mass with irregular thick margins and symptoms of increased intracranial pressure were enrolled. All the study subjects undergone SWI MRI. Brain biopsy was done during the same period of hospitalization. All the data was collected by study proforma and analysis of data was done by SPSS version 26

Results: Total 114 cases were studied and mean age of the cases was 50.64+10.37 years. Males were in majority 60.5% and females were 39.5%. Lesion average size was 4.34 cm. Glioblastoma was diagnosed among 68.4% cases on SW-MRI, while its was diagnosed among 71.1% study subjects by biopsy. SW-MRI showed sensitivity 90.1%, specificity 84.8%, PPV 93.5%, NPV 77.7% and diagnostic accuracy was found 88.59%.

Conclusion: The SW-MRI was observed to be the best diagnostic tool for glioblastoma with diagnostic accuracy of 88.59%, sensitivity 90.1% and specificity 84.8%. This diagnostic tool may helpful to indorse the expected diagnosis in clinical practice.

Open Access Original Research Article

Frequency of Anemia in Patients Admitted with Acute Decompensated Heart Failure in Tertiary Care Cardiac Hospital

Sharwan Bhuromal, Faraz Farooq Memon, Muhammad Asim Shaikh, Suresh Kumar

Journal of Pharmaceutical Research International, Page 28-34
DOI: 10.9734/jpri/2022/v34i39B36245

Introduction: Anemia is one of the potential comorbid condition in patients with acute decompensated heart failure (ADHF) which is linked to higher morbidity and mortality rates. Worldwide, its prevalence ranges from 4% to >70% in hospitalized patients with ADHF. Unfortunately data is lacking from our region and hence we aimed to conduct this study to scientifically fill the present gap by evaluating the actual burden of anemia in patients hospitalized with ADHF in a tertiary care hospital of Karachi, Pakistan.

Patients and Methods: This was a hospital based study conducted in the Department of Cardiology, Tabba Heart Institute, Karachi From 1st November 2019 to 30th April 2020. A total of 203 patients with ADHF with age >35 years and <80 years were selected. A blood sample was taken to determine the hemoglobin levels and hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men were taken as cut-off for anemia.

Results: Overall mean and SD of age was 63.70±10.53 years and among them most of were males (n = 116, 57.1%). The overall prevalence of anemia in patients with ADHF was quite high and 63.5% (n = 129). Only three condition, hypertension, diabetes mellitus, and current smoking habits had significant association with the occurrence of anemia in patients with ADHF, p value <0.05.

Conclusion: In conclusion, the results showed that anemia is an independent risk for HF. Anemia was observed in one-third of the study population. More prevalent in male gender, elderly patients of age above 60 years, and associated with other comorbids.

Open Access Original Research Article

Assessment of Efficacy of Nimesulide in the Treatment of COVID-19 Infection

Ahmed Farhan, Naveed Ullah Khan, Syed Muhammad Muneeb Ali

Journal of Pharmaceutical Research International, Page 35-42
DOI: 10.9734/jpri/2022/v34i39B36246

Objective: There are different anti-inflammatory drugs that are being used in patients with moderate to severe COVID-19 infection. However, in mild to moderate COVID-19 infection, Nimesulide treatment might impede the inflammation with a superior safety profile. Therefore, this study is intended to assess the anti-inflammatory, analgesic and antipyretic activity of Nimesulide in mild to moderate Covid-19 infection.

Methodology: This was an uncontrolled longitudinal study conducted at Pakistan Institute of Medical Sciences Islamabad. The duration of the study was about six months. A total of 66 patients were enrolled. All the patients received Nimesulide 100 mg along with 10 ml sucralfate suspension two times a day for five days. Patients with elevated C-reactive protein or further comorbidities were prescribed 250 mg azithromycin two times a day for five days. Patients with elevated D-dimer (above 500) or other comorbidities were prescribed enoxaparin in a dose of 60 mg subcutaneously once daily for five days. The Primary outcome was estimated in terms of a percent change in oxygen saturation, hospitalization, or death.

Results: The results showed that 31(47.0%) were females and 35(53.0%) were males. The mean oxygen saturation on presentation was 93%±7.9. 24(36.36%) of the patients had D-dimer levels < 250 ng/ml, while 30(45.45%) of the patients had D-dimer levels >250 ng/ml with significant difference between them (p=0.025). 16(24.24%) patients received enoxaparin while 49(74.24%) patients did not received enoxaparin and found a significant difference between the mean change in oxygen saturation of them (p<0.001). 47(71.2%) patients received azithromycin while 19(28.8%) patients did not received azithromycin and found a significant difference between the mean change in oxygen saturation of them (p=0.03).

Conclusion: This study concluded that Nimesulide treatment resulted in a rapid temperature fall within five days. Furthermore, oxygen saturation was also significantly improved in patients treated with Nimesulide.

Open Access Original Research Article

Thyroid and Extrathyroid Effects of Methimazole in Modeling Hypothyroidism with Different Doses of Antithyroid Drug: Morfofunctional Study

F. Kh. Kamilov, V. N. Kozlov, G. M. Abdullina, E. E. Ponomarev, I. A. Menshikova, T. I. Ganeev

Journal of Pharmaceutical Research International, Page 43-57
DOI: 10.9734/jpri/2022/v34i39B36247

Aims: Methimazole (MMI) is widely used in experimental thyroidology. However, the effect on thyroid function can vary widely depending on the route of administration and doses of the antithyroid drug. In some cases, it is difficult to determine whether the results obtained are a manifestation of thyroid dysfunction or a direct toxic effect of xenobiotic. The aim of the study was to establish the optimal dose of methimazole for the induction of hypothyroidism with minimal toxic effects on tissues.

Study Design: The effect of various doses of methimazole administered intragastrically to rats on thyroid status, histological structure of thyroid, liver and kidney was studied.

Place and Duration of Study:  Bashkir institute of Technology and Management (branch) of Moscow State University of Technology and Management n.a. K. G. Razumovsky, city of Meleuz, Bashkir State Medical University, Ufa, Russia, 2018-2019.

Methodology: Experiments were conducted on 60 nonlinear white male rats intragastrically administered different doses of methimazole. To assess the thyroid status, the concentration of circulating thyroid hormones in blood plasma and body temperature rhythms were determined. Along with the indicators of thyroid status, morphological changes in the thyroid gland, liver and kidneys were compared in rats that were administered different doses of MMI.

Results: Hormonal profile of rats received MMI in the dose 2,5 mg/100 g of body weight. for 3 weeks revealed decrease in mean free T4  (10,8±2,14 against 16,2±0,57 in control, P<0,001), total T3 (3,12±0,57 against 2,36±0,19, P<0,001 with the increase of TSH (0, 12±0,01 against 1,96±0,18, P<0,001). The hypothyroid state in this group of animals is also confirmed by decrease in the arithmetic mean values of body temperature.

Conclusion: The results obtained indicate that a dose of 2.5 mg/100 g of b. w. for 3 w. leads to the development of symptoms characteristic of endemic thyroid dysfunction, and is accompanied by minimal toxic effects on tissues.