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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 9 | Issue 2
Page Nos. 61-124

Online since Friday, June 26, 2020

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ORIGINAL ARTICLES  

Herbal supplement use and herb–drug interactions among patients with kidney disease p. 61
Soroush Mohammadi, Gholamreza Asghari, Afsoon Emami-Naini, Marjan Mansourian, Shirinsadat Badri
DOI:10.4103/jrpp.JRPP_20_30  
Objective: The prevalence of herb–drug interactions and herb's adverse effects may be serious in susceptible population such as patients with chronic kidney disease (CKD). In this study, we planned to determine the usage prevalence of herbal products and herb–drug interactions in CKD patients. Methods: A cross-sectional prospective study was conducted on CKD and posttransplant patients with a history of using herbal supplements in Isfahan, Iran. The patients were subjected to a validated checklist, containing demographic and clinical information. The knowledge of herbal use, side effects, and herb–drug interactions was assessed based on patients' responses. Data were reported as prevalence (percent) of the occurrence. Findings: The prevalence of herbal supplement usage among CKD patients was 18.6% in this study. The study included 400 patients (261 males and 139 females). The majority of the study population were in the age range of 50–70 years (61.5%). Hypertension (34.36%) was the most common cause of kidney failure, while diabetes mellitus (21.80%) took the second place. The most frequently used unformulated medicinal herb was Echium (Echium amoenum) (15.27%), and the most commonly used formulated herbal products were anticough and mucolytic based on Thymus vulgaris (24.27%). Eighteen patients (4.5%) used herbal mix with unknown entity and sources. In this study, ginseng has the most possible interactions with prescription drugs (18 interactions), while this interaction (with clopidogrel, warfarin, and heparin) was severe in six cases. Conclusion: The present study provided the information on possible herb–drug interactions in CKD patients on herbal usage. Since the issue of using herbal products may be arbitrarily in the majority of the patients, and considering the importance of adverse reactions or major interactions, health-care providers should play an active role to identify these cases and inform the patients regarding herbal product safety, adverse effects, and possible interactions.
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A comparative study on the efficacy of levetiracetam and carbamazepine in the treatment of rolandic seizures in children: An open-label randomized controlled trial p. 68
Parisa Ahadi, Jafar Nasiri, Mohammad Reza Ghazavi, Toktam Mosavian, Vahid Mansouri
DOI:10.4103/jrpp.JRPP_20_53  
Objective: This study was performed to investigate whether levetiracetam should be preferred to carbamazepine as a treatment choice for benign childhood epilepsy with centro Temporal spikes (BCECTS), the most common partial epilepsy of childhood. Methods: This randomized clinical trial study included 92 children with rolandic epilepsy aged 4–12 years referred to the Pediatric Neurology Clinic at Imam Hossein Hospital, Isfahan, Iran, from April 2019 to January 2020. Patients were selected consecutively and randomly assigned to two study groups (levetiracetam and carbamazepine groups). Patients were followed and revisited every 2 months for 6 months after starting the medication. The frequency and duration of seizure attacks and drug side effects were recorded before treatment and in bi-monthly visits. Data were analyzed by SPSS software Version 24 using Mann–Whitney U- test and Friedman test. Findings: In our study, the seizure frequency decrease was not significantly different between the two groups; however, patients in both groups showed significantly lower seizure frequency in 2, 4, and 6 months of follow-up compared to starting time. After a follow-up for 6 months, one out of 47 (2.1%) patients using levetiracetam showed intolerance, resulting in changing the medication. In addition, two out of 48 (4.1%) patients in the carbamazepine group had skin rashes. No significant changes had been reported regarding the duration of seizure attacks in both groups after treatment. Conclusion: This study showed encouraging results for using levetiracetam, with acceptable results and fewer side effects for the treatment of children with BCECTS in Iran.
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A comparative study of the cost and uptake of community pharmacy “Stop Smoking and Emergency Contraception” services from the perspective of the National Health Service p. 73
Wail Chalati, Philip Crilly, John Fletcher, Reem Kayyali
DOI:10.4103/jrpp.JRPP_20_35  
Objective: The objective was to explore if the community pharmacy (CP) stop smoking service (SSS) and emergency hormonal contraception patient group direction (EHC PGD) meet the needs of the English population and are cost-effective. Methods: This research was completed over 2 years. Public health resources provided details of CPs and provision of SSS and EHC PGD. Questionnaires were sent to smoking cessation/sexual health leads in local authorities to obtain information not available elsewhere. Questionnaires inquired about CP payment for provision of SSS and EHC PGD, overhead costs, successful outcomes, and validation methods. Quit rates at 4-weeks, 52-weeks, and lifetime determined SSS effectiveness. The effectiveness of EHC PGD was based on the probability of unintended pregnancy with/without levonorgestrel. Incremental cost-effectiveness ratio and cost of quality-adjusted life years (QALYs) gained were calculated. Descriptive statistics were determined. A priori of less than 0.05 (P < 0.05) was significant. Findings: SSS provision and uptake did not match local needs (smoking prevalence) even though increased CP SSS provision correlated with increased SSS success. Similarly, the need (based on teenage pregnancy rates) for EHC PGD did not correlate with the rate of CP provision but only with the uptake. Nevertheless, the provision of SSS and EHC PGD from CPs was cost-effective from an NHS perspective. Various assumptions were tested, but in all cases fell well below NICE QALY recommendations for cost-effectiveness. Conclusion: Provision of SSS and EHC PGD from CP does not meet the needs of the population even though the delivery of these services is cost-effective.
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A population-based study on patients complaining regarding community pharmacies services p. 88
Marziyeh Zare, Saba Afifi, Iman Karimzadeh, Mohammad Salehi-Marzijarani, Leila Zarei, Gholamreza Ghazipour, Mahtabalsadat Mirjalili, Kamran B Lankarani, Ali Mohammad Sabzghabaee, Fariba Ahmadizar, Payam Peymani
DOI:10.4103/jrpp.JRPP_19_82  
Objective: Patients' complain regarding pharmaceutical services at community pharmacies is a fundamental issue as it can directly affect people's service utilization. For the first time in Iran, this survey aimed to investigate the experience of people regarding declare a complaint against the pharmacy sectors as a community-based study. Methods: In this cross-sectional study, over 100 samples based on postal codes were randomly selected from the city of Shiraz in 2017–2018. The data collection instrument was designed in two parts (demographic and social profile which record the complaint experiences against pharmacists, pharmacy services, etc.). The data were analyzed by SPSS. Findings: All 1035 eligible participants had a mean age of 45.54 ± 15.82 years (ranged from 14 to 91). Nearly 70% of the participants were female. Around 81.8% had a family physician coverage, whereas 7.4% of them had no medical insurance coverage. The frequency of complaints from the pharmacies was 35.6%. Nearly 55% of the complaints were related to governmental pharmacies. Homemakers were 1.36 times more likely to have experienced complaints in comparison with their employed female counterparts. Health status had an inverse association with complaints. Those participants who had received prescription medication were about two times more likely to have filed a complaint in comparison with those who received medication without a prescription. In addition, females aged 40–59 and above 60 and unemployed participants were more satisfied with respect to complaint follow-up process. Conclusion: Low level of satisfaction with respect to the complaint process is a concerning issue; hence, strategies are warranted to improve the quality of services provided in the pharmacies.
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The effect of octreotide in acute nonvariceal upper gastrointestinal bleeding: A randomized, double-blind, placebo-controlled trial p. 94
Masoud Abrishami, Payam Peymani, Marziyeh Zare, Kamran B Lankarani
DOI:10.4103/jrpp.JRPP_19_57  
Objective: Nonvariceal upper gastrointestinal bleeding (NUGIB) is a common cause of hospitalization and is associated with considerable mortality and morbidity. Octreotide has been shown to be an effective treatment in the control of variceal UGIB. Theoretically, octreotide could be effective in the treatment of other types of bleeding ulcers. Methods: This randomized, double-blind, placebo-controlled trial was carried out on patients with NVUGIB who had been admitted to two referral centers in Shiraz, Iran. Patients were randomized to two groups: Group A (n = 58) received octreotide and Group B (n = 58) received a placebo. Patients in both groups received pantoprazole 40 mg as an initial dose, then 40 mg every 12 h intravenously. In addition to the pantoprazole, patients in Group A received 100 μg octreotide subcutaneously every 8 h for 72 h or until they were discharged. Patients in Group B received pantoprazole and a placebo at the same dose schedule. Findings: There were no statistically significant differences between Groups A and B in terms of mortality (0 vs. 5.17%; P = 0.21,) rebleeding rate (5.17% vs. 1.72%; P = 0.5), blood transfusion requirement (1.65 ± 0.47 units vs. 1.70 ± 0.45 units; P = 0.45), length of hospital stay (1.96 ± 1.00 days vs. 1.65 ± 0.84 days; P = 0.44), and need for surgery (1.72% vs. 1.72%; P = 0.7). Conclusion: The results showed that use of subcutaneous octreotide as an adjuvant treatment did not have a beneficial effect on the treatment of NVUGIB.
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The comparison of levofloxacin- and clarithromycin-based bismuth quadruple therapy regimens in Helicobacter pylori eradication p. 101
Abbas Arj, Marzieh Mollaei, Mohsen Razavizadeh, Alireza Moraveji
DOI:10.4103/jrpp.JRPP_19_86  
Objective: The aim of the current study was to compare the efficacy of quadruple therapy including levofloxacin and clarithromycin for Helicobacter pylori eradication. Methods: This clinical trial study was conducted on 189 patients with H. pylori infection who underwent gastroscopy and stomach biopsy in Shahid Beheshti Hospital, Kashan, Iran. After classification of patients, one group was treated with bismuth subcitrate (120 mg, 2 tablet/12 h), omeprazole (20 mg/12 h), amoxicillin (1 g/12 h), and clarithromycin (500 mg/12 h) and other group with bismuth subcitrate (120 mg, 2 tablet/12 h), omeprazole (20 mg/12h), amoxicillin (1 g/12 h), and levofloxacin (500 mg/12 h) for 2 weeks. After the end of the antibiotic treatment, omeprazole therapy was continued for 4 weeks. Two weeks after discontinuation of omeprazole, fecal antigen test was performed for both the groups to confirm the eradication of H. pylori infection. Findings: The success of H. pylori eradication in the levofloxacin and clarithromycin groups was observed in 78 (89.7%) and 71 (69.6%) patients, respectively (P < 0.01). A significant difference was also seen between the two groups in terms of side effects and its incidence (P < 0.01), so that the incidence of side effect types in the clarithromycin group was more than the levofloxacin group except muscular pain and fatigue (P < 0.01). Conclusion: Levofloxacin-based quadruple regimen therapy was superior to clarithromycin-based quadruple regimens regarding H. pylori eradication and side effects. Therefore, the levofloxacin-based regimen can be considered as an effective treatment for the first-line anti-H. pylori therapy.
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Intravenous drug incompatibilities in the intensive care unit of a tertiary care hospital in India: Are they preventable? p. 106
Shanmugam Sriram, S Aishwarya, Akhila Moithu, Akshaya Sebastian, Ajith Kumar
DOI:10.4103/jrpp.JRPP_20_11  
Objective: The main aim of the study was to identify the physical and chemical incompatibilities among the drugs administered intravenously to patients admitted to the Intensive Care Unit (ICU) of a 1000 bedded hospital. The study also envisaged establishing pharmaceutical guidelines for the administration of incompatible medications. Methods: This prospective cross-sectional study was conducted from January to July 2018 in the ICU after getting approval from the Hospital Ethics Committee. A total of 104 medication charts were collected, and their data were analyzed. Compatibility of the selected drug with a second drug, when given together, was then analyzed using the Micromedex health-care series, Trissel's handbook of injectable drugs, and Manufacturer's product information. The pharmaceutical intervention was performed by preparing. The drug compatibility chart of selected drugs and the same was reported to the study department. Findings: Of 104 medication charts reviewed, 66 charts had incompatibility, accounting for 90 incompatibilities. Incompatibility between two intravenous (IV) bolus drugs constituted 68.8% with pantoprazole and ondansetron (85.4%) being the most frequent combination. Incompatibility between infusion-bolus was found to be 26.6%. Meropenem (infusion) and pantoprazole (bolus) constituted 16.6%. Incompatibility between two infusions in the same IV line was found to be 4.4%. A drug compatibility chart containing 19 selected drugs was prepared and submitted to the study department for their perusal. Conclusion: The current study showed that a significant number of drug incompatibilities occur in hospitalized critically ill patients in our tertiary care hospital. These incompatibilities could generally be prevented by adhering to proper medication administration techniques like flushing the line using compatible fluid or through a multi-lumen catheter or multiple IV access.
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Effect of oral midazolam in pain relief of patients need nasogastric tube insertion: A clinical trial study p. 112
Asghar Jafari Rouhi, Alireza Zeraatchi, Farzad Rahmani, Asghar Jafari Rouhi, Nima Motamed, Ala Rastin, Afsaneh Karami, Arezoo Nejabatian
DOI:10.4103/jrpp.JRPP_19_80  
Objective: Due to the presence of pain during nasogastric tube (NGT) insertion and related complications and lack of positive clinical response of nasopharyngeal anesthesia with lidocaine and the related side effects and limitations in ketamine and intravenous midazolam, this study aims to determine the efficacy of oral midazolam in relieving pain in the patients requiring NGT insertion. Methods: A randomized, triple-blind clinical trial was performed on the patients in the Emergency Department of Zanjan Valiasr and Mousavi Hospitals in Iran, who were nominated for NGT. In each group, 100 patients were examined. Two milligram syrups of midazolam and placebo were administered 20 min before the procedure. In two groups, the pain based on the Visual Analog Scale and satisfaction rate of patients during the NGT insertion were compared. The data were analyzed through the SPSS software version 16.0. Findings: There was no statistically significant difference in the demographic characteristics of two groups. Despite the effects of potential confounding variables, the cause of the referral and indication of NGT, as well as the use of midazolam syrup, had a significant relationship with the outcome, so that midazolam group experienced less pain. The mean and standard deviation of the examined outcomes (feeling of pain and satisfaction with NGT insertion) was statistically significantly different in the midazolam group as compared to the placebo group (P = 0.001). Conclusion: Midazolam was effective in decreasing pain and increasing the satisfaction of patients after NGT insertion. This manuscript is registered in Irct. com with code IRCT20110629006922N4.
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VIEWPOINT Top

Scholarly pathway: Understanding, planning, and competency mapping in pharmacy education p. 118
Syed Wasif Gillani, Shabaz Mohiuddin Gulam
DOI:10.4103/jrpp.JRPP_19_134  
Pharmaceutical education has extensive integration of courses from life sciences to technology application and drug discovery to clinical trials. Pharmacy students are capable of diverse career selection due to acquired competencies during professional education. However, there is always a lack of real-time research exposure to pharmacy students at the undergraduate level. Therefore, the purpose is to design an effective research series that provides first-hand research experience to pharmacy students during 2–4 years of PharmD studies. The course design and delivery focused on three elements, namely, quality assurance, curriculum requirement, and assessment method. The outcomes of the course series are consistent with the emerging research skills and evidence-based practitioner role. The series and multilevel of course sequels comprising from knowledge – comprehension – argument – to – synthesis of research article. Students are expected to conduct independent research project under the supervision of college faculty. This will help them to develop and advance research skills for lifelong learning. The scholarly pathway series will develop critical appraisal skills to argue/support/value the literature and develop competency for evidence-based medicines. It will be highly beneficial to develop critical thinking, professionalism, and research skills among pharmacy students.
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BRIEF COMMUNICATION Top

Potential of drug interactions as a cause of adverse drug reactions in patients with kidney diseases p. 121
Tahereh Gholipur Shahraki, Fatemeh Yari, Shiva Seirafian, Shirinsadat Badri
DOI:10.4103/jrpp.JRPP_20_38  
Objective: Adverse drug reactions (ADRs) are one of the major causes of mortality. One of the major causes of ADR is drug–drug interactions. The purpose of this study was to evaluate the prevalence and characteristics of ADRs caused by the drug interactions in the nephrology departments. Methods: This cross-sectional prospective study was carried out in the nephrology department on 117 patients who received at least two medicines. Drug interactions were determined, and the patients were evaluated for the presence of a drug complication. Findings: A total of fifty ADRs were observed in 39 patients, whereas 26% of total ADRs (13 drug complications) were due to drug interactions. About 69% and 31% of complications were classified in terms of severity, in the category of “severe” and “moderate” complications, respectively. Warfarin had the highest contribution to major interactions (33.33%). Conclusion: ADRs, which specially occurred due to drug interactions, are particularly important for patients taking multiple medications (e.g., patient with renal insufficiency). Therefore, special attention should be paid to preventing and reducing ADRs in these patients' population.
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