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   2018| April-June  | Volume 7 | Issue 2  
    Online since June 29, 2018

 
 
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ORIGINAL ARTICLES
Dispensing of antimicrobials in Kenya: A cross-sectional pilot study and its implications
Mwasi Mary Ann Mukokinya, Sylvia Opanga, Margaret Oluka, Brian Godman
April-June 2018, 7(2):77-82
DOI:10.4103/jrpp.JRPP_17_88  PMID:30050960
Objective: The objective of this study was to evaluate the extent of self-medication of antibiotics and dispensing practices in Kenya. Methods: A cross-sectional study was carried out at three selected pharmacies in Nairobi (Kenya), between January and March 2017, targeting principally antibiotic prescriptions for systemic use issued and dispensed as well as antibiotics sold over-the-counter without a prescription. The quality of antibiotics prescribed and dispensed was assessed against key WHO and other criteria. Benchmarking was used to assess the quality of antibiotics prescribed as there are no predetermined levels, just guidance and the rationale. Key indicators included: utilization of penicillins, percentage utilization of third-and fourth-generation of cephalosporins versus first and second generation, utilization of macrolides including lincosamides and utilization of quinolones as a percent of total systemic antibiotic use. Findings: There was a low level of dispensing of antibiotics without a prescription with over 90% (94.1%) of antibiotics dispensed with a valid prescription. The most common antibiotics dispensed were the penicillins at just over 50% of all antibiotics, the cephalosporins at over 12% (12.6%) and the fluoroquinolones at just under 12% (11.7%). There were concerns with high use of third and fourth generation cephalosporins versus first- and second-generation as well as co-amoxiclav versus other penicillins. Conclusion: Low levels of self-medication of antibiotics and high adherence to quality standards for dispensing are encouraging and provide direction to other countries. Educational initiatives are needed though to address high levels of co-amoxiclav prescribing.
  1,461 173 1
REVIEW ARTICLE
Effects of carnitine on nutritional parameters in patients with chronic Kidney disease: An updated systematic review and meta-analysis
Tahereh Gholipur-Shahraki, Awat Feizi, Mojgan Mortazavi, Shirinsadat Badri
April-June 2018, 7(2):57-68
DOI:10.4103/jrpp.JRPP_18_50  PMID:30050958
Protein energy malnutrition is a common problem in patients with chronic kidney disease (CKD). Scattered reports indicate that supplementation of Carnitine may improve patients' clinical symptoms, with significant improvement in nutritional parameters. This systematic review was done to document the evidences of Carnitine effects in nutritional status of CKD patients. Peer-reviewed RCTs on Carnitine administration at any dose in CKD patients with at least four weeks of follow-up were including in the meta-analysis. Online databases (PubMed/Medline, ISI Web of Science, Embase, and Scopus) were searched to October 2017 using selected MeSH terms related to the study topic. Data was extracted independently by two reviewers using a standard form and then cross-checked. Statistical analyses were carried out with Comprehensive Meta-analysis software. Data are presented as standard mean difference (SMD) and 95% confidence interval (CI). According to the predefined criteria, a total of 14 randomized controlled clinical trials were included and screened for data extraction by two reviewers, separately. The preliminary results extracted from meta-analysis have shown that Carnitine can significantly increase the levels of albumin (SMD: -0.861; 95% CI: -1.321, -0.402), total protein (SMD: -0.418; 95% CI: -0.695, -0.141), total cholesterol (SMD: -0.350; 95% CI: -0.564, -0.135), LDL cholesterol (SMD: -0.362; 95% CI: -0.551, -0.173), transferrin (SMD: -1.465; 95% CI: -1.822, -1.108), and hemoglobin (SMD: -0.525; 95% CI: -0.732, -0.318); however there were no conclusive effects of Carnitine on body weight (SMD: -0.057; 95% CI: -0.404, 0.291) and BMI (SMD: -0.567; 95% CI: -1.548, 0.415), in pooled analyses. The results of this meta-analysis showed that there are considerable useful pieces of evidence so far about the effect of Carnitine on nutritional factors; however, there is still doubt about some evidences with this regard. It seems necessary to carry out clinical trials with stronger designs to evaluate the impact of these primary outcomes on the patients' clinical conditions. Having this evidences, the potential role of Carnitine in improving malnutrition consequences in CKD patients would be clearly defined.
  1,231 301 -
ORIGINAL ARTICLES
Trend analysis of medicine consumption based on therapeutic categories in Iran: 2000–2016
Alireza Yektadoost, Farid Ebrahimi, Mohammadreza Mashouf, Naghmeh Hadidi, Nasser Nassiri Koopaei, Abbas Kebriaeezadeh
April-June 2018, 7(2):95-103
DOI:10.4103/jrpp.JRPP_17_96  PMID:30050963
Objective: Iranian healthcare system cost has been remarkably growing during the recent decades. Drug shortages and the economic effects of the sanctions have also exposed the pitfalls and shortcomings of the pharmaceutical system. Moreover, the pharmaceutical system is a major expenditure source for the health system. Pharmaceutical market trend analysis serves as a reliable tool to gather and analyze market and consumption data to take account of the past policies and forecast the future of the market and disease trends. Methods: The present work tries to quantitatively describe and analyze past 17 years of Iranian pharmaceutical market sales data from 2000 to 2016. The anatomical therapeutic chemical-classified drug utilization data obtained from the Iranian Food and Drug Administration were used to analyze the market trends for each therapeutic class and categorize them. Findings: The size of Iranian pharmaceutical market has grown dramatically during the last 5 years reaching to $5.183 billion in 2016 from $3.847 billion in 2011 with a compound annual growth rate of 6.14%. Antidiabetics and antineoplastic agents were one of the most prominent market growth drivers. Introduction of new drug molecules to the market has also contributed to the trend. However, the noncommunicable diseases are gaining momentum in the national disease burden. Conclusion: The market growth necessitates policies to prevent the overwhelming cost burden on the healthcare system which in turn requires well-informed decision-making. Pharmaceutical market trend analysis tries to supply the evidence feed for informed policy-making to forecast, prioritize, and contain the cost burden imposed on the healthcare system by the pharmaceutical sector.
  1,239 187 1
Comparing the effect of immediate versus delayed initiation of tacrolimus on delayed graft function in Kidney transplant recipients: A randomized open-label clinical trial
Maryam Ghadimi, Simin Dashti-Khavidaki, Mohammad-Reza Khatami, Mitra Mahdavi-Mazdeh, Mansoor Gatmiri, Farzaneh Sadat Minoo, Neda Naderi, Atefeh Jafari, Mohammad-Reza Abbasi, Ali Ghafari
April-June 2018, 7(2):69-76
DOI:10.4103/jrpp.JRPP_17_90  PMID:30050959
Objective: Delayed graft function (DGF) is an early complication after kidney transplantation with negative impact on allograft outcomes. This study assessed the effect of delayed initiation of tacrolimus as a nephrotoxic drug, on DGF occurrence and allograft function. Methods: This randomized, open-label clinical trial was conducted on kidney transplant recipients with the age of at least 14 years who underwent the first kidney transplantation from deceased or living donor. Patients were randomly allocated to immediate (n = 26) or delayed tacrolimus (n = 27) groups. All patients received thymoglobulin as induction therapy and similar maintenance immunosuppression including tacrolimus, mycophenolate, and prednisolone with the difference in the time of initiation of tacrolimus either on the day of transplantation (immediate tacrolimus group) or day 3 after transplant (delayed tacrolimus group). Findings: DGF incidence (46.15% vs. 37.04%; P = 0.501) and duration (9.75 ± 6.41 vs. 8.6 ± 6.16 days; P = 0.675) were not different between the immediate and delayed tacrolimus groups. Estimated creatinine clearance using Cockcroft–Gault equation (63.14 ± 18.81 vs. 58.19 ± 19.42 mL/min in immediate and delayed tacrolimus groups respectively; P = 0.373) and estimated acute rejection-free survival were also comparable between the groups over the 3 months of follow-up. Compared with the immediate group, the delayed tacrolimus group showed higher estimated 3-month grafts' survival (100% vs. 84.27%; P = 0.072). Conclusion: Delayed initiation of tacrolimus after kidney transplantation under the umbrella of thymoglobulin induction did not result in either lower incidence or duration of DGF or improved the level of graft function in kidney transplant recipients but non-statistically significant increased 3-month grafts' survival.
  1,129 223 1
The effects of Aloe vera-Peppermint (Veramin) moisturizing gel on mouth dryness and oral health among patients hospitalized in intensive care units: A triple-blind randomized placebo-controlled trial
Vajihe Atashi, Ahmadreza Yazdannik, Hosein Mahjobipoor, Somayeh Ghafari, Reza Bekhradi, Hojatollah Yousefi
April-June 2018, 7(2):104-110
DOI:10.4103/jrpp.JRPP_18_21  PMID:30050964
Objective: Mouth dryness is one of the most prevalent problems in Intensive Care Units (ICUs). It facilitates dental plaque formation. The aim of this study was to analyze the effects of Aloe vera-Peppermint (Veramin) moisturizing gel on mouth dryness and oral health among patients hospitalized in ICUs. Methods: This triple-blind two-group randomized placebo-controlled clinical trial was undertaken in 2016–2017 on a convenient sample of 80 patients. Patients were randomly allocated to an intervention and a placebo group. Oral care for patients in the intervention and the placebo groups was provided for 5 successive days using Veramin moisturizing gel and a placebo gel, respectively. Data were collected at the 1st, 3rd, and 5th days of the study using a demographic and clinical characteristics questionnaire, the Challacombe scale (for mouth dryness assessment), and the Mucosal-Plaque Index (for oral health assessment). The Chi-square, Fisher Exact, Mann–Whitney U, and Friedman tests were used for data analysis. Findings: In the 5th day, the mean score of mouth dryness in the intervention group was significantly lower than the placebo group (P = 0.0001). On the other hand, in the third and the 5th days, the oral health mean score in the intervention group was significantly lower than the placebo group (P = 0.0001). Conclusion: Veramin moisturizing gel is effective in significantly relieving mouth dryness, preventing dental plaque formation, and improving oral health. Thus, it can be used for improving oral care outcomes in ICUs.
  1,081 220 2
CASE REPORT
Cetirizine-induced fixed drug eruption
Srija Gopal, Selvalaxmi Gnanasegaran, Gerard Marshall Raj, Sakthibalan Murugesan, Mangaiarkkarasi Adhimoolam
April-June 2018, 7(2):111-114
DOI:10.4103/jrpp.JRPP_17_99  PMID:30050965
Cetirizine, a piperazine-derivative second-generation antihistaminic, is used for a wide variety of disorders such as urticaria, eczema, and allergies. Adverse reactions due to this drug are usually rare, especially fixed drug eruption (FDE), a delayed cell-mediated hypersensitivity reaction, is scarce. Here, we report a case of cetirizine-induced FDE. A 34-year-old female developed hyperpigmented, itchy patches over both forearms, legs, feet, and right side of the chest after taking tablet cetirizine for dry cough with similar episode 2 years back on the same sites. The patient responded slowly with conservative treatment and the lesions disappeared after 10 days. She was advised to avoid the causative in near future. This case report highlighted FDE due to an antihistaminic which themselves will be prescribed to treat allergies.
  915 217 1
ORIGINAL ARTICLES
Meropenem utilization evaluation in a referral teaching hospital in Iran
Peyman Naderi, Kiana Shirani, Rasool Soltani, Farzin Khorvash, Seyed Saeed Naji Esfahani
April-June 2018, 7(2):83-87
DOI:10.4103/jrpp.JRPP_17_86  PMID:30050961
Objective: Inappropriate use of antibiotics is associated with detrimental effects including emergence of antibiotic resistance. This study aimed to evaluate the use of meropenem, an extended-spectrum antibiotic, in a referral teaching hospital to detect different types of errors in its prescription. Methods: In a cross-sectional study performed over a 6-month period (2014–2015), hospitalized adult patients who received meropenem for any indication were randomly selected. The collected data included the indication for prescription and its correctness, the basis of prescription (empirical or culture based), administered dose, duration of treatment, the status of demanding sample culture in the case of empirical prescription, the status of dose adjustment in the case of renal impairment, and the treatment outcome. Findings: Over the study period, 123 patients were evaluated. The most frequent indication for prescription of meropenem was pneumonia (31.7%) and soft-tissue infections (18.7%). Out of these prescriptions, 62.6% (77 prescriptions) were incorrect. All meropenem prescriptions were initially empirical. Furthermore, sample culture and antibiotic susceptibility test were requested for only 52% of patients (n = 66). Treatment duration was correct for 53.7% of patients. Seventeen patients (13.8%) received an inappropriate dose of the antibiotic. Furthermore, of 51 patients who needed meropenem dose adjustment because of renal impairment, 17 patients (33.33%) received unadjusted dose. Conclusion: High rate of errors exists in the utilization of meropenem in our hospital, especially in the rank order of selection for treatment (indication), dose adjustment, and treatment duration. Therefore, modification strategies are necessary to promote the rational use of meropenem in this center.
  891 164 -
Impact of a pharmacist-driven spirometry clinic service within a community family health center: A 5-year retrospective review
Michael J Cawley, William J Warning
April-June 2018, 7(2):88-94
DOI:10.4103/jrpp.JRPP_17_101  PMID:30050962
Objective: This study was designed to describe the impact of a trained pharmacist in performing quality spirometry testing within a community family health center. Methods: This was a retrospective, cohort study of 150 physician-referred patients who attended their scheduled spirometry office appointment between November 2008 and December 2013. Information obtained included type of the disease (patients with obstructive or restrictive pulmonary disease), calculated lung age decline due to smoking history, quality of spirometry testing, and percentage of patients requiring pulmonary drug regimen alterations due to spirometry results. Pearson correlation and descriptive statistics were used to address study objectives. Findings: Spirometry testing performed by a pharmacist resulted in 87% of tests meeting guidelines for quality. Testing identified patients with reversible airway disease (39%), chronic obstructive pulmonary disease (21%), restrictive (11%), and mixed obstructive/restrictive (11%) lung defect. Patients with abnormal spirometry demonstrated a greater smoking pack-year history and calculated lung age than patients with normal spirometry (29.1 pack-years vs. 17 pack-years; P = 0.024 and 76.3 years vs. 54.6 years; P < 0.001, respectively). A weak correlation was found between a 29.1 smoking pack-year history and forced vital capacity (r = −0.3593, P = 0.018). The pharmacist assisted in modifying pulmonary drug regimens in 69% of patients based on evidence-based guidelines. Conclusion: A pharmacist-driven spirometry service was associated with quality testing results, identified respiratory disease abnormalities, and helped modifications of pulmonary drug regimens based on evidence-based guidelines. Future direction of this service may include collaborative practice agreements with physicians to expand services of pharmacists to include spirometry testing.
  847 151 -
LETTER TO THE EDITOR
A new treatment approach for acute paraquat poisoning
Gholamali Dorooshi, Shafeajafar Zolfaghari, Nastaran Eizadi-Mood, Farzad Gheshlaghi
April-June 2018, 7(2):115-116
DOI:10.4103/jrpp.JRPP_18_13  PMID:30050966
  796 141 -
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