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   Table of Contents - Current issue
October-December 2020
Volume 9 | Issue 4
Page Nos. 169-219

Online since Monday, January 11, 2021

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Review of COVID-19 treatment p. 169
Somayeh Sadeghi, Mahnaz Momenzadeh, Peiman Nasri, Mina Nickpour
Many contagious diseases, such as plague or cholera, played a role in changing the pathway of history. In this respect, although coronavirus was not as dangerous as novel diseases such as swine flu and Ebola, the spread and the power of coronavirus infiltration caused public fear across the world. Three viruses among coronaviruses have been epidemic during the recent years, including severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 or new coronavirus. Respiratory droplets transmit the coronavirus through direct and indirect contact, and it can be transmitted through the contact in the case of remaining, the infected person's secretion on the surface. Based on the conducted studies on the treatment of COVID-19 disease, there is virtually no cure or vaccine for coronavirus infections yet. Those infected with Covid 19 are quarantined to prevent the outbreak of this disease. However, the researchers carried out different studies to investigate the impact of the various drugs on this virus, which in this study, we will examine the outline of this disease and the other conducted studies.
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Pharmacological and nonpharmacological studies on coronavirus disease 2019: A mini-review of the recent evidence p. 175
Amir Hossein Alizadeh Bahmani, Mehdi Hoorang, Sheida Hosseini, Mehrnoosh Eskandari, Kiana Shayestehfard, Mahyar Shekoohi, Nazafarin Hatami-Mazinani, Saba Afifi, Ali Mohammad Sabzghabaee, Payam Peymani
Coronavirus 19 (COVID-19) is an extremely transmittable microbial infection that has emerged in Wuhan (China) in late 2019, leading to severe acute respiratory syndrome coronavirus 2 syndrome, and caused a pandemic all over the globe. This study is a systematic review of all 927 clinical trial studies performed worldwide from the beginning of the COVID-19 mysterious pandemic in China. These researches have registered in different databases. According to the best of our knowledge, China (74.82%), the United States (4.49%), and France (2.72%) have the most significant number of clinical trials, respectively. Clinical trials can be randomized or nonrandomized. Due to our results, 32.58% of studies were randomized, and 7.12% were not randomized. Most of the studies were open-labeled studies (22.44%), and double-blinded (4.42%) and quadruple blinded (2.48%) studies stand in second and third place regarding the number of trials, respectively. The direction and quantity of clinical trials attempted to identify a possible cure for COVID-19 demonstrates the depth of this crisis. As we are writing this article, a significant international endeavor will find a cure or vaccine for containing this devastating and mysterious disease.
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Medicines availability among hypertensive patients in primary health care facilities in a rural province in South Africa: Findings and implications p. 181
Enos M Rampamba, Johanna C Meyer, Elvera Helberg, Brian Godman
Objective: Controlling blood pressure (BP) in hypertensive patients is a challenge, with the lack of antihypertensive medicines negatively impacting on BP control. Consequently, we assessed the availability of prescribed antihypertensives among patients with chronic hypertension attending primary health care (PHC) facilities in a rural province of South Africa and explored any association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data that included patients' demographics, BP, and data on medicines availability of the intervention group from a 3 months' operational study conducted in rural PHC facilities in South Africa were analyzed. The association between medicines availability, the number of antihypertensive medicines, and BP control was explored. Findings: Fifty-five African patients (89.1% females) with a mean age of 61.3 years were included. Two-thirds (67.2%) received all their medicines during their monthly visits, 25.5% received some, and for 7.3%, there was no record of whether medicines were dispensed or not. Patients with controlled BP (60.0%) were more likely to have been prescribed only one antihypertensive medicine compared to patients with uncontrolled BP (20.7%) (P = 0.017; odds ratio: 5.75; 95% confidence interval: 1.46, 22.61). Conclusion: It is concerning that one-third of patients went home without all of their antihypertensive medicines from PHC facilities in this Province of South Africa where there is evidence of use of herbal medicines and uncontrolled BP contributing to high morbidity and mortality from cardiovascular diseases. Additional studies are needed to fully explore the association between medicines availability, their use, and BP control among patients.
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Effect of pharmacist intervention on medication adherence and clinical outcomes of type 2 diabetes mellitus outpatients in primary healthcare in Indonesia p. 186
Nani Apriani Besemah, Ratu Ayu Dewi Sartika, Rani Sauriasari
Objective: In Indonesia, the role of pharmacists in primary healthcare is still very limited or even absent. This study evaluates the effectiveness of programs delivered for type 2 diabetes mellitus (T2DM) patients by pharmacists in primary healthcare through counseling, short message service (SMS) reminders, and medication booklets. Methods: A quasi-experimental study with a pretest–posttest design was conducted from April to August 2018 at Merdeka and Dempo primary health-care centers, Palembang, South Sumatra Province, Indonesia. Counseling and medication booklets were distributed three times during the study period, while SMS reminders were sent once a week. Counseling was given for the management of diabetes mellitus (DM), including during the Ramadan fasting period, together with management for acute and chronic complications. The medication adherence level was measured using a medication adherence questionnaire (MAQ) and pill count adherence (PCA). The study sample comprised 80 T2DM patients, who were allocated into either the control group (CG) (n = 40) or intervention group (IG) (n = 40). Clinical outcomes were determined by measuring glycated hemoglobin (HbA1c), blood pressure, and lipid profiles. Findings: After the intervention, the IG showed significant improvements in most parameters, except for high-density lipoprotein cholesterol and systolic and diastolic blood pressure. HbA1c levels were reduced, while MAQ scores and PCA scores were improved. Lipid parameters were significantly reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglyceride (TG). Compared with the CG, most parameters were significantly improved in the IG. Pharmacist counseling significantly improved almost all clinical parameters (HbA1c, TC, LDL-c, and TG). Pharmacist counseling was 7.1 times greater in lowering HbA1c compared with no counseling, after adjusted by other variables. The variable that most influenced the lowering of HbA1c was infrequent (“not often”) consumption of unhealthy foods (OR 14.9; 95% CI 3.5-63.7). Conclusion: The pharmacist primary health-care intervention program implemented in this study significantly improved HbA1c, TC, LDL-c, TG, and medication adherence in outpatients with T2DM.
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Assessment of medication adherence in patients with chronic diseases in Tabuk, Kingdom of Saudi Arabia p. 196
Kousalya Prabahar, Maymonah Abdullah Albalawi, Lama Almani, Sarah Alenizy
Objective: Uncontrolled chronic diseases such as hypertension and diabetes mellitus can lead to severe complications. Poor adherence to medication is one of the important reasons, leading to complications for chronically diseased patients. We aimed to assess the trend toward medication adherence and the reasons for medication nonadherence in chronic disease patients in Tabuk city in Saudi Arabia. Methods: A cross-sectional study was conducted at a tertiary care hospital in Tabuk, Saudi Arabia. Participants were selected and interviewed for information regarding their medication adherence. A medication adherence rating scale questionnaire was used to measure the level of adherence in study participants. The data were analyzed by the statistical package for the social sciences (SPSS) database 24. Findings: Overall, 208 participants were involved in this study. Among these, 134 (64.4%) were female, and 74 (35.6%) were male. This study showed that 159 (76.44%) participants were adherent to their medications and nearly one-quarter of patients were nonadherent to their medications. No statistically significant differences were found between male and female patients toward their medication adherence. The primary intentional and nonintentional reason for nonadherence was side effects and forgetfulness, respectively. Conclusion: Tailoring the therapy according to the individual need of the patients will maximize the patient's adherence toward medications.
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Common opioids involved in drug poisoning presenting to the Emergency Department: A cross-sectional study p. 202
Nastaran Eizadi-Mood, Elham Haghshenas, Ali Mohammad Sabzghabaee, Ahmad Yaraghi, Ziba Farajzadegan
Objective: Opioids poisoning is of the most important cause of mortality. The objective of the study was to compare the demographic factors, clinical manifestations, and outcomes of the most common opioids involved in drug overdose presenting to the Emergency Department. Methods: This cross-sectional study was conducted from October 2016 to March 2017 in the Clinical Toxicology Department of the main referral center of the university. All poisoning cases with common opioids were included in the study. Demographic factors, clinical manifestations, and outcome were recorded in a check list. ANOVA, Chi-square or Fisher's exact test, and binary logistic regression analysis were used for outcome prediction. Findings: Two hundred and thirty six patients with opioids poisoning were evaluated during the study period. The most common opioids involved in poisoning were methadone (47.9%), tramadol (24.2%), and opium (21.6%). Patients with opium poisoning were older than others (P < 0.0001). The rate of suicide was more in the tramadol group, while the past history of psychological problems was more observed in the methadone group (P < 0.0001). Increasing age (odds ratio [OR], 1.05; 95% confidence interval [CI]: 1.02–1.09; P = 0.05) and addiction (P = 0.01; OR, 7; 95% CI: 1.55–31.52) was associated with an increased complications or death. Also patients with somatic disease had more chance of complications/death (P = 0.04; OR, 3.71; 95% CI: 1.06–12.97). Kind of opioids was not a predictive factor in the outcome of the patients with acute poisoning. Conclusion: Age, addiction, and somatic disease should be considered as more important factors in outcome prediction with opioids poisoning, including opium, tramadol, and methadone.
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Sensitivity and specificity of prior methicillin-resistant Staphylococcus aureus nasal swab results for predicting methicillin-resistant Staphylococcus aureus infections in intensive care unit admissions over a 1-year period: A pilot study p. 208
Jonathan Wadle, Geoffrey C Wall, Hayden S Smith
Objective: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a pathogen worldwide. Empiric anti-MRSA therapy is often prescribed in hospital inpatients with potential infection. Recent studies have suggested, particularly for respiratory infections, that MRSA colonization as determined by nasal swab has a high negative predictive value (NPV) for MRSA infections during the index hospitalization. We examined the predictive value of a prior intensive care unit (ICU) MRSA nasal swab on the results from a subsequent ICU admission in the same patient and the results of the latter admission MRSA nasal swab. Methods: A retrospective chart review of patients 18 years or older admitted to a large tertiary care hospital in the Midwest of the United States in 2016 who had a MRSA nasal swab performed and had an ICU admission stay of over 24 h was conducted. This group of patients was matched to a patient list of subjects who were admitted as an inpatient to the same ICU at least once during the following year. Data were collected on demographic and clinical information, as well as the results of MRSA swabs and the presence of a MRSA infection during both hospitalizations. Predictive values were calculated using 2 × 2 tables including sensitivity and specificity of a first MRSA swab result with a MRSA infection during the subsequent ICU stay. Findings: Seventy-seven patients were matched who had MRSA swabs performed on two separate ICU admissions. The negative predictive value of the first MRSA swab result on a MRSA infection during the second ICU stay was 96%. Conclusion: In this pilot study, a previous negative MRSA nasal swab may predict a lack of a MRSA infection in a subsequent infection during a 1-year period.
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Evaluation of the prescribed drugs to elderly in a tertiary healthcare center for possible drug interactions with investigational drugs for covid-19 treatment p. 212
Yogendra Keche, Nitin Gaikwad, Suryaprakash Dhaneria, Apoorva Joshi
Objective: Earlier identifying drug interactions may help in risk reduction in elderly patients. Methods: Drug prescription data of 212 elderly patients of tertiary health care center had been analyzed for possible drug interactions with investigational drugs for COVID-19 treatment. Drug interaction had been checked from Stockley's Drug Interaction 2019 and Martindale the Complete Drug Reference 2017 and standard reference books of Pharmacology. Findings: Different types of drugs prescribed in the elderly were 260 and out of which 68 (26.36%) were in the category of fixed-dose combinations. Around 150 (70.75%) elderly patients were having one or more associated comorbidities. Thirty-five drugs prescribed to elderly had been found to cause drug interaction with investigational drugs for COVID-19. Possible drug interactions are mediated through CYP3A4 (eighteen patients), CYP2D6 (seven patients) isoenzymes, or P glycoproteins transporters (three patients). Conclusion: Possible drug interactions predicted in this study suggested need for modification of dose of drug or watchfulness for adverse effects. If these drug interactions are considered beforehand, complications can be prevented on account of these drug interactions in elderly who are suffering from COVID-19.
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The COVID-19 vaccine saga: A perspective p. 218
Shashank M Patil, Ramith Ramu
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