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  Citation statistics : Table of Contents
   2015| July-September  | Volume 4 | Issue 3  
    Online since August 6, 2015

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Antibiotic regimens for treatment of infections due to multidrug-resistant Gram-negative pathogens: An evidence-based literature review
Mandana Izadpanah, Hossein Khalili
July-September 2015, 4(3):105-114
DOI:10.4103/2279-042X.162360  PMID:26312249
Evidences regarding the efficacy of different antibiotic regimens proposed for treatment of multidrug-resistant (MDR) Gram-negative pathogens have been reviewed. Available data in Scopus, Medline, EMBASE, the Cochrane central register of controlled trials, and Cochrane database of systematic reviews have been collected. Several antibiotic regimens are proposed for treatment of MDR Gram-negative infections (defined as nonsusceptibility to at least one agent in three or more antimicrobial categories). The most challenging issue is the treatment of carbapenem-resistant (CR) Gram-negative pathogens. A carbapenem plus either colistin or tigecycline was the most effective regimen for treatment of CR Gram-negative pathogens with low-level resistance (minimal inhibitory concentration [MIC] ≤ 8 mg/L). However, in high-level resistance (MIC > 8 mg/L), combination of colistin and tigecycline showed promising effect.
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A review of pharmaceutical policies in response to economic crises and sanctions
Mehrnaz Kheirandish, Arash Rashidian, Abbas Kebriaeezade, Abdol Majid Cheraghali, Fatemeh Soleymani
July-September 2015, 4(3):115-122
DOI:10.4103/2279-042X.162361  PMID:26312250
An economic crisis has been defined as a situation in which the scale of a country’s economy becomes smaller in a period of time. Economic crises happen for various reasons, including economic sanctions. Economic crises in a country may affect national priorities for investment and expenditure and reduce available resources, and hence may affect the health care sector including access to medicines. We reviewed the pharmaceutical policies that the countries adopted in order to mitigate the potential negative effects on access to medicines. We reviewed published reports and articles after conducting a comprehensive search of the PubMed and the Google Scholar. After extracting relevant data from the identified articles, we used the World Health Organization (WHO) access to medicines framework as a guide for the categorization of the policies. We identified a total of 40 studies, of which 10 reported the national pharmaceutical policies adopted to reduce the negative impacts of economic crises on access to medicines in high-income and middle-income countries. We identified 89 policies adopted in the 11 countries and categorized them into 12 distinct policy directions. Most of the policies focused on financial aspects of the pharmaceutical sector. In some cases, countries adopted policies that potentially had negative effects on access to medicines. Only Italy had adopted policies encompassing all four accesses to medicine factors recommended by the WHO. While the countries have adopted many seemingly effective policies, little evidence exists on the effectiveness of these policies to improve access to medicines at a time of an economic crisis.
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Effect of Omega-3 fatty acids on blood pressure and serum lipids in continuous ambulatory peritoneal dialysis patients
Afsoon Emami Naini, Nooshin Keyvandarian, Mojgan Mortazavi, Shahram Taheri, Sayed Mohsen Hosseini
July-September 2015, 4(3):135-141
DOI:10.4103/2279-042X.162356  PMID:26312252
Objective: Hypertension and hyperlipidemia are two major risk factors for cardiovascular disease in continuous ambulatory peritoneal dialysis (CAPD) patients. This study was designed to investigate the effect of omega-3 fatty acids on blood pressure (BP) and serum lipids in CAPD patients. Methods: This study was a randomized double-blind clinical trial in which 90 CAPD patients were randomly assigned to either the omega-3 or the placebo group. Patients in omega-3 group received 3 g/day omega-3 for 8 weeks, whereas patients in the control group received placebo. At baseline and at the end of 8 weeks, the patients’ BP was controlled, and serum biochemistry was measured. Findings: Mean systolic BP decreased (–22.2 ± 14.2 mmHg) in the omega-3 group at the end of the study while in the placebo group increased (+0.5 ± 30.2 mmHg) (P < 0.0001). Mean diastolic BP of the omega-3 group decreased more (–11.95 ± 11.9 mmHg) comparing with the placebo group (–1.1 ± 17.3 mmHg) (P = 0.001). There were no significant differences between the two groups in mean changes in serum triglyceride, and total, high-density lipoprotein, and low-density lipoprotein cholesterol. Conclusion: The results of this study indicate that omega-3 reduced BP significantly but had no effect on lipid profile in our CAPD patients.
  5 2,723 410
Antimicrobial susceptibility pattern of extended-spectrum beta- lactamase producing Klebsiella pneumoniae clinical isolates in an Indian tertiary hospital
Amit Kumar Singh, Sonali Jain, Dinesh Kumar, Ravinder Pal Singh, Hitesh Bhatt
July-September 2015, 4(3):153-159
DOI:10.4103/2279-042X.162363  PMID:26312255
Objective: There is an increased prevalence of extended-spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-KP) worldwide including India, which is a major concern for the clinicians, especially in intensive care units and pediatric patients. This study aims to determine the prevalence of ESBL-KP and antimicrobial sensitivity profile to plan a proper hospital infection control program to prevent the spread of resistant strains. Methods: KP isolates obtained from various clinical samples were evaluated to detect the production of ESBL by phenotypic methods. Antimicrobial susceptibility profile was also determined of all the isolates. Findings: Of 223 nonduplicate isolates of K. pneumoniae, 114 (51.1%) were ESBL producer and antimicrobial susceptibility profile showed the isolates were uniformly sensitive to imipenem and highly susceptible to beta-lactamase inhibitor combination drugs (67–81%) and aminoglycosides (62–76%), but less susceptible to third generation cephalosporins (14–24%) and non-β-lactam antibiotics such as nitrofurantoin (57%), fluoroquinolones (29–57%), piperacillin (19–23%), and aztreonam (15–24%). Conclusion: This study found that beta-lactamase inhibitor combinations are effective in treatment of such infections due to ESBL-KP thus these drugs should be a part of the empirical therapy and carbapenems should be used when the antimicrobial susceptibility tests report resistance against inhibitors combinations.
  4 2,766 369
Provision of pharmaceutical care in patients with limited English proficiency: Preliminary findings
Devinder Singh Arora, Amary Mey, Satish Maganlal, Sohil Khan
July-September 2015, 4(3):123-128
DOI:10.4103/2279-042X.162358  PMID:26312251
Objective: Overcoming language and cultural barriers is becoming ever challenging for pharmacists as the patient population grows more ethnically diverse. To evaluate the current practices used by the pharmacists for communicating with patients with limited English proficiency (LEP) and to assess pharmacists’ knowledge of, attitude toward, and satisfaction with accessing available services for supporting LEPs patients within their current practice settings. Methods: Semi-structured interviews were conducted with five pharmacists employed in pharmacies representing multiple practice settings Queensland, Australia. Thematic analysis was primarily informed by the general inductive approach. NVivo software (QSR International Pty Ltd.) was used to manage the data. Findings: Three interlinked themes emerged from the analysis of interview data: (1) Barriers to the provision of pharmaceutical care, (2) Strategies employed in dealing with LEP patients, and (3) Lack of knowledge about existing services. Pharmacists recognized their lack of skills in communicating with LEP patients to have potential negative consequences for the patient and discussed these in terms of uncertainty around eliciting patient information and the patient’s understanding of their instructions and or advice. Current strategies were inconsistent and challenging for LEP patient care. While the use of informal interpreters was common, a significant degree of uncertainty surrounded their actual competency in conveying the core message. Conclusion: The present study highlights a significant gap in the provision of pharmaceutical care in patients with LEP. Strategies are needed to facilitate quality use of medicines among this patient group.
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Predictive performance of Vancomycin population pharmacokinetic models in Iranian patients underwent hematopoietic stem cell transplantation
Maryam Taghizadeh-Ghehi, Saeed Rezaee, Kheirollah Gholami, Molouk Hadjibabaie
July-September 2015, 4(3):129-134
DOI:10.4103/2279-042X.162357  PMID:26311080
Objective: Many hematopoietic stem cell transplantation (HSCT) patients receive vancomycin empirically during febrile neutropenia. There are several models for estimation of vancomycin pharmacokinetic parameters and calculation of initial dosing regimen accordingly. However, the performance of these methods in HSCT patients remained to be evaluated. The aim of the study was to determine which of the vancomycin population pharmacokinetic methods best fit Iranian HSCT patients. Methods: In order to evaluate predicted performance of seven vancomycin population pharmacokinetic models, the pharmacokinetic parameters of patients were estimated using each model’s equations. Then the predicted steady-state trough vancomycin concentration was calculated based on each model’s parameters and using a formula based on Sawchuk–Zaske method. The predicted steady-state trough vancomycin concentration and the real measured concentrations were compared to see which method was the most precise and least biased using mean squared error (MSE) and mean prediction error (ME) respectively. Findings: Forty-six patients (65% men) were included in the study. Calculated metrics showed a range of 38% under-prediction bias with Rodvold to 34% over-prediction bias with Matzke and Burton models. Birt and revised Burton methods showed no significant bias (ME [95% confidence interval (CI)]: –0.067 [–0.235–0.101] and 0.066 [–0.105–0.238]). Birt and revised Burton were not different significantly considering MSE (95% CI) of 0.385 (0.227–0.544) and 0.401 (0.255–0.546), respectively. Comparisons of precision with naive predictors revealed a delta MSE (95% CI) of –0.128 (–1.379–1.890) for Birt and 0.026 (–0.596–0.940) for revised Burton models. Conclusion: Although the Birt and Burton revised methods performed well, none of the studied models showed acceptable performance to be implemented as a routine method for initial dose calculation in HSCT patients. A vancomycin pharmacokinetic model specific for this high-risk subpopulation of Iranian patients should be designed and validated.
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Outcome of treatment in patients with methamphetamine poisoning in an Iranian tertiary care referral center
Parva Paydar, Ali Mohammad Sabzghabaee, Hooman Paydar, Nastaran Eizadi-Mood, Ali Joumaa
July-September 2015, 4(3):167-172
DOI:10.4103/2279-042X.162365  PMID:26312257
Objective: Methamphetamine is the second most widely abused drug worldwide. We performed a study on the treatment outcome of acute methamphetamine intoxication in a referral tertiary care University hospital in Iran. Methods: In this hospital-based, retrospective study which was carried out from 2012 to 2013, medical records of all patients aged 18 to 65 years who were admitted with a reliable history and clinical diagnosis of acute methamphetamine intoxication were abstracted and analyzed. Patients’ data included gender, age, type and route of poisoning, clinical manifestations, duration of hospitalization, and the treatment outcome. ANOVA, Chi-square, and binary logistic regression statistical tests were used for data analysis. Findings: A total of 129 patients with a mean age of 30.70 ± 0.93 (mean ± standard error), including 111 (86%) males, had been fully evaluated. Most of the patients had intentional poisoning (93.7%). In 42.6% of patients, inhalation was the main route of exposure. Most of the patients had complete improvement without any complication (89.1%). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI] 1.006–1.099), suicide history (OR, 30.33; 95% CI 3.11–295.24), route of poisoning ([ingestion: OR, 0.21; 95% CI 0.05–0.87], [inhalation: OR, 0.19; 95% CI 0.04–0.78]), and pulmonary system manifestations (OR 1.84; 95% CI 1.15–2.93) were predictive in patients outcome (P < 0.05). Conclusion: Methamphetamine poisoning was more common in males with intentional poisoning. Age, past history of suicide, route of poisoning, and pulmonary manifestations on admission could be considered as important predictive factors in patients’ outcome.
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Medication errors in oral dosage form preparation for neonates: The importance of preparation technique
Sousan Valizadeh, Mehri Rasekhi, Hamed Hamishehkar, Malihe Asadollahi, Hadi Hamishehkar
July-September 2015, 4(3):147-152
DOI:10.4103/2279-042X.162362  PMID:26312254
Objective: Considering the inability of neonates to swallow oral drugs in the form of solid tablets, the lack of appropriate dosage forms for infants, and the necessity to prepare some pills for neonates, the current study investigated dosage accuracy in drugs for neonates prepared from tablets by analyzing the concentrations of final products. Methods: Captopril and spironolactone, oral dosage forms that are not suitable for infants, were chosen as the drug model for this study. Demographic characteristics of nurses providing medications and tablet preparation methods were documented in a random observational method. To determine concentrations of final solutions, 120 drug samples (60 captopril and 60 spironolactone samples) prepared by Neonatal Intensive Care Unit nurses of the Children Cure and Health Hospital of Tabriz University of Medical Sciences were analyzed using high performance liquid chromatography (HPLC) and spectrophotometry. Findings: There was a significant error rate in the concentration of captopril in prepared solutions compared with the ordered dosage. No differences were observed in the demographic characteristics of the nurses and the method of preparation between the two drugs. The only difference related to the preparation technique was that in most cases (70.8%), one whole spironolactone tablet was used, whereas in around 50% of samples in captopril group, half or a quarter of one captopril tablet was utilized for the intended dosage (P = 0.009). Conclusion: This research suggests that the use of a whole tablet instead of a divided tablet in the manual preparation of medication dosage forms for neonates is the most appropriate approach.
  2 2,258 353
The efficacy of different doses of Midazolam added to Lidocaine for upper extremity Bier block on the sensory and motor block characteristics and postoperative pain
Azim Honarmand, Mohammadreza Safavi, Koorosh Nemati, Padideh Oghab
July-September 2015, 4(3):160-166
DOI:10.4103/2279-042X.162359  PMID:26312256
Objective: This study was designed to evaluate the effect of different doses of midazolam on anesthesia and analgesia quality when added to lidocaine during the intravenous regional anesthesia (IVRA). Methods: One hundred and forty patients underwent hand surgery were randomly allocated into four groups to receive 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the control Group L-C (n = 35), 30 μg/kg midazolam plus 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the midazolam Group L-M1 (n = 35), 40 μg/kg midazolam plus 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the midazolam Group L-M2 (n = 35), and 50 μg/kg midazolam plus 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the midazolam Group L-M3 (n = 35). Sensory and motor block and recovery times, tourniquet pain, intra-operative analgesic requirement, and visual analog scale (VAS) scores were recorded. Findings: Onset time of sensory and motor block in L-M3 Group was shorter than the L-M2 and L-M1 and L-C Groups (P < 0.001). Furthermore, prolonged sensory (P = 0.005) and motor recovery time (P = 0.001) in L-M3 were longer than the other groups. Intra-operative VAS score and intra-operative fentanyl consumption in L-M3 were lower than the other groups (P < 0.001). The numbers of patients needed to pethidine in Group L-M3 were significantly less compared with the other groups (P = 0.035). VAS scores were significantly lower in Group L-M3 in different time intervals in the postoperative period compared with the other groups (P < 0.001). Conclusion: Addition of 50 μg/kg midazolam for IVRA (Group L-M3) enhanced intra-operative analgesia and improved anesthesia quality better than other groups receiving lower midazolam doses as well as a control group.
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Premedication dilemmas, is Pregabalin the answer?
Preetha Elizabeth George, Reetika Chander, Dootika Liddle, Valsamma Abraham
July-September 2015, 4(3):142-146
DOI:10.4103/2279-042X.162364  PMID:26312253
Objective: Laryngoscopy and intubation are associated with sympathetic stimulation which can prove deleterious in patients with cardiovascular compromise; so, various methods have been tried to obtund this pressor response. In this study, we have assessed the efficacy of pregabalin in attenuating the pressor response to laryngoscopy and intubation. Methods: This prospective randomized study included 80 patients with American Society of Anesthesiologists physical status grades I-II, in the age group of 18–60 years of age. The patients were randomized into two groups of 40 patients each. Group A received the placebo orally, 90 min prior to surgery. Group B received 150 mg of pregabalin orally, 90 min prior to surgery. These patients were assessed in terms of sedation with Ramsay sedation scale (RSS). In the operation theatre, the heart rate (HR), systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation recorded at baseline and 1, 3, 5, and 10 min after intubation. The rate pressure product (RPP) was calculated for these time intervals. In the postoperative period, patients were assessed for complications like dizziness, nausea, and blurred vision. Statistical analysis was performed using Chi-square and ANOVA tests. Findings: The group receiving 150 mg of pregabalin as premedication was found to be adequately sedated at 1 h post-premedication with 52% patients having a RSS score of 3 compared to 4% with the same RSS score in the placebo group (P < 0.0001). Hemodynamics was more stable post-intubation with significant stability in the HR (P = 0.002) and RPP (P = 0.004) in the pregabalin group. Conclusion: Pregabalin when given as a premedication provides adequate sedation and obtunds the pressor response seen with intubation.
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