Abstract:

The objective of this study was to compare the effectiveness of Efavirenz and Nevirapine based First-line HIV treatment in patients attending comprehensive care centre in Mombasa. This was a prospective comparative study. The target population was HIV positive adult patients eligible for HAART. A total of 251 patients were enrolled in the study and followed up for 12 months. All ARV naive patients with CD4 count < 350/ul with WHO stage 3 or 4 and eligible for HAART were randomly into Efavirenz and Nevirapine based regimens (D4T/3TC/EFV and D4T/3TC/NVP) and followed up for a period of twelve months. Laboratory tests were done for each patient every three months by testing for Haemoglobin, Liver enzyme test (ALT), Creatinine and CD4 cell count. The study showed that first-line regimens of Efavirenz and Nevirapine were effective in suppressing HIV/AIDS infection with improvement in CD4 count (P<0.05). There was also improvement in haemoglobin levels and body weight among the patients on both regimens in the study. However, elevation of ALT and Creatinine were noted in both treatment groups, but this did not warrant drug discontinuation (P>0.05). Efavirenz based regimen appeared to be superior to Nevirapine based regimen on CD4+ profiles and renal function (P<0.05). There was no significant difference in haemoglobin levels, body weight and ALT enzyme for patients on both treatment groups.The findings demonstrated that D4TC/3TC/EFV and D4TC/3TC/NVP combinations were safe, well tolerated and effective in suppressing HIV progression in advanced HIV infected patients.

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Abstract:

Background: About 16% of the adult Qataris at ages of 20 to 79 were diabetic. The prevalence of peripheral diabetic neuropathy in Arabic ranged between 38-94% in diabetic. Medications in studied were Amitriptyline, Carbamazepine, Celecoxib, Diclofenac, Duloxetine, Fluoxetine, Gabapentin, Imipramine, Meloxicam, Paracetamol and pregabalin.

The specific objective; how the DPNP patients would perceive the benefits of medications Secondary objectives; which medication(s) perceived to restore a patient’s quality of life. In addition, which medications could realize a 50% benefits for releasing DPNP.

Setting: participants selected randomly, when attended their routine appointments in six health centers under in Qatar.

Sample size: 646 DPNP participants

Inclusion criteria: Diabetic from 18 years and above, taking medications to treat DPNP for duration of at least three weeks.

Exclusion criteria: Patients taking same medications for other ailments, diabetic less than 18 years old, and those with difficulty in communication. Results: Participants showed abilities to perceive the benefits of their medications, and their impact on some domains of quality of life. Gabapentin perceived by average percent of 70.70 % to be beneficial in the above mentioned domains. Imipramine perceived by 24% beneficial. Fluoxetine not completely perceived as beneficial. Nonsteroidal anti-inflammatory drugs studied perceived to be less than 50% beneficial. Conclusion: Patient’s perception on benefits of medications may be of high importance factor in medication selection. Anticonvulsants perceived to be more beneficial than other medications group. Recommendations: Consider patient’s preferences in selection medications.

Keywords: Patients’ perception, diabetic peripheral neuropathy medications.

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Abstract:

Clinical trials are a key research tool for advancing medical knowledge and patient care. They ultimately gear towards ameliorating and improving diagnosis and treatment of all diseases by introducing novel interventions and therapies. Essential to conducting a clinical trial is randomizing the proper study population through recruiting eligible participants based on inclusion and exclusion criteria, and ensuring study completion and adherence of study patient participation. Although these may seem simplistic, patient recruitment, retention and adherence are the most difficult challenges in clinical trials. While patient recruitment is one of the key elements to study completion, over 80% of clinical trials shockingly do not finish on time. Devising a potential strategy is vital in overcoming recruitment barriers; however, it is very costly and cumbersome. Lambda Health, LLC is in the process of creating a clinical research tool that can interface with EMR, in hopes of increasing patient retention through proper site selection, and setting reminders to patients about medication dosing, diary documentation, study procedures and visits scheduling. Ideally through implementing this tool into clinical trials, less effort and money will be spent on recruitment and the rates of adherence and retention will increase.

Keywords: Patient recruitment, retention rates, patient adherence, cost-effective, clinical research tool.

References:

[1]. Alexander, W. (2013). The Uphill Path to Successful Clinical Trials: Keeping Patients Enrolled. Pharmacy and Therapeutics, 38(4), 225–227.

[2]. Carlisle, B., Kimmelman, J., Ramsay, T., & MacKinnon, N. (2015). Unsuccessful Trial Accrual and Human Subjects Protections: An Empirical Analysis of Recently Closed Trials. Clinical Trials (London, England), 12(1), 77–83.

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[7]. G. MacDonald, Social Media Boosting Patient Recruitment, but FDA Guidance Needed, March 2011, available at: http://www.outsourcing-pharma.com/Clinical-Development/Social-media-boosting-patient-recruitment-but-FDA-guidance-needed Accessed 24 Jun 2011.

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[10].  Tufts Center for Drug Development, 2016. Protocol Amendments Improve Elements of Clinical Trial Feasibility, But at High Economic and Cycle Time Cost http://csdd.tufts.edu/news/complete_story/pr_ir_jan_feb_2016.

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Abstract:

The disorder with very common symptoms such as sneezing, itching, nasal congestion and rhinorrhea often remains undiagnosed in many individuals in the world. This is called as allergic rhinitis. According to WHO, this affects 10-30% of world population. Prevalence of allergic rhinitis is around 7.8% in USA, 5.9 % in France and 29% in United Kingdom (UK). However, in India no such study of prevalence was conducted in particular to study allergic rhinitis. Considering this fact, current study was aimed to determine disease perception and effect of allergic rhinitis on social behaviour in adult and elderly population in the areas of Mumbai metropolitan region in India using cross sectional survey methodology. Survey research of such type helps in gathering information not available from other sources. Disease perception and social behaviour assessments will help to understand psychosocial characteristics in population. Effect of allergic rhinitis on quality of life can also be investigated from this research. Questionnaire was designed and responses were collected by both online and offline modes. In total, 240 numbers of respondents agreed to participate. From the results, it was found that many respondents suffer from symptoms of sneezing, itching and nasal congestion which are cardinal symptoms of allergic rhinitis. From the results it was found that 66.67% of respondents have been diagnosed with allergic rhinitis from physician.

Keywords: allergic rhinitis, cross sectional survey, disease perception, social behaviour, India, clinical trials.

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Abstract:

The purpose of this study is to assess the perceived stress in male and female nurses working in ICU.

According to the World Health Organization, stress is a significant problem of our times and affects both physical as well as the mental health of people. ... Stress coping methods are the cognitive, behavioral and psychological efforts to deal with stress.

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Abstract:

Prostate cancer is the leading cancer causing death in Zimbabwean men according to the Zimbabwe National Cancer Registry. By 2004 prostate cancer had become the most common cancer in Zimbabwean men. The incidence of prostate cancer shows strong age, race and geographical dependence. The prostate specific antigen (PSA) is a serine protease produced by cells of the prostate gland. The PSA blood test measures the level of PSA in man’s blood and is used as a biomarker for prostate cancer (PCa). Unfortunately the PSA is prostate specific but not PCa specific. PSA testing started in Zimbabwe in 1995. The specific objectives of the study were: (i) to determine the age range most affected by PCa, (ii) to evaluate the impact of PSA testing on PCa cases in Zimbabwe. The study was a retrospective cross sectional study. Secondary data of all histology confirmed cases of PCa were obtained from the Zimbabwe National Cancer Registry (ZNCR) and analysed. Graph Pad Prism 7.03 was used to statistically analyse the data. The two-tailed T-test was employed to compare the number of pre-PSA cases against the number of post PSA era cases. 5277 PCa cases covering a thirty year period were retrieved. The first ten years (1986-1995) were the pre PSA era period and the next twenty years (1996-2015) were the post PSA era. The median age was 71 (IQR 64-78) years. There was a significant difference between number of PCa cases of the pre-PSA era (1986-1995) and the first post PSA era 1996-2005, and the second PSA era (2006-2015) (p =0.0042 and p=0.0028 respectively. This showed the impact that PSA testing had on PCa in Zimbabwe (2006- 2015). The study showed that the age group most affected by PCa was the 64-78 years. .

Keywords: Prostate cancer, Cross Sectional Study, Prostate Specific Antigen, PSA impact, age group, Zimbabwe.

References:

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Abstract:

Background: The present study was conducted to investigate the bioequivalence of Ritonavir Capsules 100 mg with that of Norvir^® Ritonavir Capsules Soft Gelatin 100 mg.

Patients and methods: This study was an open-label, balanced, randomized, two-treatment, two-period, two-sequence, single dose crossover pilot oral bioequivalence study. Study was conducted in 12 healthy, adult male subjects with age ranging from 18 to 45 years. The total duration (excluding screening) of subject participation in a study was approximately 11 days including washout period of 07 days between each dosing. The estimation of Ritonavir in human plasma is carried out by using LC/MS/MS method in Bioanalytical laboratory. The pharmacokinetic parameters assessed were AUC_0-t, AUC_0-∞, C_max, AUC_0-t/AUC_0-∞, T_max, k_el and t_½.

Results: The geometric mean ratios (90% confidence intervals) of the test drug/reference drug for Ritonavir were 100.8 (83.64-121.51) for AUC_0-t, 102.1 (85.39-122.01) for AUC_0-inf, and 97.5 (81.19-117.08) for C_max. The 90% confidence intervals of the test/reference AUC_0-t, AUC_0-∞, C_max ratio of Ritonavir were within the acceptance range for bioequivalence. In this study, single dose of Ritonavir 100 mg capsule was well tolerated by both groups of subjects under fasting conditions.

Conclusion: It was concluded that the two Ritonavir capsules formulations (the test and reference products) were bioequivalent in terms of the rate and extent of absorption. 

References:

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[6]. J Ng, CE Klein, SJ Causemaker, J Xiong, YL Chiu, K Wikstrom, TT Doan, TJ Podsadecki, B Bernstein. A Comparison of the Single Dose Bioavailability of a Ritonavir Tablet Formulation Relative to the Ritonavir Soft Gelatin Capsule in Healthy Adult Subjects. XVII International AIDS Conference, Mexico City, 3‑8 August 2008.

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Abstract:

Rheumatoid Arthritis is an autoimmune disorder and it is the most common autoimmune and inflammatory arthritis in adults (Helmic, et al, 2008), the disease mainly affects joints of the body such as knees, hands and hips. The ideology of this inflammation is unknown (Fishman, 2010). However, there are several factors that mainly contribute to the initiation and the progression of the Rheumatoid Arthritis this include gender, age, environmental factors, malnutrition and genetic makeups. The disease occurs approximately 1% of the population. It is more common in women than the male; about 80% of the cases are seen on the population between the ages of 35-50 year (Fishma, 2010). The management intervention of this disease must be started sooner rather than later, the treatment should be widely comprehensive including pain management, reducing swelling and supporting the patients to receive proper treatment that aims to cure the disease and the condition. Radiographic image should be taken to evaluate the extent of the damages on joints. This study investigates the factors that contribute the progression of the Rheumatoid Arthritis.

Keywords: Rheumatoid Arthritis, Autoimmune disorder, inflammatory arthritis.

References:

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[8]. Hakkinen A. Effectiveness and safety of strength training in rheumatoid arthritis. Curr Opin Rheumatol 2004; 16:132–7.

[9]. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum 2008;58:15–25.

[10].  Hakkinen A, Pakarinen A, Hannonen P et al. Effects of prolonged combined strength and endurance training on physical fitness, body composition and serum hormones in women with rheumatoid arthritis and in healthy controls. Clin Exp Rheumatol 2005; 23:505–12.

[11].  Jasvinder., A. Sign., et, al (2015) 2015 American College of Rheumatology, Guideline for the Treatment of Rheumatoid Arthritis.

[12].  J. Bruce Smith (2002) Rheumatoid Arthritis—A Molecular Understanding, Vol 136 No 12.

[13].  Maruotti N, Cantatore FP, Crivellato E, Vacca A, Ribatti D (2007) Macrophages in rheumatoid arthritis. Histol Histopathol 22(5):581–586.

[14].  Ropes MW, Bennet GA, Cobb S, Jacox R, Jessar RA. Revision of diagnostic criteria for rheumatoid arthritis. Bulletin on the Rheumatic Diseases 1958; 9:175-176.

[15].  Scottish Intercollegiate Guidelines Network. Management of Early Rheumatoid Arthritis. SIGN Publication No. 48. Edinburgh: SIGN, 2000. Treatment of rheumatoid arthritis and other inflammatory disorders, unknown author.

[16].  Symmons. A et., al. (2000). The global burden of rheumatoid arthritis in the year 2000.

[17].  Symmons D, et al. The prevalence of rheumatoid arthritis in the United Kingdom; new estimates for a new century. Rheumatology (Oxford) 2002; 41(7):793-800.

[18].  Symmons D, Turner G, Webb R, Aslen P, Barret E, Lunt M et al. The prevalence of rheumatoid arthritis in the United Kingdom; new estimates for a new century. Rheumatology (Oxford) 2002; 41(7):793-800. Royal College of General Practitioners. Office of Populations, Censuses and Surveys.

Abstract:

Lysins or Lytic enzymes of Bacteriophage are highly evolved molecules produced to release their progeny by hydrolyzing the bacterial host cell wall. Now days, due to Multi Drug Resistance in many streptococcal infections; this mechanism is exploited as an alternative therapy against traditional antibiotic therapy. But in the treatment of phage therapy the mode of action is still unclear in the literatures. This study will evidence the probable mode of mechanism by the lysin in the breakage of host cell wall by In Silico approach. 3-D structure of Lysin was retrieved from Protein Data Bank and structure of peptidoglycan is retrieved from the PubChem. Docking studies was performed using Hex 6.3 taking lysin as receptor and peptidoglycan as ligand. Results were visualized in PyMol molecular visualization software. Docking studies showed the hydrophilic interaction between the peptidoglycan and lysin. The interacting residue of lysin belongs to CHAP domain which is responsible for the amidase catalytic activity which results in the breakage of cell wall for the release of their progeny. Molecular interactions between the lysin and peptidoglycan showed the possible mechanism for lysin which is responsible for breaking the major bonds in peptidoglycan layer for the release of bacteriophage progeny inside the host bacterial cell. This study will give the further evidence for the mode of action and by understanding this mechanism further improved therapies can be achieved in the Multi Drug Resistance bacterial infections.

Keywords: Bacteriophage, Streptococcus spp, Multi Drug Resistance bacterial infections, Lysin, Peptidoglycan, Docking studies.

References:

[1].     Berkowitz FE. Antibiotic resistance in bacteria. South Med J 1995;88:797-804.

[2].     B. Levin, J. Bull. Population and evolutionary dynamics of phage therapy. Nature Reviews Microbiology 2004; 2: 166-173.

[3].     Hermoso JA, Garcia JL, Garcia P. Taking aim on bacterial pathogens: From phage therapy to enzybiotics. Curr Opin Microbiol 2007; 10:461-472.

[4].     Navarre WW, Ton-That H, Faull KF, Schneewind O. Multiple enzymatic activities of the murein hydrolase from staphylococcal phage phi11. Identification of a D-alanyl –glycine endopeptidase activity. J Biol chem 1999; 274:15847-56.

[5].     Nelson D, Schuch R, Chahales P, Zhu S, Fischetti VA . PlyC: A multimeric bacteriophage lysine. Proc Natl Acad Sci USA 2006; 103:10765-70.

[6].     Pritchard DG, Dong S, Baker JR, Engler JA. The bifunctional peptidoglycan lysine of Streptococcus agalactiae bacteriophage B30. Microbiology 2004; 150:2079-87.

[7].     Stark CJ, Hoopes JT, Bonocora RP, Nelson DC. Bacteriophage lytic enzymes as antimicrobials. Bacteriophage in the Detection and control of Foodborne Pathogens, eds Sabour PV, Griffith MW (ASM Press, Washington DC), 2010. pp 137-156.

[8].     Smith H W, Huggins M B. Successful treatment of experimental E.coli infections in mice using phage; its superiority over antibiotics. J Gen Microbio. 1982; 128:307-318.

[9].     S. Matsuzaki, M. Rashel, J. Uchiyama, S. Sakurai, T. Ujihara, M. Kuroda, M. Ikeuchi,T. Tani, M. Fujieda, H.Wakiguchi, S. Imai, Bacteriophage therapy: a revitalized therapy against bacterial infectious diseases. J. Infect. Chemother. 2005; 11: 211-219.

[10].  Tenover FC, Hughes JM. The challenges of emerging infectious diseases: development and spread of multiply resistant bacterial pathogens. JAMA 1996; 275:300-4.

[11].  VinodKumar C. S, Suneeta Kalsurmath, Neelagund Y.F. Utility of lytic bacteriophage in the treatment of multidrug resistant Pseudomonas aeruginosa septicemia in mice. Ind J Patho Microbiol 2008;51(3):360-366

[12].  VinodKumar C. S, Suneeta Kalsurmath, Neelagund Y.F. Bacteriophage in the treatment of experimental septicemic mice from a clinical isolate of multidrug resistant Klebsiella pneumoniae. J Commun Dis. 2005;37(3): 749-753

[13].  VinodKumar C. S, Srinivasa H, Basavarajappa K.G, Nitin Bandekar. Isolation of Bacteriophages for MRSA obtained from Diabetic foot- A Possible treatment Option in infections. Inter J Biotechnol Biochem. 2010; 6(5): 801-809.

[14].  VinodKumar C. S, Srinivasa H, Basavarajappa K.G, Geethalakshmi S, Nitin Bandekar. Isolation of Bacteriophages to MDR Enterococci obtained from Diabetic foot- A Novel antimicrobial agent waiting in the Shelf?. Ind J Pathol Microbiol. 2011;54(1):90-96

[15].  VinodKumar C. S, Srinivasa H, Basavarajappa K.G, Umakanth Patil, Nitin Bandekar, Rajashri Patil. Abrogation of Staphylococcus aureus wound infection by bacteriophage in diabetic rats. International journal of pharmacy and drug research. 2011:3(3); 202-207

[16].  VinodKumar C. S, Srinivasa H, Basavarajappa K.G, Umakanth Patil, Nitin Bandekar, Rajashri Patil. Effectiveness of bacteriophage in the treatment of Staphylococcus aureus wound infection in the diabetic animal model. Asian J Pharm Res. 2012;5: 123-127

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Abstract:

Background: Drug dosage calculation and administration is important function of nurses. The key professional role of nurses is to ensure safe drug dosage calculation while performing medication administration. Medication errors are a common cause of adverse events that may result due to wrong drug dosage calculation. The assessment of nurse's knowledge related to drug dosage calculation has not been conducted at the time of commencing their employment in the study hospital.

Purpose: The purpose of this study was to assess the drug dosage calculation knowledge and proficiency among our newly hired nurses before and after the training session.

Method and design: Participatory Action Research (PAR) approach was selected using pre and post -test to assess the newly hired nurse's knowledge and proficiency related to drug dosage calculation. Data was collected after IRB approval at private tertiary hospital, Islamabad, Pakistan.

Sample: Purposive sampling technique was adopted (n=135) all nurses on their commencement of employment from July 2016 to October 2016 participated in the study after the informed consent.

Findings: The study results showed the significant improvement in drug dosage calculation knowledge and proficiency among the study participants while comparing pre-test and post-test results.

Conclusion: The study concluded in the light of pre-test and post-test results that there is an intense need to review the nurse's drug dosage calculation knowledge and proficiency at the time of employment as nurses are key player in drug preparation and administration.

Keywords: Drug dosage calculation, conceptual skills in mathematics, proficiency, an evaluation of drug dosage, essential competency, dosage calculation knowledge, numeracy.

References:

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[3].     Aronson, J. K. (2009). Medication errors: Emerging solutions. British Journal of Clinical Pharmacology, 67(6), 589-591. doi: 10.1111/j.1365-2125.2009.03420.x.

[4].     Athanasakis, E. (2012). Prevention of medication errors made by nurses in clinical practice. Health Science Journal. Retrieved from http://www.hsj.gr/medicine/prevention-of-medication-errors-made-by-nurses-in-clinical-practice.pdf September 27, 2017.

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[7].     Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse's viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228-231.

[8].     Cousins, D. H., Sabatier, B., Begue, D., Schmitt, C., & Hoppe-Tichy, T. (2005). Medication errors in intravenous drug preparation and administration: a multicentre audit in the UK, Germany and France. Quality and Safety in Health Care, 14(3), 190-195. doi: 10.1136/qshc.2003.006676.

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[16].       Michaels, A. D., Spinler, S. A., Leeper, B., Ohman, E. M., Alexander, K. P., Newby, L. K., . . . Gibler, W. B. (2010). Medication errors in acute cardiovascular and stroke patients: a scientific statement from the American Heart Association. Circulation, 121(14), 1664-1682. doi: 10.1161/CIR.0b013e3181d4b43e.

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[18].       Savage, A. R. (2015). Educational audit on drug dose calculation learning in a Tanzanian school of nursing. Afr Health Sci, 15(2), 647-655. doi: 10.4314/ahs.v15i2.44.

[19].       Shamsuddin, A. F., & Shafie, S. D. (2012). Knowledge of Nurses in the Preparation and Administration of Intravenous Medications. Procedia - Social and Behavioral Sciences, 60, 602-609. doi: http://dx.doi.org/10.1016/j.sbspro.2012.09.429.

[20].       Simonsen, B. O., Daehlin, G. K., Johansson, I., & Farup, P. G. (2014). Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study. BMC Health Serv Res, 14, 580. doi: 10.1186/s12913-014-0580-7.

[21].       Sohrevardi, S. M., Mirjalili, M. R., Jarrahzadeh, M. H., Mirjalili, M., & Mirzaei, E. (2014). Evaluating the Frequency of Errors in Preparation and Administration of Intravenous Medications in the Intensive Care Unit of Shahid-Sadoughi Hospital in Yazd. Journal of Pharmaceutical Care, 2(3), 114-119. doi: http://jpc.tums.ac.ir/index.php/jpc/article/view/57/57.

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Abstract:

Background: Pregnancy is the time of profound physiological changes in a female’s body. Maternal drug use during pregnancy may pose a teratogenicity risk to the fetus. However, the fact that drugs are needed to mitigate the complications during pregnancy cannot be avoided, therefore, this study is designed to assess prenatal drug prescription pattern at Mbabane Government Hospital.

Objectives: Assess prenatal drug prescription patterns at the gynecology and maternity wards at Mbabane Government Hospital in Swaziland.

Methodology: A retrospective study was conducted at the maternity and gynecology wards at Mbabane Government Hospital from 3^rd – 14^th of July 2017. Data was retrieved from in-patient medical records.

Results: The study was done by enrolling 218 pregnant women. The most commonly prescribed drugs were the antimicrobial, NSAIDs, nutritional supplements, parenteral solutions and analgesics. The least prescribed were anticonvulsants. A high proportion were prescribed from US-FDA category B (42%), followed by category C (36%) and category A (9%). A small percentage of drugs (6%) were prescribed from drugs with positive evidence of risk (US-FDA category D) and (7%) were prescribed from drugs with proven fetal risk (category X).

Conclusion/ Recommendations: A considerable proportion of pregnant women were exposed to drugs, including those with positive evidence of risk and those with proven fetal risk. Healthcare providers must adopt the US-FDA risk category system when prescribing drugs to pregnant women.

Keywords: Prenatal; drug prescription pattern; US-FDA pregnancy category.

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