Journal of research in pharmacy practice 

About: Journal of research in pharmacy practice is an academic journal published by Medknow. The journal publishes majorly in the area(s): Pharmacy & Medical prescription. It has an ISSN identifier of 2279-042X. It is also open access. Over the lifetime, 350 publications have been published receiving 4141 citations. The journal is also known as: JRPP.

Effect of high-dose Ascorbic acid on vasopressor's requirement in septic shock

Abstract: Objective: Effects of ascorbic acid on hemodynamic parameters of septic shock were evaluated in nonsurgical critically ill patients in limited previous studies. In this study, the effect of high-dose ascorbic acid on vasopressor drug requirement was evaluated in surgical critically ill patients with septic shock. Methods: Patients with septic shock who required a vasopressor drug to maintain mean arterial pressure >65 mmHg were assigned to receive either 25 mg/kg intravenous ascorbic acid every 6 h or matching placebo for 72 h. Vasopressor dose and duration were considered as the primary outcomes. Duration of Intensive Care Unit (ICU) stay and 28-day mortality has been defined as secondary outcomes. Findings: During the study period, 28 patients (14 in each group) completed the trial. Mean dose of norepinephrine during the study period (7.44 ± 3.65 vs. 13.79 ± 6.48 mcg/min, P = 0.004) and duration of norepinephrine administration (49.64 ± 25.67 vs. 71.57 ± 1.60 h, P = 0.007) were significantly lower in the ascorbic acid than the placebo group. No statistically significant difference was detected between the groups regarding the length of ICU stay. However, 28-day mortality was significantly lower in the ascorbic acid than the placebo group (14.28% vs. 64.28%, respectively; P = 0.009). Conclusion: High-dose ascorbic acid may be considered as an effective and safe adjuvant therapy in surgical critically ill patients with septic shock. The most effective dose of ascorbic acid and the best time for its administration should be determined in future studies.

A comparison of five common drug–drug interaction software programs regarding accuracy and comprehensiveness

Abstract: Objective: Drug–drug interactions (DDIs) can cause failure in treatment and adverse events. DDIs screening software is an important tool to aid clinicians in the detection and management of DDIs. However, clinicians should be aware of the advantages and limitations of these programs. We compared the ability of five common DDI programs to detect clinically important DDIs. Methods: Lexi-Interact, Micromedex Drug Interactions, iFacts, Medscape, and Epocrates were evaluated. The programs' sensitivity, specificity, and positive and negative predictive values were determined to assess their accuracy in detecting DDIs. The accuracy of each program was identified using 360 unknown pair interactions, taken randomly from prescriptions, and forty pairs of clinically important ones. The major reference was a clinical pharmacist alongside the Stockley's Drug Interaction and databases including PubMed, Scopus, and Google Scholar. Comprehensiveness of each program was determined by the number of components in the drug interaction monograph. The aggregate score for accuracy and comprehensiveness was calculated. Findings: Scoring 250 out of possible 400 points, Lexi-Interact and Epocrates, provided the most accurate software programs. Micromedex, Medscape, and iFacts ranked third, fourth, and fifth, scoring 236, 202, and 191, respectively. In comprehensiveness test, iFacts showed the highest score, 134 out of possible 134 points, whereas Lexi-Interact rated second, with a score of 120. Scoring 370 and 330 out of possible 534 points, Lexi-Interact and Micromedex, respectively, provided the most competent, complete, and user-friendly applications. Conclusion: Lexi-Interact and Micromedex showed the best performances. An increase in sensitivity is possible by the combination of more than one programs and expert pharmacist intervention.

Polypharmacy in the elderly.

Abstract: Objective: The objective was to assess the frequency of polypharmacy and potential complications among local seniors. Methods: A cross-sectional convenience sample of 59 adults aged above 65 years was interviewed at Cuyahoga county (U.S. state of Ohio) senior programs. Polypharmacy was defined as more than five prescribed medications. Primary outcomes were frequent missed doses, one or more duplicate drug/s, and equal or more than one contraindicated drug combinations. Findings: Among seniors with the mean age of 76.9 years (25.4% male), 40.6% used multiple pharmacies and 35.6% had polypharmacy. Of all seniors with polypharmacy, about 57% had contraindicated drug combinations. Polypharmacy was associated with duplication ( P = 0.02), but not frequent missed doses ( P = 0.20). Conclusion: As shown by this study, polypharmacy was associated with duplicated therapy and contraindicated drug combinations. Improved communications among seniors, physicians, and pharmacists is necessary to minimize adverse consequences of polypharmacy.

A comparative study of pre- and post-menopausal breast cancer: Risk factors, presentation, characteristics and management.

Abstract: Objective: Breast cancer is the most common female cancer worldwide and is the second most commonly diagnosed cancer in Indian women. This study evaluates the differences between pre- and post-menopausal breast cancer women regarding risk factors, nature of disease presentation, tumor characteristics, and management. Methods: This is a prospective observational study, conducted in the Oncology Department of St. Ann's Cancer Hospital, for a period of 6 months from January to August 2012. Data on basic demography, clinical and pathological tumor profile, and treatment details were collected prospectively for each patient based on patient interviews and medical records. Findings: Among 100 female patients taken up for the study, 48 were premenopausal and 52 had reached menopause. The mean age of presentation for breast carcinoma was a decade earlier in these patients compared with western patients. The risk factors for both pre-and post-menopausal breast cancer were found similar other than late menopause in postmenopausal patients. Having dense breast tissue was a predominant risk factor among all women. Late presentation was the common phenomenon in almost all patients. The treatment given was not based on any standard guidelines due to inadequate public health policies. Conclusion: Late stage at presentation of breast cancer is the main problem and possesses a challenge to the health care community. In order to reduce the burden of breast cancer, a multi-sectorial approach and evidence-based strategies aiming at early detection and effective management of the disease are required.

Early administration of surfactant via a thin intratracheal catheter in preterm infants with respiratory distress syndrome: Feasibility and outcome

Abstract: Objective: Currently, the method of early nasal continuous positive airway pressure (nCPAP) and selective administration of surfactant via an endotracheal tube is widely used in the treatment of respiratory distress syndrome (RDS) in premature infants. To prevent complications related to endotracheal intubation and even a brief period of mechanical ventilation, in this study, we compared the effectiveness of surfactant administration via a thin intratracheal catheter versus the current method using an endotracheal tube. Methods: Thirty eight preterm infants ≤34 weeks' gestation with birth weight of 1000-1800 g who were putted on nCPAP for RDS within the first hour of life, were randomly assigned to receive surfactant either via endotracheal tube (ET group) or via thin intratracheal catheter (CATH group). The primary outcomes were the need for mechanical ventilation and duration of oxygen therapy. Data were analyzed by independent t-test, Mann-Whitney U-test, and Chi-square test, using SPSS v. 21. Findings: There was no significant difference between groups regarding to need for mechanical ventilation during the first 72 h of birth (3 [15.8%] in ET group vs. 2 [10.5%] in CATH group; P = 0.99). Duration of oxygen therapy in CATH group was significantly lower than ET group (243.7 ± 74.3 h vs. 476.8 ± 106.8 h, respectively; P = 0.018). The incidence of adverse events during all times of surfactant administration was not statistically significant between groups (P = 0.14), but the number of infants who experienced adverse events during surfactant administration was significantly lower in CATH group than ET group (6 [31.6%] vs. 12 [63.2%], respectively; P = 0.049). All other outcomes, including duration of treatment with CPAP and mechanical ventilation, times of surfactant administration and the need for more than one dose of the drug, the rate of intraventricular hemorrhage, mortality and combined outcome of chronic lung disease or mortality were statistically similar between the groups Conclusion: Surfactant administration via thin intratracheal catheter in preterm infants receiving nCPAP for treatment of RDS has similar efficacy, feasibility and safety to its administration via endotracheal tube.