Journal of Research in Pharmacy Practice

Abstract Drug combinations with the potential to interact comprise an important but rather neglected topic in clinical cancer research. While several studies have evaluated drug interactions in general medicine, and the potential risks for patient’s safety are well discussed, only few have addressed this subject in patients with cancer. Given the often large, and
frequently increasing, number of drugs that cancer patients take, drug–drug interactions (DDIs) may pose a real threat of undesired adverse events, of increased or decreased efficacy of antineoplastic agents and may ultimately impact on patients’ quality of life.

Abstract Pyelonephritis is an inflammatory process, and oxidative stress plays a major role in it. Anti-inflammatory or antioxidant therapy given concomitantly with antibiotics should lower the risk of postpyelonephritic scarring. As the lack of review studies in the use of antioxidants in urinary tract infections was detected, this study was designed. We conducted a review of available articles in PubMed and Google Scholar with a simple review, using keywords of "antioxidant" and "pyelonephritis" with all their possible synonyms and combinations. Only interventional studies were collected. There were neither limitations on time, nor the location of the study, type of subjects, administration rout of the antioxidant drug, and the antioxidant drug used. After studying the abstracts or in some cases the full text of articles, they were categorized based on the type of antioxidant, type and number of subjects, rout of administration, dosing, duration of treatment, year of publication of the paper, and the results. A total of 66 articles published from 1991 to 2015 were found by studying just the title of the papers. Studying the abstracts reduced this number to 51 studies. Antioxidants used for this condition were Vitamins A, E, and C, cytoflavin, caffeic acid phenethyl ester, ebselen, allopurinol, melatonin, N-acetylcysteine, oleuropein, montelukast, oxytocin, ozon, dapsone, pentoxifyllin, tadalafil, bilirubin, cranberry, meloxicam, L-carnitine, colchicine, perfluoran, methylprednisolone, and dexamethasone. Studies show that antioxidants are capable of reducing oxidative stress and can be used effectively along with antibiotics to reduce the scar formation.

Abstract Objective: Periodontitis is known to have multifactorial etiology, involving interplay 
between environmental, host and microbial factors. The current treatment approaches 
are aimed at reducing the pathogenic microorganisms. Administration of beneficial 
bacteria (probiotics) has emerged as a promising concept in the prevention and 
treatment of periodontitis. Thus, the aim of the present study is to evaluate the efficacy 
of the local use of probiotics as an adjunct to scaling and root planing (SRP) in the 
treatment of patients with chronic periodontitis and halitosis.
Methods: This is a randomized, placebo‑controlled, double‑blinded trial involving 
32 systemically healthy chronic periodontitis patients. After SRP, the subjects were 
randomly assigned into the test and control groups. Test group (SRP + probiotics) 
received subgingival delivery of probiotics and probiotic mouthwash, and control 
group (SRP + placebo) received subgingival delivery of placebo and placebo mouthwash 
for 15 days. Plaque index (PI), modified gingival index (MGI), and bleeding index (BI) 
were assessed at baseline, 1 and 3 months thereafter, whereas probing depth (PD) 
and clinical attachment level were assessed at baseline and after 3 months. Microbial 
assessment using N‑benzoyl‑DL‑arginine‑naphthylamide (BANA) and halitosis 
assessment using organoleptic scores (ORG) was done at baseline, 1 and 3 months.
Findings: All the clinical and microbiological parameters were significantly reduced 
in both groups at the end of the study. Inter‑group comparison of PD reduction (PDR) 
and clinical attachment gain (CAG) revealed no statistical significance except for PDR 
in moderate pockets for the test group. Test group has shown statistically significant 
improvement in PI, MGI, and BI at 3 months compared to control group. Inter‑group 
comparison revealed a significant reduction in BANA in test group at 1 month. ORG 
were significantly reduced in test group when compared to control group.
Conclusion: Within the limitations of the study, the present investigation showed that 
the adjunctive use of probiotics offers clinical benefit in terms of pocket depth reduction 
in moderate pockets and reduced oral malodor parameters.

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, 28patients(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±25.67vs. 71.57±1.60h,
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.

Abstract Objective: Patients on hemodialysis (HD) have a high risk for cardiovascular morbidity 
and mortality. Cardiac troponins are biomarkers for diagnosing acute myocardial 
injury or infarction. There is considerable controversy that exists in the frequency and 
significance of cardiac troponins in predicting cardiac injury and ischemia in HD patients.
Methods: In this cross‑sectional study, all HD patients more than 18‑year‑old, who 
were at least 3 months under HD, and had no sign and symptom of active cardiovascular 
disease (CVD), in two HD centers were enrolled. One hundred and one patients fulfilled 
the inclusion criteria. Blood sample for cardiac troponin I (cTnI) was drown before 
the initiation of HD session during their routine monthly blood testing from patients’ 
vascular access arterial line. cTnI levels were measured by a high‑sensitivity assay, 
VIDAS troponin I Ultra kit, and correlated with patients’ demographic, clinical, and 
laboratory results.
Findings: The patients’ different demographic and clinical characteristics had no 
statistically significant correlation with troponin levels except for marginal trend for past 
medical history of diabetes and hyperlipidemia with corresponding P values of 0.072 
and 0.055. Twenty‑six patients had cTnI level more than 0.01 µg/L and only two patients 
had cTnI level more than 0.11 µg/L. For laboratory results, only fasting blood sugar 
had statistically significant correlation with patients’ cTnI level(r = 0.357, P = 0.0001).
Conclusion: Frequency of significant elevation of cTnI level in our asymptomatic 
HD patients was very low and if such elevation is found in this population, it may be 
considered as a sign of active CVD.

Abstract Objective: To develop a valid and reliable instrument in the Persian language for 
evaluating patient satisfaction with services provided in community pharmacies.
Methods: We selected a valid and reliable instrument from the literature and translated 
it to the Persian language. Some new items were added to the first draft based on the 
special characteristics of the Iranian health system. Then, the feasibility of utilizing 
the new instrument was assessed. In the third step, we conducted a formal content 
validity study to calculate content validity indices. Having completed the content validity 
study, the factorial structure of new instruments was determined by implementing a 
factorial analysis. Finally, the reliability of the instrument was assessed by assessment 
of Cronbach’s alpha coefficient and test‑retest reliability.
Findings: The developed instrument demonstrated suitable validity and reliability. 
The final instrument showed desirable content validity, with inter‑rater agreement 
of 94% and 97% for relevance and clarity, respectively. Scale content validity 
indices for relevance and clarity were calculated as 96% and 92%, respectively, and 
comprehensiveness was calculated as 100%. Factor analysis resulted in seven factors 
with a cumulative variance of 62.14%. In internal consistency reliability, Cronbach’s 
alpha for the whole instrument was 0.912. About test‑retest reliability, six items showed 
“almost perfect” agreement, 18 items showed “substantial” agreement, and three 
items showed “moderate” agreement. Therefore, test‑retest reliability assessment too 
demonstrated appropriate results.
Conclusion: The instrument demonstrated excellent validity and reliability for 
application in Iran. This instrument is useful for evaluating patient satisfaction with 
services provided in community pharmacies in the Persian‑speaking communities.

Abstract Objective: The principal aim of this study was to explore the self‑perception of 
community pharmacists of their professional identity and roles and how they think 
patients and doctors perceive them. The study also aimed at exploring their opinions 
regarding role expansion and how they assess their capabilities.
Methods: This is an exploratory study that employed qualitative method. Individual, 
in‑depth interviews were conducted with a purposive sample of 50 community pharmacists 
working in Khartoum State, Sudan, from October to November 2015. Each interview was 
recorded, transcribed, and coded into themes. Thematic analysis was carried out.
Findings: The study revealed nine different identities of community pharmacists 
including supplier of medicines, medicines maker, dispenser, patient counselor, medicines 
expert, clinical practitioner, health promoter, monitor of medicines use, and family 
practice identity. Participants described that most of the patients value their professional 
role while doctors perceive them as merely dispensers. Most of participants believe that 
they are capable to fulfill their roles; however, they identified the need for continuous 
education. The study revealed that community pharmacists are thirst to role expansion.
Conclusion: The study concluded that community pharmacists are aware of the different 
identities of their profession. The good recognition of their role by patients reflects good 
service provided while lack of integrated primary health care system that join doctors 
and pharmacists resulted in lack of pharmacists’ recognition by doctors. Continuous 
educational program is needed for community pharmacists, and role expansion will 
allow for better self‑perception and better profession contribution in healthcare.

Abstract Objective: Self‑medication is common among patients with gastrointestinal (GI) 
symptoms. This study was performed to evaluate self‑medication among patients 
who fulfilled irritable bowel syndrome (IBS) and dyspepsia diagnostic criteria and to 
investigate the appropriateness of self‑medication with chemical and herbal drugs.
Methods: Aprospective, descriptive cross‑sectional study was conducted in outpatient’s 
GI clinics at Shiraz from November 2011 to May 2012. A GI specialist visited the patients 
and recruited those who had IBS (base on Rome III adapted criteria) or functional 
dyspepsia. We surveyed self‑medication among these patients, using a questionnaire 
containing specific questions about self‑medication.
Findings: One thousand four hundred and forty‑seven patients visited by the GI 
specialist during the study period. Seven hundred and forty‑seven patients had the 
inclusion criteria, 337 of them fulfilled criteria for IBS, with IBS‑mixed (52%) being the 
most prevalent subtype, and 410 patients had dyspepsia. Overall, 78.8% of the total 
participants had recently sought medical attention for their GI complaint. Twenty‑eight 
percent of patients selected inappropriate medication for their GI complaints. The 
H2‑blockers class were most common medicines reportedly used. We did not find any 
significant relationship between age, gender, level of education, marital status, and 
self‑medication frequency.
Conclusion: Patients who fulfilled criteria for IBS had a high tendency to self‑treat their 
GI symptoms, use of acid‑suppressive agents was common among patients. Around 
one‑third of patients self‑treated GI symptoms inappropriately. Consequently, the 
concept of self‑medication among patients has to be revised. We recommend conduction 
of educational programs to improve self‑medications selection and attitude among 
patients to reduce the burden on other health care resources.

Abstract Objective: To monitor pain intensity, pain symptoms, and medication use in elderly 
with dementia.
Methods: Nursing home residents above 65 years of age, diagnosed with dementia, 
and showing pain symptoms were included in the study. The patients’ mental status 
was monitored through a mini‑mental state examination score and observations of pain 
symptoms using Part 1 of the Mobilization‑Observation‑Behaviour‑Intensity‑Dementia‑2 
(MOBID‑2) pain scale. Community pharmacists reviewed the patients’ medication use, 
and the prescriptions were compared with guidelines for treatment of geriatric patients. 
Alterations to the patients’ medicine use were forwarded to the general practitioners.
Findings: Sixty‑one nursing home residents diagnosed with dementia were identified, 
15 of these fulfilled the inclusion criteria, and 12 agreed to participate in the study. 
The mean age was 87 years of age (range: 77–96), and 42% of the residents were 
males. The patients’ overall pain intensity was 83% for observations on the numeric 
pain rating scale (NRS) >0 and 67% for NRS ≥3. Most painful were the situations in 
which the residents were to mobilize their legs, turn around to both sides of the bed, 
and when sitting on the bed. The medication reviews identified a total of 95 individual 
prescriptions, and 33% of these were for nervous system medications, followed by 
medicines for the treatment of alimentary tract and metabolism disorders (31% of 
total). Eleven prescriptions for pain medicine were identified; the majority of these 
were for paracetamol and opioids. Seventeen proposals to patients’ medication use 
were suggested, but the general practitioners accepted only 6% of these.
Conclusion: This study indicates that the MOBID‑2 pain scale in combination with 
medication reviews can be used as a tool for optimization of patients’ medication use. 
However, we recommend the conduction of a larger‑scale study in multiple settings, to 
validate our results and the generalizability of the findings.

Abstract Objective: Hospitalization and subsequent discharge home often involve discontinuity 
of care, multiple changes in medication regimens, and inadequate patient education 
regarding the instruction of drug use, respiratory devices, and disease information 
and also lack of information about the drug’s side effects that can lead to medication 
nonadherence and low level of treatment satisfaction. Hence, we decided to design a 
study to determine the effect of patient counseling at discharge and also their follow‑up 
by pharmacist on their treatment satisfaction and medication adherence.
Methods: A total number of 154 patients within the age of 18–65 years old participated 
in the study from August 2013 to March 2014. Patients in the intervention group received 
pharmacist counseling and necessary education about their prescribed medications at 
discharge. We set up two follow‑up schedules for this group and one for control group, 
and then we compared the medication adherence and satisfaction in two groups. The 
primary outcome of this study was a significant increase in adherence to medication 
regimen and treatment satisfaction of the case group compare to control group after 
the intervention of pharmacist at the time of discharge.
Findings: There were significant differences in medication adherence and satisfaction 
between the groups at the time of second follow‑up. Medication adherence in the study group 
is 42.9% more than the control group, also the treatment satisfaction determined to be 33.5% 
more than patients in control group. Furthermore, we found that, in intervention group, 
no one is readmitted while among the patients in control group eight people readmitted.
Conclusion: Counseling patients at the time of discharge and regular follow‑up improves 
patient’s medication adherence and treatment satisfaction and consequently improves 
clinical outcomes.

Abstract Objective: In this study, we aimed to evaluate the attachment to stress ulcer prophylaxis 
(SUP) guideline in the neurology wards of two teaching and nonteaching hospitals.
Methods: A total of 243 patients were retrospectively reviewed in the neurology wards 
of two teaching and nonteaching hospitals. To assess the appropriate administration of 
SUP, an internal guideline was prepared using the American Society of Health‑System 
Pharmacists (ASHP) protocol.
Findings: SUP prescriptions were noncompliant with ASHP guideline in about 93.1% 
and 84.6% of cases in the nonteaching and teaching hospitals, respectively.
Conclusion: SUP may be better practiced in teaching hospitals versus nonteaching ones.

Abstract Objective: Pharmacy‑driven medication history (MH) programs have been shown 
to reduce the number of serious or potentially life‑threatening (S/PLT) medication 
discrepancies (MDs) in many settings, but not Intensive Care Units (ICUs).
Methods: MHs were repeated over a 6‑week period. Demographics, number, and nature 
of MDs were documented. Discrepancy severity was graded using a previously published 
method. Primary outcome was the proportion of MHs containing >1 S/PLT MDs.
Findings: Sixty‑three MHs were repeated. Pharmacy MHs were less likely to 
contain ≥1 S/PLT MDs (0% vs. 50%, P < 0.001).
Conclusion: Pharmacy MHs contained fewer S/PLT MDs in this small sample. S/PLT 
MDs on admission and home medication lists were common in patients admitted to 
the medical ICU. Pharmacy‑driven medication reconciliation (MR) reduced the number 
and frequency of these discrepancies. Further research is required to improve current 
MR procedures.

Abstract Sialadenitis is a rare adverse effect of captopril. We report a case of captopril‑induced 
sialadenitis in a patient with end‑stage renal disease (ESRD). A 20‑year‑old man with 
ESRD encountered parotid and submandibular swelling after receiving two doses of 
captopril, administered sublingually. Despite of prescribing dexamethasone, resuming 
hemodialysis, and discontinuing other drugs that also can cause parotitis, he improved 
later than what was reported in patients with normal renal function. In conclusion 
recovery from captopril‑induced sialadenitis in patients with ESRD may be more 
prolonged than that of patients with normal renal function; moreover, early hemodialysis 
which helps in drug removal may be the most effective treatment.