Journal of Research in Pharmacy Practice

Abstract For many decades, researchers are aware of the importance of circadian rhythm in 
physiological/biochemical properties and drug metabolism. Chronopharmacology is the study 
of how the effects of drugs vary with biological timing and endogenous periodicities. It has 
been attaching substantial attention in the last years. Chronopharmacodynamics mainly deals 
with the biochemical and physiological effects of drugs on the body, the mechanisms of drug 
action, the relationship between drug concentration and effect in relation to circadian clock. 
In this review, we will focus on mammalian circadian pharmacodynamics and discuss new 
chronotherapy approaches. Moreover, we will try to highlight the chronopharmacodynamics 
of cardiovascular drugs, anti‑cancer drugs, analgesics and non‑steroidal anti‑inflammatory 
drugs (NSAIDs) and give some practical concerns for clinical pharmacists and pharmacy 
practitioners, concerning this issue.

Abstract Objective: The aim of this study was to evaluate the awareness and perception of general 
educated Indian individuals about Doctor of Pharmacy course.
Methods: A cross‑sectional structured Pharm.D questionnaire survey was conducted at 
educational institutions of India mainly through e‑mails. Pharm.D questionnaire survey was 
conducted over a period of six months. The questionnaire was classified into four major 
categories, including course‑related questions, roles‑related questions, critical comparative 
questions, and opinion‑based questions. The responses were collected and analyzed to assess 
the opinions and attitudes of the study population regarding the course Pharm.D.
Findings: Out of 2819 responses, 66.01% agreed that Indian syllabus, teaching procedure, 
and hospital training in institutions are enough to prepare an ideally graduated Pharm.D. 
Respondents of about 70.59% agreed that Pharm.Ds should take care of complete 
responsibility of drug therapy rather than physicians prescribing the medications and Pharm.
Ds fixing the dose. The statement “Pharm.Ds play a vital role in improving medication 
adherence through patient counseling” was accepted by 47.80%, whereas 41.40% did not 
accept it as they felt that the Pharm.D’s role in this regard is not more than the physician’s 
role, and 10.80% suggested that other healthcare professionals would play a better role. 
Among all the respondents, 73.64% of the study population was found to be ready for giving 
equal credit and respect to Pharm.Ds as physicians.
Conclusion: Our survey emphasizes on the opinion of educated people of having Pharm.Ds 
in both government and private hospitals to take care of complete therapy and for improving 
medication adherence.

Abstract Objective: Addition of vasoconstrictors to local anesthesia results in prolonged pain 
control. However, associated soft‑tissue anesthesia (STA) of the lips and tongue typically lasts 
3‑5 hours which is longer than required time for pain control after routine dental procedures 
can lead to inadvertent biting of the soft tissue, particularly in children. The present study 
aimed to evaluate phentolamine mesylate (PM) effect on duration of STA and incidence of 
soft‑tissue trauma after mandibular block injection.
Methods: This randomized, double‑blinded, controlled clinical trial included 54 patients 
with the age of 4‑11 years. In group 1 at the first visit, the children received ordinary local 
anesthetic (LA) consisting of lidocaine 2% and epinephrine 1:80,000 and the PM injection was 
performed 30 minutes later. At the second visit, the contralateral side received LA injection 
then the dental procedure was done and a sham injection was performed. In group 2 at the 
first visit, patients received control injection and at the second visit received PM injection. 
Then the reversal time for normal sensation of soft tissue, the vital signs, and the incidence 
of soft‑tissue trauma in a period of 3‑5 hours after injection were evaluated.
Findings: There was a statistically significant difference (P < 0.001) in recovery time of normal 
lip sensation between case and control groups and also between two groups (P < 0.003). 
Incidence of soft‑tissue trauma between case and control groups showed a statistically 
significant difference (P < 0.039).
Conclusion: PM can be considered as a safe and effective drug for reduction of reversal 
time of STA after dental procedures.

Abstract Objective: Considering the physiologic roles of vitamin D on insulin regulation, the effects 
of vitamin D treatment on insulin sensitivity and resistance indexes and beta cell function 
in pre‑diabetic vitamin D deficient patients were investigated.
Methods: In a randomized open clinical trial, 61 pre‑diabetic vitamin D deficient patients 
who were the first degree relatives of type 2 diabetic patients, were enrolled and randomized 
into three groups (A, B and C). GroupA (n = 21) were treated with intramuscular injection 
of 300,000 units of vitamin D at the beginning of the study and one month later. In 
group B (n = 20), injection of vitamin D plus 500 mg/d calcium and in group C (n = 20), just 
calcium was administered for two months. At baseline and two months later, oral glucose 
tolerance test was done. Homeostasis Model of Assessment-Insulin Resistance (HOMAIR), insulin resistance index, Homeostasis Model of Assessment-B (HOMA-B) which is a 
beta cell function index, and Matsuda index, an insulin sensitivity index, were calculated and 
compared before and after intervention and between three groups.
Findings: In vitamin D treated groups (A + B), the mean (SD) of HOMA‑IR increased 
from 2.46 (1.36) to 3.1 (2.3) (P  =  0.02), and Matsuda index decreased from 11 (3) to 
9.0 (2.3) (P = 0.001).
Conclusion: Injection of vitamin D increased insulin resistance and decreased insulin 
sensitivity indexes.

Abstract Objective: This study aims at the outcome of providing pharmaceutical care service for 
asthma patients through an active partnership between clinical pharmacist and patients, for 
an optimal pharmacotherapy and a better quality of life (QoL).
Methods: In this controlled clinical trial, which was conducted for 8 months (2009) in 
the Institute of Pulmonary Medicine and Research Centre of a 550-bedded multispecialty 
tertiary care teaching hospital in India, all patients diagnosed with asthma at least 6 months 
before getting enrolled in this study were included (n = 66). Patients were divided into the 
intervention group who received pharmaceutical care through asthma education, medication 
counselling, instructions on lifestyle modifications, asthma care diary, etc., and the control 
group who were not provided any pharmaceutical care. Asthma control in the two groups 
was assessed using Asthma Control Test (ACT) at regular intervals. QoL in both groups was 
assessed at regular intervals using standardized Asthma Quality of Life Questionnaire (AQLQ). 
Findings: The mean AQLQ scores for the intervention group at the baseline were changed 
to significantly higher amounts in the final visit indicating overall, activity, symptoms, emotional, 
and environmental domains, respectively (P < 0.05). The mean ACT scores for intervention 
group at baseline were also increased in statistically significant amounts in the final visit for 
all the five ACT questions (P < 0.05). 
Conclusion: Our pharmaceutical care program showed a positive impact in improving 
patient’s asthma-related QoL, lung function, and asthma control. By providing structured 
pharmaceutical care, clinical pharmacists can help asthma patients to achieve desired health 
outcomes.

Abstract Objective: Recently, adenosine deaminase (ADA) is introduced as helpful marker in 
diagnosis, prognosis, and monitoring of treatment in rheumatoid arthritis (RA). The aim 
of this study was to determine the efficacy of the serum ADA in diagnosis, prognosis, and 
monitoring of treatment with methotrexate (MTX) in RA.
Methods: This was a self‑controlled clinical trial conducted in university hospitals of 
Isfahan, Iran. The serum level of ADA, erythrocyte sedimentation rate (ESR), and rheumatoid 
factor(RF) were measured for 70 patients with active RA (Disease Activity Score-28 [DAS28] 
> 3/2). After three months of MTX treatment and disease remission (DAS28 < 2.6) these 
markers were measured again. ANCOVA multiregression and paired t‑test were used to 
compare and evaluate the mean level and correlation of ADA, ESR, IgM‑RF, and DAS before 
and after RA remission.
Findings: The mean value for ADA activity was significantly higher than the normal one 
compared with other studies. Significant decreases were seen in values of ADA, ESR, 
RF, visual analogue scale (VAS), and DAS after remission. Also, the correlation coefficient 
between the values of ADA with ESR and DAS were statistically significant in baseline. 
Moreover, the statistically significant correlation between ADA and ESR, VAS, and DAS 
were seen after remission. No correlation was found in the case of the dosage of MTX 
with the value of ADA.
Conclusion: It was concluded that ADA may be considered useful as a marker in diagnosis, 
prognosis, and monitoring of treatment with Methotrexate in RA.

Abstract Objective: Pseudocatalase/superoxide dismutase (PSD) is a topical gel considered 
having therapeutic effects in vitiligo. This study was designed to evaluate the efficacy of 
this combination in vitiligo.
Methods: This was a pilot randomized, double‑blind, placebo‑controlled trial on 46 
symmetrical vitiligo lesions of limbs in 23 patients referring to dermatology clinics, 
Isfahan, Iran in 2010. Patients were received this formula or placebo gels for the right 
and left lesions. Lesion area and degree of pigmentation were assessed at baseline, 2, 4, 
and 6 months.
Findings: There were no significant changes in lesion area and perifollicular pigmentation 
in each group (P > 0.05).
Conclusion: The results indicated no significant therapeutic effect for PSD in vitiligo.

Abstract