Journal of Research in Pharmacy Practice

Abstract

Abstract Objective: Any operation leads to body stress and tissue injury that causes pain and 
its complications. Glucocorticoids such as Dexamethasone are strong anti‑inflammatory 
agents, which can be used for a short time post‑operative pain control in various surgeries. 
Main purpose of this study is to evaluate the effect of administration of intravenous (IV) 
Dexamethasone on reducing the pain after cesarean.
Methods: A double‑blind prospective randomized clinical trial was performed on 60 
patients candidate for elective caesarean section. Patients were randomly assigned into 
two groups: A (treatment: 8 mg IV Dexamethasone) and B (control: 2 mL normal saline). 
In both groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), 
respiratory rate (RR), pain and vomiting severity (based on visual analog scale) were 
recorded in different time points during first 24 h after operation. Statistical methods 
using repeated measure analysis of variances and t‑test, Mann‑Whitney and Chi‑square 
tests were used for analyzing data.
Findings: The results indicated that within‑group comparisons including severity of pain, 
MAP, RR and HR have significant differences (P < 0.001 for all variables) during the study 
period. Between group comparisons indicated significant differences in terms of pain 
severity (P < 0.001), MAP (P = 0.048) and HR (P = 0.078; marginally significant), which in 
case group were lower than the control group.
Conclusion: IV Dexamethasone could efficiently reduce post‑operative pain severity and 
the need for analgesic consumption and improve vital signs after cesarean section.

Abstract Objective: Phenytoin is an antiepileptic drug used widely for prophylaxis and treatment of 
seizure after neurotrauma. Phenytoin has a complex pharmacokinetics and monitoring of its 
serum concentrations is recommended during treatment. Total phenytoin concentration 
is routinely measured for monitoring of therapy. In this study, we evaluated the correlation 
between phenytoin total and free concentrations in neurotrauma critically-ill patients to 
determine whether the phenytoin total concentration is a reliable predictor of free drug, 
which is responsible for the therapeutic effects.
Methods: A total of 40 adult head trauma patients evaluated for free (unbound) and total 
serum phenytoin concentrations. Patients were divided into two groups. GroupA consists of
20 unconscious patients with severe head injury under mechanical ventilation and Group B 
consists of 20 conscious self-ventilated patients. Correlation and agreement between total 
and free phenytoin plasma concentrations were analyzed.
Findings: Pearson correlation analysis and Bland-Altman test showed weak to moderate 
correlation (r = 0.528) and poor agreement between free and total phenytoin concentrations 
in patients with severe trauma and higher Acute Physiology And Chronic Health Evaluation 
II (APACHE II) scores (GroupA) and good correlation (r = 0.817) and moderate agreement 
in patients with mild to moderate trauma and lower APACHE II scores (Group B).
Conclusion: Our results indicated that total phenytoin serum concentration is not a 
reliable therapeutic goal for drug monitoring in severely-ill head trauma patients even in 
the absence of hypoalbuminemia, renal and hepatic failure. It seems justifiable to measure 
free phenytoin concentration in all severely ill neurotrauma patients.

Abstract Objective: Tricyclic antidepressant (TCA) poisoning is among highly prevalent and potentially 
dangerous toxicities. ST‑T changes are observed in the electrocardiogram (ECG) of most 
of TCA poisoned patients. We aimed to study ST‑T segment changes in TCA toxicity and 
its probable relationship with other ECG findings.
Methods: This retrospective study was carried out in Noor and Ali Asghar University 
Hospital, Isfahan (Iran) in 2012. Patients with TCA toxicity based on the patients’ history 
who had not consumed any cardio-active drugs and did not have a past medical history of 
cardiovascular disease in the recent 5 years, were randomly selected and investigated. Their 
demographic and medical data on admission including ECG, age, sex, type and amount of 
ingested TCA, poisoning severity score, QRS changes, QT interval, heart axis position and 
R‑wave were all recorded. ST‑T changes and their relation with other ECG parameters have 
been determined using statistical analysis.
Findings: Medical records of 272 patients were analyzed. In symptomatic patients, ST change 
prevalence was 40.8% and T change prevalence was 9.5%. In asymptomatic patients, the 
frequency of ST and T changes were 4.8% and 0.8%, respectively (P < 0.05). The most common 
ST and T changes in baseline (on admission) ECG were non‑significant elevation (15.4%), 
significant elevation (11%) in pre‑cordial leads, and T‑wave flattening (6.6%). A statistically 
significant correlation was documented between ST segment changes with QRS and R‑wave 
in aVR. The correlation between T‑wave changes and R‑wave in aVR lead was also significant.
Conclusion: ST‑T changes in TCA poisoned patients are more prevalent in symptomatic 
patients. Obviously for a more definite conclusion, it is necessary to design a prospective study 
with the control group. This may facilitate a better understanding of ST‑T segment changes.

Abstract Objective: The objective of this study is to analyze the health‑care cost by calculating the 
direct and indirect costs of diabetes with co‑morbidities in south India. 
Methods: A prospective observational study was conducted at Rohini super specialty hospital 
(India). Patient data as well as cost details were collected from the patients for a period of 
6 months. The study was approved by the hospital committee prior to the study. The diabetic 
patients of age >18 years, either gender were included in the study. The collected data was 
analyzed for the average cost incurred in treating the diabetic patients and was calculated 
based on the total amount spent by the patients to that of total number of patients. 
Findings: A total of 150 patients were enrolled during the study period. The average 
costs per diabetic patient with and without co‑morbidities were found to be United States 
dollar (USD) 314.15 and USD 29.91, respectively. The average cost for those with diabetic 
complications was USD 125.01 for macrovascular complications, USD 90.43 for microvascular 
complications and USD 142.01 for other infections. Out of USD 314.15, the average total 
direct medical cost was USD 290.04, the average direct non‑medical cost was USD 3.75 
and the average total indirect cost was USD 20.34. 
Conclusion: Our study results revealed that more economic burden was found in male 
patients (USD 332.06), age group of 51‑60 years (USD 353.55) and the patients bearing 
macrovascular complications (USD 142.01). This information can be a model for future 
studies of economic evaluations and outcomes research.

Abstract Objective: Emergency departments (EDs) are characterized by simultaneous care of 
multiple patients with various medical conditions. Due to a large number of patients with 
complex diseases, speed and complexity of medication use, working in under‑staffing and 
crowded environment, medication errors are commonly perpetrated by emergency care 
providers. This study was designed to evaluate the incidence of medication errors among 
patients attending to an ED in a teaching hospital in Iran.
Methods: In this cross‑sectional study, a total of 500 patients attending to ED were randomly 
assessed for incidence and types of medication errors. Some factors related to medication 
errors such as working shift, weekdays and schedule of the educational program of trainee 
were also evaluated.
Findings: Nearly, 22% of patients experienced at least one medication error. The rate of 
medication errors were 0.41 errors per patient and 0.16 errors per ordered medication. The 
frequency of medication errors was higher in men, middle age patients, first weekdays, night‑time 
work schedules and the first semester of educational year of new junior emergency medicine 
residents. More than 60% of errors were prescription errors by physicians and the remaining 
were transcription or administration errors by nurses. More than 35% of the prescribing 
errors happened during the selection of drug dose and frequency. The most common 
medication errors by nurses during the administration were omission error (16.2%) followed 
by unauthorized drug (6.4%). Most of the medication errors happened for anticoagulants and 
thrombolytics (41.2%) followed by antimicrobial agents (37.7%) and insulin (7.4%).
Conclusion: In this study, at least one‑fifth of the patients attending to ED experienced 
medication errors resulting from multiple factors. More common prescription errors 
happened during ordering drug dose and frequency. More common administration errors 
included dug omission or unauthorized drug.

Abstract Objective: The main objective of this study was to assess the effects of pharmaceutical 
care interventions in patients with essential hypertension in Lakshmi Pat Singhania Institute 
of Cardiology, Kanpur, India.
Methods: The study was carried out from July 2010 to August 2011. Pharmaceutical care 
was provided for 54 patients (intervention group) which was comprised of the patient 
education, the prescription assistance and the life style modifications and motivation for 
health. Then the clinical outcome as well as health related quality of life (HRQOL) were 
compared with the control group (48 patients) in which the pharmaceutical care was not 
provided. Furthermore, the effect of pharmaceutical care intervention on HRQOL was 
assessed using Short Form‑36 (SF‑36), a general health related quality of life questionnaire 
used to evaluate the QOL of patients. Blood pressure (BP) measurements and QOL survey 
was performed at baseline and at the follow‑up session.
Findings: The difference between blood pressure readings from the baseline to the second 
follow‑up was significant for systolic [(P = 0.0001), 12.24 mmHg] and diastolic BP [(P = 0.001), 
5.17 mmHg] in the intervention group. The questionnaire used to evaluate the QOL of 
patients also showed improvement in the mean score for intervention group.
Conclusion: Results from our study showed that applying pharmaceutical care to 
hypertensive patients can help in the control of these patients’ blood pressure, and 
consequently lower the risk that hypertension poses in cardiovascular disease. Successful 
implementation of pharmaceutical care has the potential to increase patients’ satisfaction 
with their pharmacists’ activities and may increase patients’ expectations that pharmacists 
will work on their behalf to assist them with their healthcare needs.

Abstract Objective: Methadone poisoning can occur accidentally or intentionally for suicide or 
homicide purposes. The aim of this study was to evaluate the epidemiological and clinical 
manifestations of Methadone poisoning.
Methods: A descriptive analytical study was performed from 2010 to 2012 in the poisoning 
emergency and clinical toxicology departments of Noor hospital affiliated with Isfahan 
University of Medical Sciences (Isfahan, Iran). All patients with Methadone poisoning within 
this period of time were investigated. Different variables were recorded in a checklist.
Findings: A total of 385 patients were studied. About 85.7% had ingested only Methadone 
and 14.3% had ingested other medications with Methadone. Mean ± standard deviation 
of the age was 32.1 ± 15 years (range: 1‑90). Most of the patients were male (76.4%). 
Nearly 40% of the patients were narcotic addicts, 25.5% were addicts under surveillance of 
Methadone maintenance therapy centers and 34.5% were non‑addicts. Intentional poisoning 
was observed in most of the patients (57.7%). Most of the patients had a low level of 
consciousness on admission (58.2%). Respiratory depression and hypotension was observed 
in 35.6% and 12.7% of the cases as the most common symptoms. Regarding vital signs, there 
was a significant difference in respiratory rate on admission among different evaluated 
groups (P = 0.02). Length of hospital stay was 18.79 ± 0.72 h (range: 4‑240 h, median: 15 h). 
About 57 patients (25.8%) from the intentionally poisoned patients and 19 patients (12.3%) 
from the unintentionally poisoned patients had a history of psychiatric disorder (P = 0.001). 
Most of the patients survived without complications.
Conclusion: Addiction, age, gender, attempt to suicide and a history of psychiatric disorder 
were of the most important factors effective in Methadone poisoning, which should be 
considered in the public training and prevention of poisoning.