Journal of Research in Pharmacy Practice

Abstract Objective: The increasing number of available drugs and drug users, as well as more complex 
drug regimens led to more side effects and drug interactions and complicates follow‑up. The 
objective of this study was to assess drug‑related problems (DRPs) and associated factors 
in hospitalized patients.
Methods: A hospital‑based cross‑sectional study design was employed. The study was 
conducted in Jimma University Specialized Hospital, Jimma, located in the south west of Addis 
Ababa. All patients who were admitted to the medical ward from February 2011 to March 
2011 were included in the study. Data on sociodemographic variables, past medical history, 
drug history, current diagnosis, current medications, vital signs, and relevant laboratory data 
were collected using semi‑structured questionnaire and data collection forms which were 
filling through patient interview and card review. Data were analyzed using SPSS version 16 for 
windows. Descriptive statistics, cross‑tabs, Chi‑square, and logistic regression were utilized.
Findings: Out of 257 study participants, 189 (73.5%) had DRPs and a total of 316 DRPs 
were identified. From the six classes of DRPs studied, 103 (32.6%) cases related to untreated 
indication or need additional drug therapy, and 49 (15.5%) cases related to high medication 
dosage. Unnecessary drug therapy in 49 (15.5%) cases, low medication dosage in 44 (13.9%) 
cases, and ineffective drug therapy in 42 (13.3%) cases were the other classes of problems 
identified. Noncompliance in 31 (9.8%) cases was the least prevalent DRP. Independent 
factors which predicted the occurrence of DRPs in the study population were sex, age, 
polypharmacy, and clinically significant potential drug‑drug interactions. The prevalence of 
DRPs was substantially high (73.5%).
Conclusion: Drug‑related problems are common among medical ward patients. 
Indication‑related problems, untreated indication and unnecessary drug therapy were the 
most common types of DRPs among patients of our medical ward.

Abstract Objective: Gram‑negative bacilli are the most important cause of nosocomial urinary 
tract infections (UTIs). The production of extended‑spectrum β‑lactamase (ESBL) enzymes 
is a common mechanism of resistance among these bacteria. The aim of this study was to 
determine the rate of ESBL producing Gram‑negative bacteria causing nosocomial UTI in a 
referral hospital as well as their susceptibility pattern to the most commonly used antibiotics.
Methods: In a prospective cross‑sectional study performed over a 6‑month period, urinary 
specimens obtained from hospitalized patients with documented culture‑proved nosocomial 
UTI (age range of 1-87 years). Isolated aerobic Gram‑negative bacteria underwent further 
microbiologic tests for detection of ESBL, as well as antimicrobial susceptibility test using 
Kirby-Bauer (disk diffusion) and E‑test methods.
Findings: During the study period, 213 urine samples were detected to have growth of 
Gram‑negative organism. Escherichia coli was the most frequently isolated organism (61%). 
ESBL was detected in 102 isolates including 38.5% of E. coli, 39.5% of Klebsiella pneumonia, 
88.5% of Pseudomonas aeruginosa, and 100% of Acinetobacter baumannii strains. Imipenem 
and meropenem were the most effective antibiotics on E. coli and K. pneumoniae strains. P.
aeruginosa and A. baumannii strains showed high resistance to all tested antibiotics.
Conclusion: Large numbers of Gram‑negative bacteria causing nosocomial UTIs produce 
ESBL with most being multidrug‑resistant. Therefore, routine ESBL detection testing and 
subsequent antibiogram with disk diffusion method could be useful to determine the best 
treatment options for UTI.

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.

Abstract Objective: The aim of this study was to compare the substantivity of chlorhexidine (CHX) 
and doxycycline bond to the dentin in diffusion disk method.
Methods: A total of 92 dentin disks were prepared from Bovine’s teeth root. After removing 
cementum and standardizing disks in weight and outer diameter, they were irrigated with 
sodium hypochlorite 2.5%, ethylenediaminetetraacetic acid 17% and sterile saline and 
sterilled in autoclave. Then, the first group (n = 36) were irrigated with chlrohexine 2% and 
the second group (n = 36) with doxycycline 100 mg/mL, each for a period of 10 min. The 
third group (n = 20) was considered as the control group. Samples were divided into four 
subgroups, which after 1 day, 3, 6, and 12 weeks were incubated in plates containing Muller 
Hinton agar broth and Enterococcus faecalis for a period of 48 h at 37°C temperature; then 
the diameter of the zone of inhibition was measured. The antimicrobial effect of irrigating 
solutions without binding to the dentin was also studied using the plate well method. 
One‑way and univariate variance tests as well as Post‑hoc Tukey were used for data analyses.
Findings: The diameter of the zone of inhibition of doxycycline group was significantly 
more than the CHX group from the beginning to the 3rd week (P < 0.005). After 3rd week, 
mean diameter in doxycycline group declined as compared with the CHX group up to 
12th week (P < 0.005). The difference between means in two groups was not significant in 
the 3rd week (P = 0.87).
Conclusion: The results of this study show that CHX and doxycycline show antibacterial 
activity for 12 weeks; although after 3rd week, the substantivity of CHX was significantly 
greater than doxycycline. Both of these irrigants can be used in other pharmacological and 
medical fields whenever a long‑lasting antibacterial action is needed.

Abstract Objective: The practice of self‑medication is growing world‑wide. It is associated with 
problems that may lead to potentially life‑threatening complications represent a priority 
to be investigated. The aim of this study was to estimate the prevalence of self‑medication 
among undergraduate medical students and to evaluate the possible role of the pharmacist 
in self‑medication in Kuwait.
Methods: A descriptive cross‑sectional study was performed, using the questionnaire on 
a sample of 900 male and female students randomly selected from three health faculties 
in Kuwait. The prevalence of self‑medication, as well as the contribution of pharmacist in 
self‑medication was assessed. In addition, the role of the pharmacist as drug consultant for 
the students after getting the medication was evaluated.
Findings: The overall prevalence of self‑medication was 97.8%. The age was significantly 
inversely proportional to self‑medication. There was a significant difference between male 
and female students in self‑medication practice. Headache was the highest health conditions 
that most frequently motivated self‑medication with 90.1% prevalence, followed by 84.7% 
for dysmenorrhea and 60.3% for constipation. Contribution of the pharmacist as a part 
of self‑medication care was low totally, with the highest rate for cough conditions 40.1%. 
However, the role of the pharmacist as a drug consultant was more noticeable after obtaining 
the drug, not before. Around 80.1% of the students request information from the pharmacist 
about doses, duration of treatments and side‑effects.
Conclusion: The prevalence of self‑medication among undergraduate students in Kuwait 
is high and there were significant differences for age and gender. The contribution of the 
pharmacist was low in self‑medication, while it was high after getting the drugs for obtaining 
drug related information. The practice of self‑medication is alarming. Improved awareness 
about the role of pharmacist as a drug consultant for careful and cautious use of medicines 
available for self‑medication would be strongly recommended.

Abstract Objective: Oxytocin routinely used as an uterotonic drug in cesarean delivery. Clothing 
problems, adverse effects on fibrinogen and bleeding were presented as side effects of 
oxytocin. In in vivo investigation, modest hypercoagulable state was suggested as a side effect 
for infusion of oxytocin in parturients. In this study, effects of two different infusion rates of 
oxytocin on coagulation of parturient were evaluated during cesarean delivery.
Methods: In a randomized double‑blinded clinical trial, 84 healthy parturient in two equal 
groups took oxytocin infusion with the rate of 15 IU/h (Group A) or 30 IU/h (Group B), 
after the umbilical cord clamping. Coagulation status measured 30 min after beginning of 
infusion by thromboelastography. Data were analyzed by χ2
, paired sample test and ANOVA 
considering as significant at P < 0.05.
Findings: The mean (standard deviation) of variables in GroupsA and B were 2.4024 (0.86) 
and 2.0429 (0.68) for K (kinetics of clot development), 55.4429 (11.30) and 60.7595 (10.41) 
for α (speed of clot strengthening) and 59.779 (19.15) and 70.61 (11.30) for maximum 
amplitude (maximum clot strength), respectively. The P values for these variables were 0.036, 
0.028 and <0.001, respectively; these changes are consistent with increasing coagulability. 
Other measures did not have significant differences.
Conclusion: This in vivo investigation clarified that increasing infusion rate of oxytocin to 
30 IU/h can augment coagulability in term parturients.

Abstract Objective: Hyponatremia is one of the most common electrolyte abnormalities in 
hospitalized patients. The treatment of hyponatremia is controversial as rapid correction 
of serum sodium can give rise to neurologic disorder and at the same time if not corrected 
timely, it can lead to brain damage. The aim of this study was to compare the efficacy of 
Tolvaptan with 3% hypertonic saline solution for the management of hyponatremia in 
hospitalized patients.
Methods: In this prospective observational study, data of 60 hospitalized patients having 
hyponatremia from February 2013 to July 2013 were collected and analyzed. Patients 
either received oral Tolvaptan or intravenous infusion of 3% hypertonic saline solution. The 
serum sodium concentration before administration of treatment and 24 h and 48 h after 
the administration of the drugs were recorded and analyzed. Data were analyzed using 
GraphPad Software, by Student’s paired t‑test and one‑way analysis of Variance (ANOVA).
Findings: Tolvaptan and 3% hypertonic saline solution had significant effects in raising serum 
sodium level in hyponatremic patients at both 24 h and 48 h (P < 0.0001). This increase 
was about 8.030 ± 0.6507 mEq/L and 12.33 ± 0.6489 mEq/L for 3% hypertonic saline and 
about 5.111 ± 0.6616 mEq/L and 10.11 ± 0.6230 mEq/L for Tolvaptan, after 24 h and 48 h, 
respectively.
Conclusion: Both drugs had significant effects in raising serum sodium level in hyponatremic 
patients; however administration of 3% hypertonic saline solution had a slightly superior 
efficacy in raising the serum sodium concentration at both 24 h and 48 h periods in 
Hyponatremic patients compared with oral Tolvaptan.