Journal of Research in Pharmacy Practice

Abstract

Abstract Objective: Type 2 diabetes mellitus (DM‑T2) is commonly associated with increased 
triglycerides (TG), low‑density lipoprotein cholesterol (LDL‑C) and low high‑density 
lipoprotein cholesterol (HDL‑C) levels. Fibrates like gemfibrozil are frequently used in 
diabetic patients to decrease TG and increase HDL‑C levels. We compared the efficacy of 
Vitamin C, an antioxidant vitamin, with gemfibrozil on serum HDL‑C in diabetic patients.
Methods: Type 2 diabetic patients, referred to our out‑patient clinic were randomly divided 
into three groups. After 1 month of lifestyle and diet modifications, groupsA, B, and C were 
prescribed 1000 mg Vitamin C, 600 mg gemfibrozil and combination of both, respectively. 
Before the study initiation and after 6th week of drug prescription, the blood samples were 
taken and analyzed for total cholesterol (Total‑C), HDL‑C, TG, fasting blood sugar (FBS), 
and hemoglobin A1c (HbA1c) levels.
Findings: Sixty‑seven patients entered, and 50 patients (18 male, 32 female) finished 
the study. Overall, serum HDL‑C increased significantly from 39.8 to 45.2 mg/dL in the 
participants (P = 0.001). HDL‑C increased 6.3, 4.4 and 5.0 mg/dL in groups A, B and C, 
respectively (related significances were 0.017, 0.022 and 0.033, respectively). Significant 
decrease of serum TG and Total‑C occurred in gemfibrozil and combination groups, 
but not in Vitamin C group. Changes in serum HDL‑C between three groups were 
not significant (P = 0.963). We found a significant decrease in TG and Total‑C in the 
groups B and C (P < 0.05), but no significant changes of TG, Total‑C, LDL‑C, FBS and HbA1c 
in group A (P > 0.05).
Conclusion: The results demonstrated that Vitamin C may have beneficial effects on HDL‑C 
in diabetic patients without significant effects on plasma glucose or other lipid parameters; 
however, its role for the treatment of low HDL‑C patients should be evaluated in larger 
studies.

Abstract Objective: Previous studies on bone mineral density (BMD) abnormalities associated with 
hypothyroidism are scarce and not conclusive. The effect of thyroid hormone therapy on 
BMD has shown mixed results. The aim of the present study was to determine the severities 
of osteoporosis in female patients with hypothyroidism in comparison to healthy women.
Methods: This cross‑sectional descriptive study was performed on 150 women aged 
over 50 years. Totally, 100 patients with primary hypothyroidism and 50 healthy subjects were 
enrolled in this study and divided into three groups. GroupA, which consisted the patients who had 
been recently diagnosed with primary hypothyroidism. The second group of patients diagnosed 
with primary hypothyroidism for at least 2 years and was treated with levothyroxine (Group B). 
The third group of healthy individuals was selected as a control group (Group C). Blood samples 
were taken for the measurements of thyroid stimulating hormone (TSH), and bone densitometry 
was performed to determine the BMD reported as T‑score in order to measure the severity 
of osteoporosis. T‑score of the lumbar vertebra (L2‑L4) and femoral neck were measured with 
dual energy X‑ray absorptiometry and were compared between the three groups. Data were 
analyzed by SPSS using regression analysis and Mann–Whitney, Kruskal–Wallis, or analysis of 
variances statistical tests. The statistical significance was set at a P < 0.05.
Findings: The average age of patients and baseline serum TSH levels in Group B was 
significantly different from the other two groups (P < 0.001). T‑score of the lumbar 
spine (L2‑L4) in Group B was significantly lower than the other groups (P = 0.01). The 
linear regression between serum TSH levels and BMD categories were not clearly associated. 
However, after removing the effect of the baseline TSH level in Group B, bone loss was 
significantly greater than the other two groups (P = 0.01).
Conclusion: According to the present study, it seems that the treatment of hypothyroidism 
with thyroid hormones reduces both serum levels of TSH and bone density. Hence, proper 
control of this risk factor can be an effective way in prevention of osteoporosis.

Abstract Objective: Brand‑generic scheme was implemented in Iran to improve the competition 
in the pharmaceutical market. In this study, we aim to assess if this policy had any positive 
effect on efficiency of Iranian pharmaceutical companies.
Methods: We used data envelopment analysis to evaluate the relative efficiency of 
pharmaceutical companies during 1999-2008. The Wilcoxon matched‑pairs signed‑rank and 
sign tests were used to assess the difference between mean technical efficiency of companies 
before and after implementation of the new policy.
Findings: Although the Wilcoxon matched‑pairs signed‑rank tests did not show any 
significant differences in favor of the new policy in terms of both relative and pure (managerial) 
technical efficiency for included companies (P = 0.079 and 0.07, respectively), but the 
one‑sided sign test indicated that only relative pure (managerial) efficiency has been improved 
after this policy (P = 0.031).
Conclusion: The “brand‑generic scheme” does not seem to be a successful policy to 
improve efficiency level and prompt competition in pharmaceutical companies in Iran. To 
achieve this aim, consideration of infrastructural requirements including transparent and 
non‑discriminating laws and regulations to support competition, the competitive pricing 
policies, the presence of international companies in the market, and full privatization of 
companies had to be also deeming by policy makers.

Abstract Objective: Intraoperative hypothermia is a common problem with anesthesia. Spinal 
anesthesia, the same as general anesthesia, affects the process of temperature regulation. The 
aim of this study was to compare the prophylactic effect of intravenous(IV) ondansetron with 
intrathecal (IT) meperidine on prevention of shivering during spinal anesthesia in patients 
underwent orthopedic surgery of the lower limb.
Methods: In this study, 120 patients with American Society of Anesthesiologists physical 
status I to II, between the ages 16 and 65 were randomized into three groups. Group O 
and Group M were given IV ondansetron 8 mg and IT meperidine 0.2 mg/kg, before spinal 
anesthesia, respectively. Group C received IV saline 0.9%. The core and ambient temperatures, 
the incidence and intensity of shivering, blood pressure, heart rate, and maximum level of 
sensory block were recorded.
Findings: Shivering was observed in 15%, 2.5%, and 37.5% of patients in Groups O, M, and 
C, respectively. There was a significant difference between Group O and M compared to 
Group C (P = 0.023 for Group O vs. Group C, P < 0.001 for Group M vs. Group C, P = 0.049 
for Group M vs. Group O). Shivering incidence and intensity in Group M was significantly 
lower than Group O (P = 0.049 and P = 0.047, respectively). Twenty‑two patients required 
additional IV meperidine among which 15 patients were from Group C (37.5%), six patients 
from Group O (15%) and one patient from Group M (2.5%).
Conclusion: We concluded that IT meperidine and IV ondansetron comparably can 
decrease intensity and incidence of shivering compared to control group as well as decreasing 
the requirement to additional doses of meperidine for shivering the control without any 
hemodynamic side effect.

Abstract Objective: The pure essence of plants (essential oils) provides both psychological and 
physiological benefits when used accurately and safely. Conventionally, Lavender oil is known 
for relaxing, carminative, and sedative effects. Hence, an attempt was made to know the 
effect of Lavender essential oil on dental patient anxiety.
Methods: The present study included two comparison groups (Lavender and control 
group), each comprising five dental clinics. In Lavender group, the ambient odor of Lavender
essential oil was maintained with the help of a candle warmer in the reception area and in 
the control group, candle warmer with normal water was used. A total of 597 patients, aged 
above 18 years were included. A questionnaire comprising demographic information, and a 
modified dental anxiety scale was given to the patients in waiting room, and data regarding 
anxiety levels was recorded.
Findings: Student’s t‑test (unpaired) showed a significant reduction in anxiety scores of 
Lavender group compared with the control group. Analysis of variances test showed reduction 
in anxiety scores as age increased in Lavender group.
Conclusion: Fragrance of Lavender oil at reception area may effectively reduce the patient’s 
state or current anxiety. This practice on routine usage can improve the quality of dental 
treatments.

Abstract Objective: This study aim to evaluate and compare type and prevalence of drug‑drug 
interactions (DDIs) in prescriptions dispensed in both community and hospital setting in 
Zabol, Iran.
Methods: A total of 2796 prescriptions were collected from community and inpatient and 
outpatient pharmacy of Amir‑al‑momenin only current acting hospital in Zabol, Iran. The 
prescriptions were processed using Lexi‑Comp drug interaction software. The identified 
DDIs were categorized into five classes (A, B, C, D, X).
Findings: Overall 41.6% of prescriptions had at last one potential DDI. The most common 
type of interactions was type C (66%). The percentage of drug interactions in community 
pharmacies were significantly lower than hospital pharmacies (P < 0.0001).
Conclusion: Our results indicate that patients in Zabol are at high risk of adverse drug 
reactions caused by medications due to potential DDIs. Appropriate education for physicians 
about potentially harmful DDIs, as well as active participation of pharmacists in detection 
and prevention of drug‑related injuries, could considerably prevent the consequence of 
DDIs among patients.

Abstract