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   2011| October-December  | Volume 3 | Issue 4  
    Online since November 23, 2011

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The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems
Menizibeya Osain Welcome
October-December 2011, 3(4):470-478
Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe) health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine surveillance and medical intelligence as the backbone of the health sector is necessary, besides adequate management couple with strong leadership principles.
  17,803 1,904 44
Alternative therapies useful in the management of diabetes: A systematic review
Awanish Pandey, Poonam Tripathi, Rishabh Pandey, Rashmi Srivatava, Shambaditya Goswami
October-December 2011, 3(4):504-512
Diabetes mellitus is a metabolic disorder in the endocrine system. This dreadful disease is found in all parts of the world and becoming a serious threat of mankind health. There are lots of chemical agents available to control and to treat diabetic patients, but total recovery from diabetes has not been reported up to this date. In addition to adverse effects, drug treatments are not always satisfactory in maintaining euglycemia and avoiding late stage diabetic complications. Alternative to these synthetic agents, plants provided a potential source of hypoglycemic drugs and are widely used in several traditional systems of medicine to prevent diabetes. Several medicinal plants have been investigated for their beneficial effect in different type of diabetes. Other alternative therapies such as dietary supplements, acupuncture, hydrotherapy, and yoga therapies less likely to have the side effects of conventional approaches for diabetes.
  14,090 777 82
Blue cures blue but be cautious
Pranav Sikka, VK Bindra, Seema Kapoor, Vivek Jain, KK Saxena
October-December 2011, 3(4):543-545
Methemoglobinemia is a disorder characterized by the presence of >1% methemoglobin (metHb) in the blood. Spontaneous formation of methemoglobin is normally counteracted by protective enzyme systems, for example, nicotinamide adenine dinucleotide phosphate (NADPH) methemoglobin reductase. Methemoglobinemia is treated with supplemental oxygen and methylene blue (1-2 mg/kg) administered slow intravenously, which acts by providing an artificial electron acceptor for NADPH methemoglobin reductase. But known or suspected glucose-6-phosphate dehydrogenase (G6PD) deficiency is a relative contraindication to the use of methylene blue because G6PD is the key enzyme in the formation of NADPH through pentose phosphate pathway and G6PD-deficient individuals generate insufficient NADPH to efficiently reduce methylene blue to leukomethylene blue, which is necessary for the activation of the NADPH-dependent methemoglobin reductase system. So, we should be careful using methylene blue in methemoglobinemia patient before G6PD levels.
  9,887 236 16
Is propolis safe as an alternative medicine?
Maria Graça Miguel, Maria Dulce Antunes
October-December 2011, 3(4):479-495
Propolis is a resinous substance produced by honeybees as defense against intruders. It has relevant therapeutic properties that have been used since ancient times. Nowadays, propolis is of increasing importance as a therapeutic, alone or included in many medicines and homeopathic products or in cosmetics. Propolis is produced worldwide and honeybees use the flora surrounding their beehives for its production. Therefore its chemical composition may change according to the flora. The phenolic and volatile fractions of propolis have been revised in the present study, as well as some of the biological properties attributed to this natural product. An alert is given about the need to standardize this product, with quality control. This has already been initiated by some authors, mainly in the propolis from the poplar-type. Only this product can constitute a good complementary and alternative medicine under internationally acceptable quality control.
  9,407 225 33
Bacterial vaginosis: Etiology and modalities of treatment-A brief note
Nikhil Kumar, Beauty Behera, Sai S Sagiri, Kunal Pal, Sirsendu S Ray, Saroj Roy
October-December 2011, 3(4):496-503
A large women population of the world is suffering from a vaginal infection commonly known as bacterial vaginosis. The disease is associated with the decrease in the lactobacilli count in the vagina. Till date, there is a lack of full proof treatment modalities for the cure of the disease. The treatment includes the use of antimicrobials and/or acidifying agents and probiotics, either separately or in combination. This note discusses about the etiology and the various present-day modalities of treatment of bacterial vaginosis.
  6,802 369 25
Antibiotic prescription patterns at admission into a tertiary level intensive care unit in Northern India
Aparna Williams, Ashu S Mathai, Atul S Phillips
October-December 2011, 3(4):531-536
Context : An audit of antibiotic prescribing patterns is an important indicator of the quality and standard of clinical practice. Aims : To study the (1) antibiotic prescription and consumption patterns at admission into the intensive care unit (ICU); (2) average costs of antibiotics prescribed; and (3) correlation of antibiotic usage and the costs incurred with age, severity of illness, and diagnosis. Settings and Design : A 13-bedded tertiary level ICU. A prospective, observational audit. Materials and Methods : Two hundred consecutive prescriptions on patients admitted to the ICU from August to October, 2008, were audited. The total number of drugs and antibiotics, the class, dose, route, and cost of antibiotics were noted and the Defined Daily Dose/100 bed-days (DDD/100 bed-days) of the 10 most frequently prescribed antibiotics were calculated. Statistical analysis used: Univariate analysis was performed using Epi Info software (version 8.0). Results : A total of 1246 drugs and 418 antibiotics were prescribed in the 200 patients studied, that is, an average of 6.23 (± SD 2.73) drugs/prescription and 2.09 (± SD 1.27) antibiotics/prescription. Antibiotics were prescribed on 190 patients (95%) at admission. There was a significant correlation between the number of patients prescribed three or more antibiotics and mortality rates (53% nonsurvivors vs. 33.5% survivors (P = 0.015). The average cost of the antibiotics was Rupees 1995.08 (± SD 2099.99) per patient and antibiotics expenditure accounted for 73.2% of the total drug costs. Conclusions : Antibiotics are commonly prescribed to most ICU patients at admission and contribute significantly to the total drug costs. Antibiotic restriction policies and a multidisciplinary effort to reduce usage are urgently required.
  5,169 468 17
Prevalence and determinants of diabetes mellitus in Puducherry, South India
Dharamvir Ranjan Bharati, Ranabir Pal, Sumit Kar, R Rekha, TV Yamuna, Mausumi Basu
October-December 2011, 3(4):513-518
Background : Diabetes mellitus is an emerging global health problem. It is a chronic, noncommunicable, and expensive public health disease. Aims and Objectives : To determine the prevalence and the risk factors of type 2 diabetes mellitus among the adult population of Puducherry, South India. Materials and Methods : This was a population-based cross-sectional study carried out during 1 st May 2007-30 th November 2007 in the rural and urban field practice area of Mahatma Gandhi Medical College and Research Institute, Puducherry. Simple random sampling technique was used for the selection of 1370 adult 20 years of age and above. Main outcome measures were the assessment of the prevalence of prevalence and correlates of diabetes among the adult population. Predesigned and pretested questionnaire was used to elicit the information on family and individual sociodemographic variables. Height, weight, waist, and hip circumference, blood pressure was measured and venous blood was also collected to measure fasting blood glucose, blood cholesterol. Results : Overall, 8.47% study subjects were diagnosed as diabetic. The univariate analysis and multivariate logistic regression analysis showed that the important correlates of diabetes mellitus were age, blood cholesterol, and family history of diabetes. The findings were found to be statistically significant. Conclusions : In our study we observed that adults having increased age, hypercholesterolemia, and family history of diabetes mellitus are more likely to develop diabetes mellitus.
  4,116 392 12
Ageing in Puducherry, South India: An overview of morbidity profile
Dharamvir Ranjan Bharati, Ranabir Pal, R Rekha, TV Yamuna, Sumit Kar, Angeline Neetha Radjou
October-December 2011, 3(4):537-542
Background : The geriatric health problems are related to chronic disease as a result of increasing life expectancy. Objective : This study was undertaken to assess the health problems of the elderly in Puducherry. Materials and Methods : This cross-sectional study was carried out on 214 elderly persons from the age group of 60 years and above using a pre-designed and pre-tested questionnaire that addressed the disease magnitude in comparison with the socioeconomic variables. Results : Overall, 43% of the participants were diabetic, 47.7% hypertensive, 86% anemic and 68.2% visually impaired. All the morbidities were noted to be higher in the 70-79 years age group. Diabetes was significantly higher in participants from urban areas, with family history and increasing waist-hip ratio, but significantly lower in the below poverty line areas. Hypertension risk was significantly higher among females, among those leading sedentary life, those eating vegetarian food, those addicted to tobacco and with abdominal obesity. Anemia was significantly lower among urban vegetarians. Overweight and obese were noted in 31% of the participants, and were higher in females (87.5%). Rural residence, female sex, living in joint family, literacy, sedentary life style, decreasing per capita income and decreasing body mass index (BMI) were significantly associated with visual impairment. Conclusion : This study highlights the burden of health problems of elderly individuals in South India.
  3,568 295 9
Resistant patterns of bacteria isolated from bloodstream infections at a university hospital in Delhi
MS Alam, PK Pillai, Prem Kapur, KK Pillai
October-December 2011, 3(4):525-530
Background : The choice of antimicrobial therapy for bloodstream infections is often empirical and based on the knowledge of local antimicrobial activity profiles of the most common bacteria causing such infections. Aims : The present study was aimed to investigate frequency of bacterial pathogens causing septicemia and their antimicrobial resistant pattern in hospital admitted patients. Settings and Design : It was a prospective study, conducted at Majeedia Hospital, Hamdard University, New Delhi, India. Material and Methods : We examined prospectively, 168 bacterial strains isolated from 186 clinically diagnosed septicemia cases admitted at a University Hospital in New Delhi, over a period of six months from July 2009 to December 2009. Antimicrobial susceptibility was performed according to Clinical and Laboratory Standards Institute (CLSI, USA) guidelines. Results : The most frequently identified Gram-positive bacteria were coagulase-negative staphylococci 63.5%, Staphylococcus aureus 23.1%, enterococci 5.8% and alpha-haemolytic streptococci 5.8%. The most frequently Gram-negative bacteria identified were Acinetobacter species 31%, Salmonella typhi 24.1%, Escherichia coli 23.3% and Pseudomonas aeruginosa 13.8%. Coagulase-negative staphylococci showed maximum resistance to cefaclor 57.1% and ampicillin 46.9%. Staphylococcus aureus showed maximum resistance to amoxicillin 100% and ampicillin 91.7%. Acinetobacter species showed maximum resistance to amoxicillin 89.7%, amoxiclav 87.1% and ampicillin 85.7%. Salmonella typhi, Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae showed maximum resistance to ampicillin, 46.4%, 92%, 93.8% and 100%, respectively. Conclusions : Gram-negative pathogens predominated in bloodstream infections. Resistance to most of the antimicrobial agents for a number of pathogens implicated in bloodstream infections, especially in Gram-negative bacteria, has reached worrisome levels and continues to increase.
  3,552 210 13
Effect of amiloride: An Na + / H + exchange inhibitor in the middle cerebral artery occlusion model of focal cerebral ischemia in rats
Mohammad Akhtar, KK Pillai, Abul Kalam Najmi, Divya Vohora
October-December 2011, 3(4):519-524
Purpose : The effect of pretreatment with amiloride (AML), an Na + / H + exchange inhibitor was studied in the middle cerebral artery occlusion (MCAO) model of focal cerebral ischemia in rats. Materials and Methods : Male wistar rats were subjected to 2 hr of MCAO followed by 22-hr reperfusion. Grip strength, locomotor activity, and spontaneous alternation performance were assessed after 24 hr. Immediately after behavioral activities, animals were sacrificed and the oxidative stress markers were estimated in brains. Results : An elevation of thiobarbituric acid reactive substances (TBARS), reduction in glutathione, and antioxidant enzymes activities, namely glutathione-S-transferase, glutathione peroxidase (GPx), glutathione reductase (GR), and superoxide dismutase (SOD) were observed following MCA occluded rats. Pretreatment with AML (0.91 and 1.82 mg/kg p.o) significantly reversed the MCAO-induced elevation in TBARS but could not reverse the other parameters. Paradoxically, AML further reduced the levels of GPx, GR, and SOD, but no significant changes were observed in the catalase activity, grip strength, and spontaneous alternation behavior of rats. Locomotor activity was reduced slightly but reversed on pretreatment with AML. Conclusions : Although pretreatment with single dose of AML showed reduction in oxidative stress markers, further multiple doses of AML as pre- and post-treatments are required to establish its potential to be used in cerebral ischemia.
  2,565 107 6
Ipilimumab: Melanoma and beyond
Vishal Patel, Hardik Gandhi, Aman Upaganlawar
October-December 2011, 3(4):546-546
  2,054 73 3
Limitation of EPR: A thing to be noted
Viroj Wiwanitkit
October-December 2011, 3(4):469-469
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