The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Pocket guides include all recommendations from a guideline along with key points, checklists, and other supplementary materials when available. Each pocket guide is designed for double-sided printing (in color or black and white) on one sheet of 8.5″ x 11″ paper. Once printed, fold the single sheet into quarters, and the pocket guide is ready to use.
Find more information at https://www.hivguidelines.org/antiretroviral-therapy/cd4-and-viral-load-monitoring/ and https://www.hivguidelines.org/antiretroviral-therapy/hiv-resistance-assays/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Pocket guides include all recommendations from a guideline along with key points, checklists, and other supplementary materials when available. Each pocket guide is designed for double-sided printing (in color or black and white) on one sheet of 8.5″ x 11″ paper. Once printed, fold the single sheet into quarters, and the pocket guide is ready to use.
Find more information at https://www.hivguidelines.org/antiretroviral-therapy/cd4-and-viral-load-monitoring/ and https://www.hivguidelines.org/antiretroviral-therapy/hiv-resistance-assays/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Современное лечение ВИЧ.Обобщённые данные с конференции CROI 2020 / Contempor...hivlifeinfo
Современное лечение ВИЧ.Обобощенные данные с конференции CROI 2020 / Contemporary Management of HIV.Integrating New Data From CROI 2020
Широкий спектр вопросов, включая стратегии АРТ на поздних стадихя заболевания, менеджмент ожирения, метаболические исходы АРТ, данные по АРТ во время беременности и пр
Format: Microsoft PowerPoint (.ppt)
File Size: 554 KB
Released: April 14, 2020
“Comparitive Study of Prevalence of Hyperlactatemia in HIV / AIDS Patients re...IOSR Journals
Hyperlactatemia is one of the important metabolic abnormalities in HIV infected patients. The
prevalence of hyperlactatemia in natural course of HIV disease is approximately about 2%. Aim of this study is
to estimate the prevalence of hyperlactatemia in HIV patients receiving two antiretroviral regimens, advocated
by NACO by monitoring the plasma lactate levels. This study was taken up with 200 patients to compare the
prevalence of hyperlactatemia of two commonly used NACO regimens (zidovudine+ lamivudine+ nevirapine)
Vs (stavudine+ lamivudine+ nevirapine). The plasma lactate levels were estimated between 9th to 18thmonth
after initiation of antiretroviral therapy. The comparision and correlation between plasma lactate levels, CD4
counts and haemoglobin percentage in both regimens was done. There was statistically significant rise in the
plasma lactate levels (p<0.05) in both regimens. The increase in plasma lactate levels is more in stavudine
group compared to zidovudine group. There was low degree of positive correlation between plasma lactate and
haemoglobin in Stavudine group but negative correlation between Plasma lactate and CD4 counts in both
groups. More focus is needed on Pharmacovigilance of NRTIs induced hyperlactatemia especially Stavudine.
Современное лечение ВИЧ: новые парадигмы в АРТ / Contemporary Management of H...hivlifeinfo
Набор слайдов c рассмотрением важных вопросов об АРТ первого ряда, арв-препаратами пролонгированного действия и схемами АРТ с двумя препаратами, акцент в публикации на роль новых стратегий.
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусологической супре...hivlifeinfo
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусологической супрессией (2021) / Contemporary Management of HIV: Modifying ART in Virologically Suppressed Patients 2021
Contemporary Management of HIV.How Aging Affects ART Management.2018hivlifeinfo
In this downloadable slideset, Expert Faculty review key data on managing aging patients with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 720 KB
Date posted: 3/7/2018
Expert Insights in Selecting a Switch Regimen for Virologically Suppressed HI...hivlifeinfo
Expert Insights in Selecting a Switch Regimen for Virologically Suppressed HIV-Infected Patients.2018
In this slideset, Babafemi Taiwo, MBBS, discusses expert approaches to selecting an HIV switch regimen in a series of cases studies involving HIV-infected patients with virologic suppression on their current ART regimen.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.10 MB
Оптимизация лечения ВИЧ в 2018 году / HIV Treatment Optimization: 2018hivlifeinfo
HIV Treatment Optimization: 2018
In this downloadable slideset, Eric S. Daar, MD, provides a comprehensive update on ART management.
Format: Microsoft PowerPoint (.ppt)
File Size: 723 KB
Released: April 26, 2018
Key Slides on Individualizing ART Management Based on Treatment Safety and To...hivlifeinfo
Обзор последних рекомендаций DHHS , индивидуализация лечения в отдельных группах пациентов, минимизация побочных эффектов и межлекарственных взаимодействий
SEPSIS IS MOST FATAL DISEASE WORLD WIDE. EARLY DETECTION OR PREDICTION OF SEPSIS IS A CHALLENGE
SEPSIS BIOMARKERS ARE OUR WEAPON TO EARLY DETECT SEPSIS. WE HAVE TO UNDERSTAND IT WELL
HIV Alert- Novel Strategies and Agents for HIV Management.2016hivlifeinfo
In this downloadable slideset, Daniel R. Kuritzkes, MD, and Paul E. Sax, MD, review potential future HIV treatment strategies—including long-acting ART, dual-therapy regimens, and investigational agents—and discuss where these strategies might fit into the current therapeutic landscape.
Format: Microsoft PowerPoint (.ppt)
File size: 926 KB
Date posted: 6/21/2016
Модификация схем АРТ у пациентов с вирусной супрессией и после вирусологичес...hivlifeinfo
Best Practices in Antiretroviral Therapy: Switching ART in Virologically Suppressed Patients and After Virologic Failure
In this downloadable slideset, Joseph J. Eron, Jr., MD, discusses data on changing antiretroviral therapy in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
Современное лечение ВИЧ.Обобщённые данные с конференции CROI 2020 / Contempor...hivlifeinfo
Современное лечение ВИЧ.Обобощенные данные с конференции CROI 2020 / Contemporary Management of HIV.Integrating New Data From CROI 2020
Широкий спектр вопросов, включая стратегии АРТ на поздних стадихя заболевания, менеджмент ожирения, метаболические исходы АРТ, данные по АРТ во время беременности и пр
Format: Microsoft PowerPoint (.ppt)
File Size: 554 KB
Released: April 14, 2020
“Comparitive Study of Prevalence of Hyperlactatemia in HIV / AIDS Patients re...IOSR Journals
Hyperlactatemia is one of the important metabolic abnormalities in HIV infected patients. The
prevalence of hyperlactatemia in natural course of HIV disease is approximately about 2%. Aim of this study is
to estimate the prevalence of hyperlactatemia in HIV patients receiving two antiretroviral regimens, advocated
by NACO by monitoring the plasma lactate levels. This study was taken up with 200 patients to compare the
prevalence of hyperlactatemia of two commonly used NACO regimens (zidovudine+ lamivudine+ nevirapine)
Vs (stavudine+ lamivudine+ nevirapine). The plasma lactate levels were estimated between 9th to 18thmonth
after initiation of antiretroviral therapy. The comparision and correlation between plasma lactate levels, CD4
counts and haemoglobin percentage in both regimens was done. There was statistically significant rise in the
plasma lactate levels (p<0.05) in both regimens. The increase in plasma lactate levels is more in stavudine
group compared to zidovudine group. There was low degree of positive correlation between plasma lactate and
haemoglobin in Stavudine group but negative correlation between Plasma lactate and CD4 counts in both
groups. More focus is needed on Pharmacovigilance of NRTIs induced hyperlactatemia especially Stavudine.
Современное лечение ВИЧ: новые парадигмы в АРТ / Contemporary Management of H...hivlifeinfo
Набор слайдов c рассмотрением важных вопросов об АРТ первого ряда, арв-препаратами пролонгированного действия и схемами АРТ с двумя препаратами, акцент в публикации на роль новых стратегий.
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусологической супре...hivlifeinfo
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусологической супрессией (2021) / Contemporary Management of HIV: Modifying ART in Virologically Suppressed Patients 2021
Contemporary Management of HIV.How Aging Affects ART Management.2018hivlifeinfo
In this downloadable slideset, Expert Faculty review key data on managing aging patients with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 720 KB
Date posted: 3/7/2018
Expert Insights in Selecting a Switch Regimen for Virologically Suppressed HI...hivlifeinfo
Expert Insights in Selecting a Switch Regimen for Virologically Suppressed HIV-Infected Patients.2018
In this slideset, Babafemi Taiwo, MBBS, discusses expert approaches to selecting an HIV switch regimen in a series of cases studies involving HIV-infected patients with virologic suppression on their current ART regimen.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.10 MB
Оптимизация лечения ВИЧ в 2018 году / HIV Treatment Optimization: 2018hivlifeinfo
HIV Treatment Optimization: 2018
In this downloadable slideset, Eric S. Daar, MD, provides a comprehensive update on ART management.
Format: Microsoft PowerPoint (.ppt)
File Size: 723 KB
Released: April 26, 2018
Key Slides on Individualizing ART Management Based on Treatment Safety and To...hivlifeinfo
Обзор последних рекомендаций DHHS , индивидуализация лечения в отдельных группах пациентов, минимизация побочных эффектов и межлекарственных взаимодействий
SEPSIS IS MOST FATAL DISEASE WORLD WIDE. EARLY DETECTION OR PREDICTION OF SEPSIS IS A CHALLENGE
SEPSIS BIOMARKERS ARE OUR WEAPON TO EARLY DETECT SEPSIS. WE HAVE TO UNDERSTAND IT WELL
HIV Alert- Novel Strategies and Agents for HIV Management.2016hivlifeinfo
In this downloadable slideset, Daniel R. Kuritzkes, MD, and Paul E. Sax, MD, review potential future HIV treatment strategies—including long-acting ART, dual-therapy regimens, and investigational agents—and discuss where these strategies might fit into the current therapeutic landscape.
Format: Microsoft PowerPoint (.ppt)
File size: 926 KB
Date posted: 6/21/2016
Модификация схем АРТ у пациентов с вирусной супрессией и после вирусологичес...hivlifeinfo
Best Practices in Antiretroviral Therapy: Switching ART in Virologically Suppressed Patients and After Virologic Failure
In this downloadable slideset, Joseph J. Eron, Jr., MD, discusses data on changing antiretroviral therapy in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
Les Roms dans la Capitale européenne de la culture
Présentes dans toute l’Europe depuis des siècles, et en Provence depuis le XVe siècle, les cultures Roms et Tsiganes, expression de la plus importante minorité européenne, représentent un patrimoine commun historique complexe et vivant. Pour l’année Capitale européenne de la culture, Marseille-Provence 2013 a souhaité, d’une part, mettre en lumière (sans prétendre à l’exhaustivité) les manifestations culturelles, portées parles acteurs du territoire, qui donnent à découvrir des artistes roms ou des propositions d’artistes interrogeant notre regard sur la vie des Roms en Europe.
Congenital Agenesis Of The Corpus Callosum With Intracerebral Lipoma And Fron...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Interleukin16 and Interleukin 28B Genes Polymorphism in HBV Infected Saudi pa...iosrjce
The course of hepatitis B virus (HBV) infection is variable depending on many factors. In this study,
we investigated single nucleotide polymorphisms of interleukin-28B and interleukin-16 as possible host factors
which may determine the occurrence of hepatocellular carcinoma (HCC) in Saudi patients. Chronic hepatitis B
(CHB) patients (75), HCC patients (42), and healthy controls (70) were analyzed for polymorphisms of the IL16
and IL28B genes using PCR and restriction fragment length polymorphism (RFLP). Results showed that HCC
and chronic HBV patients had higher prevalence of rs11556218TG genotype than controls. The rs11556218GG
genotype was higher among HCC (14.4%) compared to chronic HBV (2.7%) patients. The IL-16 genotype
rs4072111CT was higher among HCC (47.6%) and chronic HBV (46.7%) patients than controls (28.6%). The
rs4072111TT genotype was higher among HCC patients compared to the other two groups. The T allele
frequency was higher among HCC patients than controls. The CT and TT of the IL-28B rs12979860 genotype
were significantly less frequent in chronic HBV and HCC patients. The IL-28B rs8099917 TG genotype was
more frequent among HCC (19%) compared to chronic HBV (8%) patients. However, no significant difference
was detected in the allele distribution.
Adherence to treatment and quality of life during hepatitis C therapy:a prosp...Michel Rotily
Adherence to treatment and quality of life during hepatitis C therapy:a prospective, real-life, observational study by Patrick Marcellin, Michel Chousterman, Thierry Fontanges, Denis Ouzan, Michel Rotily, Marina Varastet,Jean-Philippe Lang, Pascal Melin and Patrice Cacoub, for the CheObs Study Group published in Liver Int 2011
Efficacy and safety of Sulfad tablets in supporting patientswith viral
hepatitis:Aprospective,double-blind,randomized, placebo-controlled,
phase III clinical trial
La disponibilidad de un sistema de multiplicación del virus de la hepatitis C (VHC) infeccioso en cultivos celulares está permitiendo investigar nuevos factores de respuesta a tratamientos antivíricos en condiciones controladas. Se presentará evidencia de que el fitness vírico puede ser un factor de multiresistencia a inhibidores y quese pueden obtener eficientes reducciones de carga viral empleando diseños secuenciales de administración de inhibidores que incluyan ribavirina. Se discutirán posibilidades de aplicación clínica.
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Analytical Study of Urine Samples for Epidemiology of Urinary Tract Infection...iosrphr_editor
The current study was carried out in District Abbottabad aimed to determine the common urinary
tract infections in local community to determine the epidemiology of significant diseases in asymptomatic patients
of renal disorder. In this study a total of 1000 urine samples were examined during 3rd February to 1st April 2015
from patients attending Ayub Teaching Hospital Abbottabad by using dipstick and microscopic analysis of urine.
There were 638 females and 362 males patients examined during this period. The range of age groups is between
1.5 years to 80 years. Results of this study was reported as Pyuria 11%, Proteinuria 21.1%, Hematuria 10.4%,
Epithelial Cells 8.2%, pH 7.8 %, Granular casts 7.3%, Triple phosphate 6.6%, Calcium oxalate 6.4%, Glycosuria
6.3%, Bacteria 6.2% and mucous 4.1%. This study concludes that routing urinalysis should be performed for all
individuals to diagnose the asymptomatic diseases that will help in simple therapeutic measurements as urinalysis
is a simple step to determine the root of Urinary tract disorders.
Chest sonography images in neonatal r.d.s. And proposed gradingiosrphr_editor
BACKGROUND : Lung sonography has been used to monitor the patients of R.D.S. in
N.I.C.U. in recent times.
AIMS : To Describe and Grade the changes of R.D.S. by lung sonography.
SETTING & DESIGN : Tertiary care institutional set up in a rural medical college.
STUDY DURATION : September 2014 to May 2015. Follow-up variable, upto 2 weeks.
PROSPECTIVE, ANALYTICAL STUDY.
MATERIALS AND METHODS -This was a single institute study approved by the institutional ethics
committee. Prior informed consent was obtained from the parents. 100 consecutive patients admitted in
N.I.C.U. WITH gestational age < 36 weeks with respiratory complaints were enrolled. Chest x-ray was
obtained within few hours of admission and lung sonography was performed within 24 hours. Follow – up
sonography was performed as and when necessary. Sonography image was graded and correlated with chest
xray and clinical picture
The Comprehensive Review on Fat Soluble Vitaminsiosrphr_editor
This review article deals with brief description of fat soluble vitamins with figures and tables
showing statistical analytical data duly quoting the references wherever necessary. The word “soluble” actually
means “able to be dissolved.” Whether a vitamin is classified as 'fat-soluble' or 'water-soluble' has to do with
how the vitamin is absorbed, stored and removed from the body. Vitamins are tiny organic compounds with a
huge impact on the health and well-being of the body. The body needs a small amount of fat soluble vitamins in
order to stay in optimal health. Fat soluble vitamins play an important role in keeping the body healthy and
functioning from immune system and muscle and heart function, easy flow and clotting of blood as well as eye
health. They are critical to health and wellness–particularly reproductive health and wellness. Low-fat, no-fat
and vegan diets are woefully lacking in fat soluble vitamins. However a diet based on traditional foods can
naturally provide these vitamins. Science is still learning about many of the functions of vitamins. "Too much
vitamin A, D, or K can lead to increased levels that are unhealthy and can cause serious health consequences.
Diseased conditions leading to decreased fat absorption leads to decreased absorption of vitamins. The fatsoluble
vitamins work most safely and effectively when obtained them from natural foods within the context of a
diet rich in all their synergistic partners. If fat soluble vitamins are stored for lengthy time they generate threat
for toxicity than water soluble vitamins and such situation even aggravated, provided they are consumed in
excess. Vitamin products, above the legal limits are not considered food supplements and must be registered as
prescription or non-prescription (over-the-counter drugs) due to their potential side effects. Vitamin A and E
supplements do not provide health benefits for healthy individuals, instead they may enhance mortality, and it is
held proved that beta-carotene supplements can be harmful to smokers
Sulphasalazine Induced Toxic Epidermal Necrolysis A Case Reportiosrphr_editor
Toxic Epidermal Necrolysis (TEN) is a rare and life threatening mucocutaneous reaction
characterized by extensive necrosis and detachment of epidermis. The Worldwide incidence of TEN is 0.9 to 1.4
per million populations per year [1]. Here we have discussed a case of Toxic Epidermal Necrolysis secondary
to Sulfasalazine managed with fluid replacement, analgesics, anti-infective therapy aggressive nutritional
support and intravenous high dose steroid therapy.
Keywords- Toxic Epidermal Necrolysis, Sulfasalazine
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
FIBROLIPOMATOUS HAMARTOMA OF ULNAR NERVE: A RARE CASE REPORT.iosrphr_editor
Nervous fibrolipomatous hamartoma is said to be a rare tumor-like condition involving the peripheral
nerves,in which the epineurium and perineurium are enlarged and distorted by excess of fatty and fibrous tissue
s that infiltrate between and around nerve boundaries. The median nerve is more likely to develop a hamartoma
than other nerves with a predilection for the carpal tunnel.
A fibrolipomatous hamartoma – is a rare, benign, congenital lesion most commonly found in the median nerve,
usually at the level of the wrist or hand.
We report a case of this rare condition in ulnar nerve.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
Indonesian Wild Ginger (Zingiber sp) Extract: Antibacterial Activity against ...iosrphr_editor
Lempuyang gajah (Zingiber zerumbet (L.) Smith), lempuyang pahit (Zingiber amaricans BL.), and
lempuyang wangi (Zingiber aromaticum Vahl.) are used as traditional medicine (jamu) in Indonesia. It is also
used for treatment of microbial infections, helps to increase appetite and stimulate digestion in chickens.
Information on their uses are available, but only limited in the scientific data on their bioactivity. The study was
conducted on the antibacterial effect of organic extracts of these plants with Mycoplasma gallisepticum as the
agent of chronic respiratory disease in chickens. Juice and extracts of fresh and dried rhizome are evaluated
through the disc diffusion assay and minimum inhibitory concentration. Oxytetracyclin (30 µg) are used as
standards. All extracts are individually exhibited as antibacterial activity against Mycoplasma gallisepticum (7
± 0.11 mm to 21 ± 0.86 mm). The minimum inhibitory concentration (MIC) determination of plants extracts are
ranged from 7.8 mg/ml to 31.2 mg/ml. The preliminary results suggested promising antibacterial properties of
wild ginger from Indonesia, and probably could be used in management of chronic respiratory disease in
chickens.
A case of allergy and food sensitivity: the nasunin, natural color of eggplantiosrphr_editor
Abstract: Allergies and food sensitivities can both be considered as "adverse reactions individualistic" to food.
Are pathological and individual forms because they affect a few individuals in way rather serious; immediate
or delayed reactions occur instead with simple effects histamine, or, in severe cases with respiratory and
anaphylactic shock
The eggplant (Solanum melongena L.) is known to cause food allergies in some Asian countries, but detailed
studies on allergies caused by eggplant are lacking, however, it was highlighted the presence of allergens in
edible parts of eggplant with preponderance in the peel .
The purpose of this study was to propose an extraction method rapid, efficient and cost of natural dye from
waste products from the food industry, such as the peels of eggplant, from which it was extracted, isolated and
purified the nasunin,a colored molecule in red-fuchsia.
Nasusin was tested on 58 patients to evaluate the potential sensitizing effect on the skin. The results demonstrate
that allergenic effects are negligible and therefore the nasunin can be used as a colorant in various industrial
sectors with a certain safety margin
Complete NMR Assignment of MogrosidesII A2, II E andIII A1Isolated from Luo H...iosrphr_editor
NMR analysis allowed complete assignments of three known mogrol glycosides, Mogroside IIA2 (1),
II E (2)and IIIA1 (3), isolated from the extracts of Luo Han Guo. Herein, complete 1H and 13C NMR
assignmentsof all threemogrosidesare described based on NMR experiments (1H NMR, 13C NMR, COSY,
HSQC-DEPT, HMBC, NOESY and 1DTOCSY) and mass spectral data.
Nanoemulsion and Nanoemulgel as a Topical Formulationiosrphr_editor
: Nanoemulsion is referred type of emulsion with uniform and extremely small droplet size in the range
of 20-200 nm. Nanoemulsion provides numerous advantages over other carrier such as polymeric nanoparticle
and liposomes, including low cost preparation procedure, high hydrophilic and lipophilic drug loading system
to enhance the longer shelf live upon preserving the therapeutic agents. Incorporating the preparation of
nanoemulsion with hydrogel matrix to produce nanoemulgel exhibited by the two separate systems that forming
it. Nanoemulgel possesses the properties of thixotropic, non-greasy, effortlessly spreadable, easily be removed,
emollient, not staining, soluble in water, longer shelf life, bio-friendly, translucent and agreeable appearance.
Pharmacokinetics of High-Dose Methotrexate in Egyptian Children with Acute Ly...iosrphr_editor
Aim:Since several factors have been shown to influence the clearance of methotrexate, the purpose of this study
was to identify potential relationships between patient covariates and the methotrexate clearance estimates and
deduce a pharmacokinetic model for the estimation of methotrexate clearance in Egyptian pediatric ALL
patients that may help dosage adjustment and achieve target steady-state plasma concentrations in a similar
sittings.
Patients and methods: A total of 94 pediatric patients with B-cell ALL, of whom 70 were the studied population
and 24 were the test population, were treated with four courses of HDMTX doses 2.5 gm/m2
(low-risk arm) or 5
gm/m2
(standard-/high-risk arm) given every other week by intermittent intravenous infusions over 24 hours as
a part of their treatment protocol. Patients were monitored for the 24 hour MTX concentration and the systemic
methotrexate clearance was calculated for each methotrexate dose
Epidemiology of Tuberculosis (TB) in Albania 1998-2009iosrphr_editor
Abstract : In Albania, many people erroneously think that tuberculosis (TB) is a disease of the past-an illness
that no longer constitutes a public health threat. Surveillance is an integral part of tuberculosis (TB) control.
Albania has a highTB notification rate and there are doubts about underreporting. The evolution of the
incidence of tuberculosis is presented, together with more detailed figures over the period 1998-2009. These
figures were obtained by the monthly forms (called 14/Sh) compared with the individual notification data.
Objective: To examine the distribution and sources of increased tuberculosis (TB) morbidity and reporting
system deficiencies in the Albania from 1998 through 2009. Metodology: The study is descriptive one conductet
during the period 1998-2009. The statistical analysis is based on data reported from regional level (regional
epidemiological departments) to the central level (Public Health Institute). Results: The main findings were:
discordance between the collected data (individual form) and reported data (monthly form); tuberculosis
incidence rate shows little oscillations which ranges from 6.67 to 9.2 cases/100.000 population; 50% of the
regions show a lack of information on the confirmation of diagnosis and laboratory examination type used for
confirmation. Conclusion: TB disease in high-risk populations where it is difficult to detect, diagnose, and treat;
limitations of current control measures and the need for new tests and treatments, including an effective
vaccine; improving information system, regulation of individual form and personnel training.
Total Phenol and Antioxidant from Seed and Peel of Ripe and Unripe of Indones...iosrphr_editor
Study on total phenol and antioxidantactivity ofsugar apple fruits of various solvent, part of fruits, and level of ripening. Solvent extraction used were 80% (v/v) methanol, 50% (v/v) acetone, boiling water, and 50% (v/v) ethanol. Part of fruits thatbeen used for samples were seed and peel which are normally by products of sugar apple processing, level of ripening were unripe, and ripe sugar apple fruits. Total phenol was determined by Folin-ciocalteau method. Total antioxidant was quantified by 1,1-diphenyl-2-picrylhydrazyl(DPPH) method.Therewas a difference in type of solvent, part of fruits, and level of ripeningon total phenol and antioxidant concentration of sugar apple fruits. Seeds have higher total phenol concentration than peels of this fruits. Unripe sugar apple fruits have higher total phenol and antioxidant than ripe fruit. The best solvent for phenol extraction was ethanol 50%butthe best solvent for antioxidant extraction was acetone 50%.
A Review on Step-by-Step Analytical Method Validationiosrphr_editor
When analytical method is utilized to generate results about the characteristics of drug related samples it is essential that the results are trustworthy. They may be utilized as the basis for decisions relating to administering the drug to patients. Analytical method validation required during drug development and manufacturing and these analytical methods are fit for their intended purpose. To comply with the requirements of GMP pharmaceutical industries should have an overall validation policy which documents how validation will be performed. The purpose of this validation is to show that processes involved in the development and manufacture of drug, production and analytical testing can be performed in an effective and reproducible manner. This review article provides guidance on how to perform validation characteristics for the analytical method which are utilized in pharmaceutical analysis.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
Hematological and biochemical alterations in malaria and their correlation wi...iosrphr_editor
Malaria is a major health problem in India with 1.04 million cases reported in 2012 leading to 504 deaths. The clinical spectrum depends on the infecting species, level of parasitemia and the immune status of the host. Malaria pathogenesis is based on extensive changes in hematological and biochemical parameters. The objective of this study was to study the clinical features, hematological and biochemical parameters in malaria patients and correlate them with the parasitic index (PI). Material and methods: We conducted a study on 300 malaria patients. The frequency of various symptoms and signs of malaria caused by various plasmodium species were determined. The degree of anemia, WBC count, platelet count serum bilirubin, liver enzymes and serum creatinine levels were studied and their variation depending on the parasitic index was documented. Results: 197 patients had vivax malaria, 76 patients had falciparum malaria and 27 patients had mixed infection. 171 patients had a PI of less than 2%, 100 patients had PI between 2 to 5%, 23 patients had PI between 5 to 10% and only 6 patients had PI of more than 10%. 72.3% of patients had thrombocytopenia, 46.66% had anaemia, 25% had increased bilirubin 29.66% showed increased liver enzymes and 7.66% had increased creatinine levels. Conclusion: There was a correlation between degree of parasitemia and severity of malaria in majority of cases. Derangements in hematological and biochemical parameters were more frequently seen in patients with higher PI. Hence PI can be used as an indicator by the clinician to know the severity of infection and plan appropriate treatment.
Treatment of Uthiravatha Suronitham (Rheumatoid Arthritis) with a Siddha Comp...iosrphr_editor
Uthiravathasuronitham, a vatha disease described by Sage Yugi can be correlated to Rheumatoid arthritis. A 53 year old lady diagnosed as Uthiravathasuronitham was treated with Siddha medicines Karpoora Chindhamani Mathirai and MannennaiKalavaiThylam. A single case study of Uthiravathasuronitham is detailed in this article.The patient presented with pain and swelling in minor joints of hand, wrist, ankle, shoulder joints and morning stiffness. The RA factor, CRP was positive at the time of enrollment. She was admitted in the IPD of Sirappu Maruthuvam Department of National Institute of Siddha for 45 days. The treatment outcome was encouraging. Hence further clinical studies can be carried out.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
B042207013
1. IOSR Journal Of Pharmacy
(e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219
www.Iosrphr.Org Volume 4, Issue 2(February - 2014), Pp 07-13
Safety and Efficacy of Pegylated Interferon alpha-2a and
Ribavirin Combination in Treatment of Egyptian Patients with
Chronic Hepatitis C Genotype-4
Abdel-Hameed I.M. Ebid1, Abdallah Atef Derbala1, Ahmed A. Gomaa2
1
2
Department of Pharmacy Practice, Faculty of Pharmacy, Helwan University. Cairo, Egypt.
Department of Tropical Medicine, Faculty of Medicine, El-Fayoum University. El-Fayoum, Egypt
ABSTRACT : Introduction: Egypt has the highest hepatitis C virus (HCV) seroprevalence in the world mostly
caused by HCV genotype 4. The standard of care for chronic hepatitis C (CHC) is a combination of pegylated
interferon (INF) and ribavirin (RBV). A new locally manufactured pegylated INF with different pegylation
chemistry than products with well characterized clinical profiles has been introduced into the Egyptian market
with a much lower price. Little is known about the safety and efficacy of this product. So, the aim of this study is
to comprehensively evaluate the safety and efficacy of this product.
Patients and methods: A total of 97 treatment naïve patients with CHC genotype 4 with mean age 46.68 ± 8.76
years old of whom 79 were males and 18 were females, were treated with pegylated INF alpha-2a and RBV for
48 weeks. Patients were monitored for safety and efficacy during the treatment and 24-week follow up periods.
Results: fifty-one (52.58%) patients achieved a sustained virological response (SVR). The rate of SVR varied
significantly by age, baseline fibrosis stage, aspartate aminotransferase (AST), alanine aminotransferase (ALT),
alpha fetoprotein (AFP), and (WBC). Most adverse effects were mild to moderate in severity and were well
tolerated. The overall continuance rate without dose reduction was 37.11%. Three patients discontinued
treatment, one died and the others discontinued due to fundal hemorrhage and neutropenia, respectively.
Hematologic toxicity included anemia with a frequency 60.82%, neutropenia 4.12%, and thrombocytopenia
1.02%.
Conclusion: The efficacy and safety profile of the drug is comparable to previously approved original products.
Considering its low cost, it represents an opportunity to fight the HCV epidemic in Egypt at reasonable an
affordable costs.
KEYWORDS – HCV, Interferon, Ribavirin, SVR.
I.
INTRODUCTION
Hepatitis C virus (HCV) is a hepatotropic RNA virus with a propensity to cause chronic infection,
causing a worldwide burden of chronic hepatitis (CHC), cirrhosis and hepatocellular carcinoma (HCC). HCV
infection is the principal cause of chronic liver disease and hepatocellular carcinoma and the leading indication
for liver transplantation [1]. Nearly 123 million people worldwide are currently infected with the HCV [2] and
approximately 3.2 to 5 million of these individuals are in the United States [3]. In Egypt, the situation is quite
worse. The national prevalence rate of HCV antibody positivity estimated at 14.7% of the country’s
population[4, 5] with an estimated 91% of infections are caused by genotype 4[6]. So, Egypt has the highest
HCV seroprevalence in the world [7, 8]. Today, HCV infection and its complications are among the leading
public health challenges in Egypt [9].The current standard of care for chronic hepatitis C is a combination of
pegylated interferon (INF) alpha and ribavirin (RBV). Two pegylated formulations of IFN alpha, a 40-kDa
pegylated IFN alpha-2a and a 12-kDa pegylated IFN alpha-2b, have been developed and tested clinically and
approved for use in the United States [10, 11]. The cost of such treatment in Egypt was quit prohibitive until a
locally manufactured biosimilar of pegylated IFN was produced and led to a 6-fold reduction in the price of a
48-week treatment course of pegylated IFN and RBV which currently costs less than US $2000[12]. However,
this generic biosimilar is structurally different from the original approved pegylated IFN alpha-2a. It consists of
20-kDa linear pegylated INF alpha-2a instead of 40-kDa branched pegylated INF alpha 2-a [13]. Difference in
pegylation chemistry reflects on pharmacokinetics, specific antiviral activity and possibly on clinical profile
[14]. Although safety and efficacy data for generic interferon is limited, it has been widely used by the Health
Insurance Organization (HIO) in Egypt to treat CHC patients. Therefore, the aim of this study was to investigate
the safety and efficacy of 20-kDa linear pegylated INF alpha-2a and ribavirin in treatment of Egyptian patients
with CHC genotype 4 as well as studying the various factors that may affect patients’ response to treatment.
7
2. Safety and Efficacy of Pegylated Interferon….
II.
PATIENTS AND METHODS
2.1 Patient Selection:
Adult Egyptian patients with previously untreated CHC that were enrolled for treatment at Fayoum
Health Insurance Hospital were screened in the period from April 01, 2012 to April 30, 2012 and entered the
study if they: were aged 18-65 years old, had at least one elevated serum alanine aminotransferase (ALT) level
more than twice the upper limit of normal during the 6 months before treatment, had positive serum anti-HCV
antibodies, had a detectable HCV-RNA on testing with polymerase chain reaction (PCR), and agreed to sign an
informed consent to participate in the study.
Patients were excluded from the study if they: don’t meet the above mentioned inclusion criteria, had
other causes of chronic liver disease (hepatitis B infection, autoimmune hepatitis, metabolic liver disease such as
hemochromatosis or chronic alcoholism), were co-infected with human immunodeficiency virus (HIV), were
pregnant or breast feeding females, had ischemic heart disease (IHD), had severe neurologic or psychological
conditions, had hematologic conditions such as white blood cell (WBC) count < 3.5×10 6 /mm3, absolute
neutrophilic count (ANC) < 1500 /mm3, hemoglobin (Hg) < 12 gm/dl, or platelet (PLT) count < 100,000 /mm3,
or had autoimmune disease, hemolytic anemia, or poorly controlled diabetes mellitus (HbA1c > 8.5%).
2.2 Treatment:
Selected patients were assigned to receive 160 µgm of 20-kDa linear pegylated INF alpha-2a (Reiferon
Retard®; Rhein-Minapharm Inc.) once a week for 48-weeks and ribavirin (Ribavirin®; Minapharm Inc.) 1000
mg/day for patients weighing < 75 kg and 1200 mg/day for patients weighing > 75 kg. INF dose was reduced to
120 µgm/week if: ANC < 750 /mm3, PLT < 50,000 /mm3, Hg < 8.5 g/dl. INF administration was temporarily
suspended if ANC < 500 /mm3 and was permanently discontinued if ANC < 350 /mm3 or PLT < 25,000 /mm3.
RBV dose was reduced to 600 mg/day if Hg < 10 gm/dl.
2.3 Monitoring:
Patients were carefully monitored every week for the first 2 weeks and at 4 th week then every 4 weeks
by physical examination with stress on treatment induced adverse effects together with laboratory parameters
evaluations that included: complete blood picture (CBC), aspartate aminotransferase (AST), ALT, total
bilirubin, international normalized ratio (INR), serum creatinine, thyroid stimulating hormone (TSH) level, and
alpha fetoprotein (AFP) level. Serum HCV-RNA levels were measured at 12th, 24th, 48th, and 72nd weeks of
treatment.
2.4 Virologic Assessment and Definition of Virologic Response:
HCV-RNA was quantified by Amplicor Monitor Assay; Roch Molecular Systems. The specimen
requirement for HCV-RNA by PCR is one EDTA Serum needs to be separated from cells within 6 hours of
collection and refrigerated or frozen to avoid degradation of viral RNA. A DNA copy of viral RNA is
synthesized by reverse transcription. This DNA molecule is amplified millions of times by PCR. The lower limit
of detection for the assay was 6 KIU/ml. The early virological response (EVR) was defined as more than 2-log
reduction in HCV-RNA compared with baseline or undetectable HCV-RNA at 12th week of treatment; the end
of treatment response (ETR) as undetectable HCV-RNA at the end of the 48-week course of treatment; and
sustained virological response (SVR) as undetectable HCV-RNA 24 weeks after finishing treatment. Patients
with less than 2-log reduction in HCV-RNA at 12th week of treatment were considered non-responders and had
to discontinue treatment according to hospital protocol. This was also done with patients who showed
reappearance of HCV-RNA while on treatment (breakthrough response). Relapse is defined as reappearance of
HCV-RNA after finishing the course of treatment. Anti-viral efficacy was evaluated for all study patients using
intention-to-treat analysis (ITT analysis).
2.5 Statistical Analysis:
Results are presented as means ± standard deviations (SD) and range for continuous variables, median
and range for non-normally distributed variables, and as frequencies and percentages for categorical data.
Analysis of normality was performed using the Kolmogorov-Smirnov test. Categorical data and
proportions were analyzed using the χ2 test or the Fisher’s exact test, as required. Student’s t test was used to
compare the means of the 2 groups with normal distributions, and the Mann-Whitney U test was used to
compare variables with non-normal distributions. All tests were 2-tailed. P-values <0.05 were considered
statistically significant. Analysis was conducted using SPSS version 22.
8
3. Safety and Efficacy of Pegylated Interferon….
III.
RESULTS
3.1 Baseline Characteristics:
The study was performed from April 2012 to September 2013 at Fayoum Health Insurance Hospital. A
total of 97 treatment naïve Egyptian CHC patients were studied of whom 79 (81.45%) were males and 18
(18.55%) were females. The mean age for studied patients was 46.68 ± 8.76 years old. Table 1 summarizes the
baseline demographic and clinical data for the studied population.
3.2 Adverse Events (AEs):
All patients had at least one AE during treatment. Most treatment-related AEs were considered mild or moderate in
severity and were consistent with flu-like symptoms such as fever, headache, and fatigue. All AEs reported with
a frequency of at least 10% are summarized in Table 2. Treatment-related serious adverse events (SAEs)
included fundal hemorrhage (1 patient) that required treatment discontinuation 16th week and resulted in
breakthrough response, thyroid dysfunction (1 patient) that required thyroid hormone replacement. One patient
died during the study in the 34th week of treatment due to febrile neutropenia with severe thrombocytopenia.
3.3 Clinical Laboratory Evaluation:
Most changes in laboratory values were mild or moderate, as classified by World Health Organization
(WHO) criteria. Grade 3 (500 to <750/mm3) and grade 4 (<500/mm3) neutropenia occurred in 3 (3.1%) and 2
(2.1%) patients, respectively. One of the patients with grade 4 neutropenia discontinued treatment at week 32
(ANC 345/mm3) but achieved an SVR, and the other had improved counts when re-tested and was managed
with suspending IFN doses for 2 weeks. The magnitude of reductions in hemoglobin concentration from
baseline was similar in all age groups. At nadir, the mean change from baseline ranged from - 4.1 g/dl to - 4.2
g/dl. Anemia was managed through dose reduction of RBV in 47 (48.45%) patients and 12 patients (12.37%)
required both IFN alfa-2a and RBV dose reduction.
Table 1: Patients’ baseline demographic and clinical features.
Characteristic
Value
Number of patients
97
*
Age (years)
46.68 ± 8.76
Sex (male/female)
79 / 18
Body Weight*(kg)
63.4 ± 12.23
Albumin*(g/dl)
4.4 ± 0.44
*
ALT (IU/L)
67.39 ± 33.44
*
AST (IU/L)
62 ± 30.15
ALP*(IU/L)
116.21 ± 43.84
AFP**(ng/ml)
4.7 / 0.2 - 120
*
Total Bilirubin (mg/dl)
0.85 ± 0.35
Serum Creatinine*(mg/dl)
0.76 ± 0.17
*
3
WBC (×1000/mm )
5.81 ± 1.72
*
Hemoglobin (g/dl)
*
13.90 ± 1.25
3
PLT (×1000/mm )
201.09 ± 70.450
TSH*(mIU/L)
1.27 ± 1.0
*
Fasting blood glucose (mg/dl)
91.93 ± 24.81
HbA1c* ’ ***(%)
6.8 ± 0.65
** ‘ ****
180 / 0.1 – 4116
METAVIR fibrosis score (0-2/3-4)
70 / 27
METAVIR activity score (0-1/2-3)
40 / 57
Viral load
(KIU/ml)
ALT: alanine aminotransferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase; AFP: alpha-feto
protein; WBC: white blood cells; PLT: platelets; TSH: thyroid stimulating hormone; HbA1c: Glycated
hemoglobin.* mean ± SD, ** median / range, *** for patients with fasting blood glucose > 126 mg/dl (n=4).
**** 1 KIU/ml = 900 copies/ml.
9
4. Safety and Efficacy of Pegylated Interferon….
Grade 2 thrombocytopenia (PLT 50,000 – 75,000/mm3) occurred in 10 patients (10.3%), and only one
patient (1.03%) had grade 3 (49,000/mm3) that was managed by INF dose reduction. Twenty-two patients
(22.68%) had at least one abnormal thyroid-stimulating hormone (TSH) value during the treatment, and one
(1.03%) had clinical hypothyroidism for whom levothyroxine replacement was used to manage. Table 3
summarizes laboratory abnormalities encountered during treatment.
Table 2: Treatment related adverse events stratified by age (> 10% incidence in all patients)
AE, n (%)
18–35 Y (n = 16)
General constitutional symptoms
Fever
14 (87.5%)
Chills
4 (25%)
Fatigue
8 (50%)
Weight loss*
2 (12.5%)
ISR
5 (31.25%)
Gastrointestinal disorders
Nausea
6 (37.5%)
Vomiting
3 (18.75%)
Abdominal Pain
3 (18.75%)
Anorexia
2 (12.5%)
Respiratory tract disorders
Breathlessness
1 (6.25%)
Cough
1 (6.25%)
Musculoskeletal disorders
Arthralgia
3 (18.75%)
Myalgia
4 (25%)
Nervous system disorders
Headache
9 (56.25%)
Dizziness
2 (12.5%)
Psychological Disorders
Nervousness
&
2 (12.5%)
aggression
Insomnia
3 (18.75%)
Anxiety
2 (12.5%)
Depression
3 (18.75%)
Skin disorders
Hair fall
Pruritus
4 (25%)
2 (12.5%)
36–50 Y (n = 43)
51–65 Y (n= 38)
All Patients (n = 97)
37 (86%)
7 (16.28%)
21 (48.84%)
8 (18.6%)
10 (23.26%)
29 (76.32%)
12 (31.58%)
20 (52.63%)
4 (10.53%)
11 (28.95%)
80 (82.47%)
23 (23.71%)
49 (50.52%)
14 (14.43%)
26 (26.8%)
9 (10.93%)
2 (4.65%)
6 (13.95%)
13 (30.23%)
10 (26.32%)
8 (21.05%)
7 (18.42%)
9 (23.68%)
25 (25.77%)
13 (13.4%)
16 (16.49%)
24 (24.74%)
6 (13.95%)
3 (6.98%)
5 (13.16%)
4 (10.53%)
12 (12.37%)
8 (8.25%)
4 (9.3%)
10 (23.26%)
6 (15.79%)
10 (26.32%)
13 (13.4%)
24 (24.74%)
21 (48.84%)
7 (16.28%)
24 (63.16%)
5 (13.16%)
54 (55.67%)
14 (14.43%)
4 (9.3%)
5 (13.16%)
11 (11.34%)
12 (27.9%)
3 (6.98%)
8 (18.6%)
14 (36.84%)
5 (13.16%)
11 (28.95%)
29 (29.9%)
10 (10.31%)
22 (22.68%)
12 (27.9%)
8 (18.6%)
13 (34.21%)
7 (18.42%)
29 (29.9%)
17 (19.59%)
AE: adverse event; Y: years old; ISR: injection site reaction.
* > 5% from baseline.
Table 3: Treatment related laboratory abnormalities
Laboratory test
Nadir, mean ± SD
Change from baseline, mean ± SD
3
1473.87 ± 478.69
- 1433.35 ± 841.66
ANC, (/mm )
9.69 ± 1.13
- 4.21 ± 1.55
Hg, (g/dl)
3
125.7 ± 41.67
- 68.92 ± 64.18
PLT, (×1000/mm )
2.34 ± 0.83
1.07 ± 1.27
TSH, (mIU/L)*
ANC: Absolute Neutrophilic Count; Hg: Hemoglobin; PLT: Platelets; TSH: Thyroid Stimulating Hormone.
* Result is reported as zenith.
10
5. Safety and Efficacy of Pegylated Interferon….
3.4 Dose Reduction / Treatment Discontinuation for AEs:
The overall continuance rate without dose reduction was 37.11%. Three patients discontinued
treatment, one died at week 32 because of febrile neutropenia with severe thrombocytopenia and the other 2
patients discontinued due to fundal hemorrhage and neutropenia, respectively. IFN or RBV dose reductions
were required for 60 (61.86%) patients, usually because of anemia 59 (60.82%), neutropenia 3 (3.09%), or
thrombocytopenia 1 (1.03%). Treatment was suspended for one patient who had neutropenia (ANC 345 /mm3).
Causes and frequency of dose reduction and treatment discontinuation and their effect on viral response are
summarized in Table 4.
Table 4: Adverse events leading to dose reduction or interruption.
Adverse Event
Frequency, n (%)
Anemia
Management
SVR rate, n (%)
59 (60.82)
47 RBV dose reduction
30 (63.83)
12 RBV & INF dose reduction
7 (58.33)
1Treatment Discontinuation
1 (100)
1 Suspended INF
0 (0)
2 INF dose reduction
2 (100)
4 (4.12)
Neutropenia
Thrombocytopenia
1 (1.03)
INF dose reduction
1 (100)
Fundal Hemorrhage
1 (1.03)
Treatment discontinuation
0 (0)
Death
1 (1.03)
N/A
0 (0)
SVR: Sustained Virological Response; INF: Interferon; RBV: Ribavirin; N/A: Not Applicable.
3.5 Virological Response:
Twenty-two (22.68%) patients were non-responders, whereas 75 (77.32%) patients attained EVR of
whom 62 (63.92%) had ETR and 13 (13.4%) had a breakthrough response. Of the 62 patients with ETR, 11
(11.34%) had a relapse while 51 (52.58%) patients achieved SVR. Fig. 1 and Fig. 2 summarize viral responses
in the studied patients.
Figure 1: Number of patients with undetectable HCV-RNA by weeks of treatment.
Figure 2: Patients who failed to achieve a sustained virological response.
11
6. Safety and Efficacy of Pegylated Interferon….
Factors associated with SVR were assessed using variables in Table 1. Significant factors included:
age, baseline viral load, baseline METAVIR fibrosis score, AST, ALT, ALP, AFP, TSH and WBC. Table 5
summarizes the effect of studied patients’ variables on SVR rate.
IV.
DISCUSSION
Egypt is confronted with an HCV disease burden of historical proportions that distinguishes this nation
from others. The start of the epidemic was attributed to parenteral antischistosomal treatment campaign that
took place in the 1930s which involved the use of improperly sterilized parenteral administration tools [4].
Although such treatment has discontinued since the late 1980s, a substantial transmission is still going in
modern day Egypt [9]. Much of this transmission occurs through iatrogenic and interfamilial routes of
transmission [15, 16]. Nevertheless, a significant proportion of CHC Egyptian patients have an unknown source
of infection indicating the possibility of undiscovered modes of transmission [17]. That is why treatment is
considered a corner stone in the control of hepatitis C epidemic in Egypt.
Table 5: Difference in baseline variables between patients who achieved SVR and those who didn’t.
Factor
Viral Response
Non-SVR
2
p-value
18-35
SVR
14
36-50
23
20
51-65
14
24
Male
43
36
Female
8
10
Very low**
10
2
Low**
17
6
Moderate**
20
26
High**
4
12
METAVIR
fibrosis
0-2
42
28
3-4
9
18
METAVIR
activity
0-1
34
23
2-3
17
23
4.41 ± 0.46
4.39 ± 0.42
AST (IU/L)
55.53 ± 20.32
69.174 ± 37.16
0.03*
ALT (IU/L)
60.21 ± 17.59
75.35 ± 43.80
0.033*
ALP (IU/L)
Age
Sex
Baseline Viral
Load***
(KIU/ml)
Albumin (gm/dl)
0.003*
0.444
0.002*
0.018*
0.096
0.823
105.65 ± 36.42
127.91 ± 48.57
0.012*
Total bilirubin**** (mg/dl)
0.84 ± 0.27
0.85 ± 0.43
0.878
Serum creatinine**** (mg/dl)
0.75 ± 0.18
0.76 ± 0.16
0.716
TSH**** (mIU/L)
1.44 ± 1.13
1.08 ± 0.78
0.067
5440.78 ± 1556.41
6228.70 ± 1810.17
0.023*
13.91 ± 1.41
13.88 ± 1.05
0.889
Platelets (/mm )
210149.02 ± 80281.83
191043.48 ± 56838.94
0.184
AFP*** (ng/ml)
4.0
6.40
0.001*
3
WBC (/mm )
Hemoglobin (gm/dl)
3
SVR: sustained virological response; AST: aspartate aminotransferase; ALT: alanine aminotransferase; ALP:
alkaline phosphatase; TSH: thyroid stimulating hormone; WBC: white blood cells; AFP: alpha feto protein.
* Statistically significant difference between SVR and non-SVR groups.
** Very low < 10 KIU/ml, low < 100 KIU/ml, moderate < 1000 KIU/ml, high > 1000 KIU/ml.
*** Results are reported as median and Mann-Whitney U test was used to detect significance.
**** Effect may be unclear because all patients had a normal baseline values.
12
7. Safety and Efficacy of Pegylated Interferon….
Treatment of CHC with pegylated INF and ribavirin combination is the current standard of care. The response this
treatment varies considerably among different populations and viral genotypes. Our study demonstrates that 20-kDa
pegylated INF and ribavirin combination is associated with an overall SVR rate of 52.58% in Egyptian patients with
genotype 4. It is also found that the SVR rate varies significantly with age and fibrosis stage which is consistent with the
published data about the same product of INF [13]. The effect of sex on SVR rate was unclear because of the relatively small
number of females participating in the study. Also, we could not determine the effect of baseline serum total bilirubin, TSH,
and serum creatinine because all patients had normal baseline value. The current study demonstrates that other factors that
have a significant effect on SVR include: baseline viral load, AST, ALT, AFP, and WBC.
The safety and tolerability issues reported in our study is different from that reported by Esmat et al [13]. We
report a 60.82% frequency of anemia (Hg < 10 gm/dl), 4.12% for neutropenia (ANC < 750 /mm 3), one case of INF dose
reduction due to thrombocytopenia, one case of death, and 2 cases of treatment discontinuation due to adverse effects. On the
other hand, Esmat et al reported a 6% frequency of anemia, 9% for neutropenia, and no dose reduction or treatment
discontinuation due to adverse effects although the studied sample is of similar size (n = 100). It is worth mentioning that an
author of that paper declared a conflict of interest of being the principal investigator in a trial sponsored by Minapharm
pharmaceutical company Egypt, the producer of the product under investigation. Nevertheless, the product remains of
comparable safety and tolerability with respect to published data on 40-kDa INF alpha-2a or 12-kDa INF alpha-2b [10, 11,
18-20].
V.
CONCLUSION
Although significantly lower in price, locally manufactured pegylated INF alpha-2a has a comparable safety and
Efficacy. The large scale use of such product for treatment of Egyptian CHC patients will help to combat hepatitis C
epidemic in Egypt at reasonable and affordable cost. The response to pegylated INF alpha-2a and RBV combination in CHC
Egyptian patients varies depending factors including: age, baseline fibrosis stage, ALT, AST, ALP, AFP, and WBC.
Knowledge of these factors is important for individualized patient treatment decisions and to determine patients’ priority
treatment in case of scarce financial resources allocation.
Acknowledgements: None.
Conflict of Interest: The authors declare that they don’t have any conflict of interest.
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