This study compared the efficacy and safety of two doses of oral midazolam (0.5 mg/kg and 0.75 mg/kg) as premedication in 40 pediatric patients aged 1-5 years undergoing surgery. The number of children who were comfortably sedated and reacted well to separation from parents was higher in the 0.75 mg/kg group. Post-extubation sedation scores showed more children in the 0.75 mg/kg group had satisfactory sedation levels. However, recovery times were similar between groups. The study concluded that 0.75 mg/kg oral midazolam is an effective and safe premedication dose for pediatric patients in this age range.
The efficacy of domperidone in the treatment of childhood gerdFaisal Wahid
This study investigated the efficacy and side effects of domperidone in treating gastroesophageal reflux disease in 220 children between 1 month and 15 years old over a period of 3 years. Domperidone was found to effectively treat symptoms in 85.5% of children with few side effects. The most common side effect was loose stool in 15% of children. There was no significant relationship between treatment response and factors like age, sex, or clinical symptoms. This study suggests that domperidone is an effective and well-tolerated treatment for reflux in children regardless of age or sex.
Desvenlafaxine Succinate: Is it a New Promise and Hope for Management of Vaso...Apollo Hospitals
Natural menopause, specifically, is confirmed after 12
consecutive months of amenorrhea in the absence of any
obvious, pathologic cause.1 These 12 months of amenorrhea and beyond, characterize a woman as postmenopausal. This can further be divided into early postmenopause (4 years after the FMP) and late postmenopause (>5 years since the FMP)
1. The document discusses extended cycle oral contraceptives that provide contraception for 84 days by suppressing ovulation through a combination of ethinyl estradiol and levonorgestrel, followed by 7 days of placebo or low-dose estrogen pills.
2. Clinical trials showed that extended cycle pills were as effective at preventing pregnancy as conventional 28-day pills, with similar safety profiles. Adverse effects were mild and consistent with other combined oral contraceptives.
3. The extended cycle regimen was found to be over 99% effective at preventing pregnancy when taken correctly, and resulted in less frequent bleeding and spotting compared to a 28-day regimen.
This study compared the analgesic efficacy of intravenous paracetamol versus intramuscular pethidine for labor pain in primigravid women undergoing normal vaginal delivery. 80 women were randomly assigned to receive either 1000mg intravenous paracetamol or 50mg intramuscular pethidine for labor pain. Pain levels were assessed after delivery using a visual analogue scale. The average pain score was significantly lower in the paracetamol group compared to the pethidine group. No significant complications occurred in either group. The study concluded that intravenous paracetamol provides more effective labor pain relief than intramuscular pethidine for normal vaginal deliveries.
Administering Medications Through an Enteral Feeding Tube SafelyMichael Allen Welborn
This document outlines a plan to improve the safe administration of medications through enteral feeding tubes. It notes that altering medication form can impact absorption and interaction, and calls for improved guidelines. The plan includes developing a medication database with properties and administration guidelines. Nurses will receive training on proper techniques using materials like procedures, presentations and competency evaluations. Administration will be monitored and nurses retrained if issues arise. The goal is to standardize best practices and reduce risks to patient safety.
Here are the steps to solve this problem:
1) Convert 15.4 lbs to kg: 15.4 lbs = 7 kg
2) The dosage range is 75-150 mg/kg per day
3) To calculate the dosage for this order:
7 kg * 150 mg/kg = 1050 mg per day
4) The doctor's order of 200 mg every 8 hours is:
200 mg * 4 times per day = 800 mg per day
5) The doctor's order of 800 mg per day is within the recommended dosage range of 75-150 mg/kg per day (which is 1050-2100 mg per day for this patient).
Therefore, the doctor's order is within the desired dosage range
This document summarizes several research studies that have investigated the physiological effects and potential therapeutic applications of wet cupping therapy. Specifically, the studies found that wet cupping therapy can reduce oxidative stress biomarkers, restore autonomic nervous system balance, reduce pain and improve function for neck pain patients, and may have benefits for over 120 medical conditions according to traditional Persian medicine texts. However, the document also notes that many cupping studies to date have been of low methodological quality.
The efficacy of domperidone in the treatment of childhood gerdFaisal Wahid
This study investigated the efficacy and side effects of domperidone in treating gastroesophageal reflux disease in 220 children between 1 month and 15 years old over a period of 3 years. Domperidone was found to effectively treat symptoms in 85.5% of children with few side effects. The most common side effect was loose stool in 15% of children. There was no significant relationship between treatment response and factors like age, sex, or clinical symptoms. This study suggests that domperidone is an effective and well-tolerated treatment for reflux in children regardless of age or sex.
Desvenlafaxine Succinate: Is it a New Promise and Hope for Management of Vaso...Apollo Hospitals
Natural menopause, specifically, is confirmed after 12
consecutive months of amenorrhea in the absence of any
obvious, pathologic cause.1 These 12 months of amenorrhea and beyond, characterize a woman as postmenopausal. This can further be divided into early postmenopause (4 years after the FMP) and late postmenopause (>5 years since the FMP)
1. The document discusses extended cycle oral contraceptives that provide contraception for 84 days by suppressing ovulation through a combination of ethinyl estradiol and levonorgestrel, followed by 7 days of placebo or low-dose estrogen pills.
2. Clinical trials showed that extended cycle pills were as effective at preventing pregnancy as conventional 28-day pills, with similar safety profiles. Adverse effects were mild and consistent with other combined oral contraceptives.
3. The extended cycle regimen was found to be over 99% effective at preventing pregnancy when taken correctly, and resulted in less frequent bleeding and spotting compared to a 28-day regimen.
This study compared the analgesic efficacy of intravenous paracetamol versus intramuscular pethidine for labor pain in primigravid women undergoing normal vaginal delivery. 80 women were randomly assigned to receive either 1000mg intravenous paracetamol or 50mg intramuscular pethidine for labor pain. Pain levels were assessed after delivery using a visual analogue scale. The average pain score was significantly lower in the paracetamol group compared to the pethidine group. No significant complications occurred in either group. The study concluded that intravenous paracetamol provides more effective labor pain relief than intramuscular pethidine for normal vaginal deliveries.
Administering Medications Through an Enteral Feeding Tube SafelyMichael Allen Welborn
This document outlines a plan to improve the safe administration of medications through enteral feeding tubes. It notes that altering medication form can impact absorption and interaction, and calls for improved guidelines. The plan includes developing a medication database with properties and administration guidelines. Nurses will receive training on proper techniques using materials like procedures, presentations and competency evaluations. Administration will be monitored and nurses retrained if issues arise. The goal is to standardize best practices and reduce risks to patient safety.
Here are the steps to solve this problem:
1) Convert 15.4 lbs to kg: 15.4 lbs = 7 kg
2) The dosage range is 75-150 mg/kg per day
3) To calculate the dosage for this order:
7 kg * 150 mg/kg = 1050 mg per day
4) The doctor's order of 200 mg every 8 hours is:
200 mg * 4 times per day = 800 mg per day
5) The doctor's order of 800 mg per day is within the recommended dosage range of 75-150 mg/kg per day (which is 1050-2100 mg per day for this patient).
Therefore, the doctor's order is within the desired dosage range
This document summarizes several research studies that have investigated the physiological effects and potential therapeutic applications of wet cupping therapy. Specifically, the studies found that wet cupping therapy can reduce oxidative stress biomarkers, restore autonomic nervous system balance, reduce pain and improve function for neck pain patients, and may have benefits for over 120 medical conditions according to traditional Persian medicine texts. However, the document also notes that many cupping studies to date have been of low methodological quality.
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.
This study compared neonatal and maternal outcomes following administration of fentanyl and midazolam or placebo to 60 pregnant women prior to Cesarean section under spinal anesthesia. The study found:
1) No significant differences between groups in neonatal Apgar scores, neurobehavioral scores, or continuous pulse oximetry measurements over three hours.
2) Mothers who received fentanyl and midazolam were more likely to report finding the study medication helpful, but both groups showed no difference in recall of the birth.
3) Maternal catecholamine levels and neonatal cord blood gas values were similar between groups.
The study concluded that a single dose of fentanyl and mid
This document provides updates on several topics in pediatrics from the past 6 months, as determined by editors and authors to be particularly notable. It includes:
1) Updated recommendations for the diagnosis and treatment of head lice from the American Academy of Pediatrics.
2) A warning from the FDA about potential health risks of over-the-counter homeopathic treatments for asthma.
3) Evidence that head circumference standards may vary between countries/ethnic groups, and local standards may be preferable to WHO standards in some cases.
Oral midazolam and ketamine were compared for procedural sedation in pediatric dental patients. Thirty children received either 0.5mg/kg oral midazolam or 5mg/kg oral ketamine along with nitrous oxide. Psychological parameters were evaluated during treatment. Both regimens effectively reduced anxiety. No significant differences were found in physiological measures between groups. However, the midazolam group showed marginally better psychomotor effects. The study concluded that oral midazolam and ketamine with nitrous oxide provide safe and effective sedation for pediatric dental procedures when administered within the studied dosages.
The document provides instructions for various methods of parenteral drug administration including intravenous push, intramuscular injection, and subcutaneous injection. It describes the procedures for each method including necessary equipment, sites of injection, steps for administration, and potential complications. Intravenous push involves injecting medication directly into the intravenous line. Intramuscular injections are administered into muscle tissue, with recommended sites being the deltoid, ventrogluteal, dorsogluteal, rectus femoris, and vastus lateralis muscles. Subcutaneous injections involve injecting medication into the subcutaneous tissue, with common sites being the upper arm, abdomen, front of the thigh, upper back, and upper buttock.
Reducing the Incidence of Chronic Lung Disease in Very Premature Infants with...amir mohammad Armanian
This study assessed the effects of aminophylline in reducing chronic lung disease (CLD) in very premature infants. 52 infants weighing 1200g or less were randomly assigned to receive aminophylline for the first 10 days (group A) or no aminophylline (group C). Infants receiving aminophylline had significantly shorter oxygen dependency times and lower incidence of CLD compared to the control group. Only 2 infants who received aminophylline developed CLD, compared to 11 infants in the control group. No side effects were reported from aminophylline. This study supports the preventative effects of aminophylline in reducing CLD in very premature infants.
This document discusses several key points regarding pediatric pharmacy practice:
- Children represent a significant portion of the global population but have poorly developed organ functions and are at higher risk for toxicity and adverse drug reactions. Historical events like the sulfanilamide elixir death and thalidomide tragedy demonstrate this risk.
- Pediatric patients require specialized pharmacist care due to age-related variability in drug absorption, distribution, metabolism, and excretion, as well as higher risk of dosing errors due to non-standard doses, need for compounding and dilutions, and less tolerance for mistakes.
- The roles of pediatric pharmacists include dosing calculations and consultations, medication history reviews, discharge counseling, drug
This document summarizes several studies that compare the efficacy of shorter courses of antibiotic therapy (3 days) to traditional longer courses (5 days or more) for treating community-acquired pneumonia. Two studies found that 3 days of antibiotics was as effective as 5 days for treating non-severe pneumonia in children. However, another study found 3 days was less effective than 5 or 10 days for treating pediatric pneumonia. Additionally, one study suggested 3 days of IV antibiotics followed by 5 days of oral antibiotics was not inferior to 8 days of treatment for mild to moderate pneumonia in hospitalized adults.
Assessment of the Prevalence of Proactive Penicillin Allergy Testing in Patie...BRNSS Publication Hub
This study aims to promote penicillin allergy testing in an outpatient to penicillin allergy and educate both patients and clinicians about testing. Patients with a history of penicillin allergy were screened for penicillin allergy testing. The results of allergy testing and patient satisfaction after testing were the main outcomes. A total of 82 patients were recruited, although only 37 actually underwent testing. None of these 37 had a positive skin test and none of 36 had a positive oral challenge (one refused it). Following testing, 2 patients (5%) had subjective reactions within 24 h. Three (10%) were subsequently treated with a beta-lactam, and all reported that testing provided important information to their medical history. In conclusion, the penicillin allergy testing safely evaluates patients labeled as penicillin allergic. It is well tolerated and embraced by the patients who undergo testing. In our study, none of the patients tested had an allergic reaction, but we identified multiple barriers to developing a protocol for testing patients from the primary care setting.
This literature review investigated restrictions on oral intake during labour. It found no evidence that restricting intake improves maternal or neonatal outcomes when the mother is low risk. While earlier concerns about aspiration prompted restrictions, modern techniques have made aspiration extremely rare. The evidence suggests low-risk women who wish to eat or drink lightly in labour should not be prevented from doing so.
MAP0004, an orally inhaled formulation of dihydroergotamine (DHE), was evaluated in a randomized, double-blind, placebo-controlled study for the acute treatment of migraine. 903 patients experiencing a migraine attack were randomized to receive either MAP0004 (0.63 mg emitted dose) or placebo via inhalation. The primary endpoints were pain relief and absence of photophobia, phonophobia, and nausea at 2 hours. MAP0004 was superior to placebo for all primary endpoints. A greater percentage of patients treated with MAP0004 experienced pain relief, absence of photophobia, absence of phonophobia, and absence of nausea compared to those receiving placebo. MAP0004 was well tolerated with no serious
The National guidelines on Pediatric TB diagnosis and treatment were updated based on recent evidence. Key changes include:
1. A new diagnostic algorithm focuses on demonstrating bacteriological evidence and alternative specimens if sputum is unavailable. Tuberculin skin tests and inaccurate diagnostics are not recommended.
2. Seriously ill children may receive daily therapy in the hospital then switch to thrice weekly DOT. New case definitions and six weight bands to determine drug dosages were introduced.
3. Treatment regimens were simplified to two categories. Extensions to intensive and continuation phases were recommended for specific disease types or delayed response. TB preventive therapy dosage increased to 10mg/kg daily for 6 months.
A Systematic Review on the Efficacy of Iontophoresis
as a Treatment for Lateral Epicondylitis by James McKivigan*, Brent Yamashita and Derek Smith in Research & Investigations in Sports Medicine
The document discusses standards, principles, and guidelines related to drug preparation and administration in nursing practice. It outlines learning objectives for nurses regarding knowledge of principles, roles and responsibilities, and accurate calculations related to drug administration. It also discusses Florence Nightingale's Pledge, knowledge and skills required of nurses, and various rules and techniques for safely preparing and giving medications. The document provides examples of administration guidelines for specific drug types and ends with a test to assess understanding of drug administration concepts.
Ojus Tablet in the Treatment of Irritable Bowel Syndrome Amit Kumawat
Irritable bowel syndrome (IBS) is on of the commonly occurring gastrointestinal disorder characterized by abdominal pain and altered bowel habits. https://www.biogetica.com/
Paediatric (pediatrics) medication-drugs therapy in pediatricsRavish Yadav
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
Module 4 Submodule 4. 2 Final June 2007Flavio Guzmán
The document discusses key considerations for clinicians in evaluating the results of drug clinical trials. It emphasizes the importance of critically assessing trial design, results, and whether the findings warrant changing clinical practice. Clinicians are advised to consider factors like trial methodology, potential biases, statistical/clinical significance, applicability to their patients, and safety. The document provides guidance on how to distinguish high-quality trials that produce useful results for patient care.
A randomized, double-blind, placebo-controlled pilot study was conducted to determine if preoperative modafinil improved recovery after general anesthesia in patients with obstructive sleep apnea (OSA). 102 patients with OSA were given either 200mg of modafinil or placebo before surgery. The primary outcome of length of stay in the post-anesthesia care unit (PACU) showed no difference between groups. Secondary measures of emergence and recovery also did not differ significantly. While respiratory rate was higher and blood pressure lower in the modafinil group in the PACU, the study results suggest single-dose preoperative modafinil does not improve functional recovery after general anesthesia in patients with OSA.
This study investigated the antibacterial potency of fortified and unfortified honey on two clinical bacterial isolates - Escherichia coli and Salmonella typhi. Honey samples tested included honey fortified with ginger, honey fortified with lemon, unfortified honey, and natural honey. The agar ditch method was used to determine zones of inhibition. Results showed that honey fortified with lemon produced the largest zones of inhibition against both bacteria, indicating it had the highest antibacterial activity. This was attributed to antibacterial compounds in lemon combining synergistically with honey's natural compounds. Unfortified honey showed less activity than fortified honey. The study demonstrated that fortifying honey, especially with lemon, can increase its antibacterial properties.
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.
This study compared neonatal and maternal outcomes following administration of fentanyl and midazolam or placebo to 60 pregnant women prior to Cesarean section under spinal anesthesia. The study found:
1) No significant differences between groups in neonatal Apgar scores, neurobehavioral scores, or continuous pulse oximetry measurements over three hours.
2) Mothers who received fentanyl and midazolam were more likely to report finding the study medication helpful, but both groups showed no difference in recall of the birth.
3) Maternal catecholamine levels and neonatal cord blood gas values were similar between groups.
The study concluded that a single dose of fentanyl and mid
This document provides updates on several topics in pediatrics from the past 6 months, as determined by editors and authors to be particularly notable. It includes:
1) Updated recommendations for the diagnosis and treatment of head lice from the American Academy of Pediatrics.
2) A warning from the FDA about potential health risks of over-the-counter homeopathic treatments for asthma.
3) Evidence that head circumference standards may vary between countries/ethnic groups, and local standards may be preferable to WHO standards in some cases.
Oral midazolam and ketamine were compared for procedural sedation in pediatric dental patients. Thirty children received either 0.5mg/kg oral midazolam or 5mg/kg oral ketamine along with nitrous oxide. Psychological parameters were evaluated during treatment. Both regimens effectively reduced anxiety. No significant differences were found in physiological measures between groups. However, the midazolam group showed marginally better psychomotor effects. The study concluded that oral midazolam and ketamine with nitrous oxide provide safe and effective sedation for pediatric dental procedures when administered within the studied dosages.
The document provides instructions for various methods of parenteral drug administration including intravenous push, intramuscular injection, and subcutaneous injection. It describes the procedures for each method including necessary equipment, sites of injection, steps for administration, and potential complications. Intravenous push involves injecting medication directly into the intravenous line. Intramuscular injections are administered into muscle tissue, with recommended sites being the deltoid, ventrogluteal, dorsogluteal, rectus femoris, and vastus lateralis muscles. Subcutaneous injections involve injecting medication into the subcutaneous tissue, with common sites being the upper arm, abdomen, front of the thigh, upper back, and upper buttock.
Reducing the Incidence of Chronic Lung Disease in Very Premature Infants with...amir mohammad Armanian
This study assessed the effects of aminophylline in reducing chronic lung disease (CLD) in very premature infants. 52 infants weighing 1200g or less were randomly assigned to receive aminophylline for the first 10 days (group A) or no aminophylline (group C). Infants receiving aminophylline had significantly shorter oxygen dependency times and lower incidence of CLD compared to the control group. Only 2 infants who received aminophylline developed CLD, compared to 11 infants in the control group. No side effects were reported from aminophylline. This study supports the preventative effects of aminophylline in reducing CLD in very premature infants.
This document discusses several key points regarding pediatric pharmacy practice:
- Children represent a significant portion of the global population but have poorly developed organ functions and are at higher risk for toxicity and adverse drug reactions. Historical events like the sulfanilamide elixir death and thalidomide tragedy demonstrate this risk.
- Pediatric patients require specialized pharmacist care due to age-related variability in drug absorption, distribution, metabolism, and excretion, as well as higher risk of dosing errors due to non-standard doses, need for compounding and dilutions, and less tolerance for mistakes.
- The roles of pediatric pharmacists include dosing calculations and consultations, medication history reviews, discharge counseling, drug
This document summarizes several studies that compare the efficacy of shorter courses of antibiotic therapy (3 days) to traditional longer courses (5 days or more) for treating community-acquired pneumonia. Two studies found that 3 days of antibiotics was as effective as 5 days for treating non-severe pneumonia in children. However, another study found 3 days was less effective than 5 or 10 days for treating pediatric pneumonia. Additionally, one study suggested 3 days of IV antibiotics followed by 5 days of oral antibiotics was not inferior to 8 days of treatment for mild to moderate pneumonia in hospitalized adults.
Assessment of the Prevalence of Proactive Penicillin Allergy Testing in Patie...BRNSS Publication Hub
This study aims to promote penicillin allergy testing in an outpatient to penicillin allergy and educate both patients and clinicians about testing. Patients with a history of penicillin allergy were screened for penicillin allergy testing. The results of allergy testing and patient satisfaction after testing were the main outcomes. A total of 82 patients were recruited, although only 37 actually underwent testing. None of these 37 had a positive skin test and none of 36 had a positive oral challenge (one refused it). Following testing, 2 patients (5%) had subjective reactions within 24 h. Three (10%) were subsequently treated with a beta-lactam, and all reported that testing provided important information to their medical history. In conclusion, the penicillin allergy testing safely evaluates patients labeled as penicillin allergic. It is well tolerated and embraced by the patients who undergo testing. In our study, none of the patients tested had an allergic reaction, but we identified multiple barriers to developing a protocol for testing patients from the primary care setting.
This literature review investigated restrictions on oral intake during labour. It found no evidence that restricting intake improves maternal or neonatal outcomes when the mother is low risk. While earlier concerns about aspiration prompted restrictions, modern techniques have made aspiration extremely rare. The evidence suggests low-risk women who wish to eat or drink lightly in labour should not be prevented from doing so.
MAP0004, an orally inhaled formulation of dihydroergotamine (DHE), was evaluated in a randomized, double-blind, placebo-controlled study for the acute treatment of migraine. 903 patients experiencing a migraine attack were randomized to receive either MAP0004 (0.63 mg emitted dose) or placebo via inhalation. The primary endpoints were pain relief and absence of photophobia, phonophobia, and nausea at 2 hours. MAP0004 was superior to placebo for all primary endpoints. A greater percentage of patients treated with MAP0004 experienced pain relief, absence of photophobia, absence of phonophobia, and absence of nausea compared to those receiving placebo. MAP0004 was well tolerated with no serious
The National guidelines on Pediatric TB diagnosis and treatment were updated based on recent evidence. Key changes include:
1. A new diagnostic algorithm focuses on demonstrating bacteriological evidence and alternative specimens if sputum is unavailable. Tuberculin skin tests and inaccurate diagnostics are not recommended.
2. Seriously ill children may receive daily therapy in the hospital then switch to thrice weekly DOT. New case definitions and six weight bands to determine drug dosages were introduced.
3. Treatment regimens were simplified to two categories. Extensions to intensive and continuation phases were recommended for specific disease types or delayed response. TB preventive therapy dosage increased to 10mg/kg daily for 6 months.
A Systematic Review on the Efficacy of Iontophoresis
as a Treatment for Lateral Epicondylitis by James McKivigan*, Brent Yamashita and Derek Smith in Research & Investigations in Sports Medicine
The document discusses standards, principles, and guidelines related to drug preparation and administration in nursing practice. It outlines learning objectives for nurses regarding knowledge of principles, roles and responsibilities, and accurate calculations related to drug administration. It also discusses Florence Nightingale's Pledge, knowledge and skills required of nurses, and various rules and techniques for safely preparing and giving medications. The document provides examples of administration guidelines for specific drug types and ends with a test to assess understanding of drug administration concepts.
Ojus Tablet in the Treatment of Irritable Bowel Syndrome Amit Kumawat
Irritable bowel syndrome (IBS) is on of the commonly occurring gastrointestinal disorder characterized by abdominal pain and altered bowel habits. https://www.biogetica.com/
Paediatric (pediatrics) medication-drugs therapy in pediatricsRavish Yadav
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
Module 4 Submodule 4. 2 Final June 2007Flavio Guzmán
The document discusses key considerations for clinicians in evaluating the results of drug clinical trials. It emphasizes the importance of critically assessing trial design, results, and whether the findings warrant changing clinical practice. Clinicians are advised to consider factors like trial methodology, potential biases, statistical/clinical significance, applicability to their patients, and safety. The document provides guidance on how to distinguish high-quality trials that produce useful results for patient care.
A randomized, double-blind, placebo-controlled pilot study was conducted to determine if preoperative modafinil improved recovery after general anesthesia in patients with obstructive sleep apnea (OSA). 102 patients with OSA were given either 200mg of modafinil or placebo before surgery. The primary outcome of length of stay in the post-anesthesia care unit (PACU) showed no difference between groups. Secondary measures of emergence and recovery also did not differ significantly. While respiratory rate was higher and blood pressure lower in the modafinil group in the PACU, the study results suggest single-dose preoperative modafinil does not improve functional recovery after general anesthesia in patients with OSA.
This study investigated the antibacterial potency of fortified and unfortified honey on two clinical bacterial isolates - Escherichia coli and Salmonella typhi. Honey samples tested included honey fortified with ginger, honey fortified with lemon, unfortified honey, and natural honey. The agar ditch method was used to determine zones of inhibition. Results showed that honey fortified with lemon produced the largest zones of inhibition against both bacteria, indicating it had the highest antibacterial activity. This was attributed to antibacterial compounds in lemon combining synergistically with honey's natural compounds. Unfortified honey showed less activity than fortified honey. The study demonstrated that fortifying honey, especially with lemon, can increase its antibacterial properties.
This document summarizes a study that investigated the pharmacognostic, antioxidant, and antimicrobial properties of Kigelia africana Lam. Benth leaves. Pharmacognostic evaluation of the leaf's physical characteristics and microscopic anatomy was performed. Phytochemical analysis revealed the presence of alkaloids, flavonoids, tannins, and saponins. The crude methanol extract and fractions showed significant antioxidant activity in DPPH radical scavenging assays. Testing against bacterial and fungal strains found that the crude extract and fractions inhibited the growth of most pathogens, except the aqueous fraction. The results support traditional use of K. africana for treating infectious diseases.
This document summarizes a study that assessed the knowledge, attitudes, and practices of mothers in Jos North, Nigeria regarding childhood immunization. The study used a questionnaire to survey 232 mothers with children aged 0-1 years old. It found that while most mothers (89.6%) had good overall knowledge of vaccines, less than 60% reported vaccinating their children on schedule and less than 3% had negative attitudes towards immunization. Factors like education level, marital status, religion, and whether the mother was vaccinated as a child influenced mothers' knowledge. Records also showed only 23.4% of children completed their vaccination schedules, revealing poor practice. The study concluded health education and promotion efforts are needed to improve mothers' knowledge
Este documento presenta los puntos a desarrollar para el Trabajo de Aplicación sobre un Estudio de Caso. Se pide caracterizar a los actores sociales involucrados y sus interrelaciones e interpretar los conflictos socio-espaciales. También se solicita evaluar críticamente el papel del Estado en el proceso de gestión urbanística del proyecto, determinando su accionar. Por último, se debe precisar los componentes del entorno y del proyecto a considerar para evaluar su Impacto Socio-Ambiental.
This document discusses microRNAs (miRNAs), which are small non-coding RNA molecules that regulate gene expression. It provides a brief history of miRNA discovery and defines miRNAs and how they differ from siRNAs. The document highlights that miRNAs are encoded in genomes and bind to mRNAs to repress translation or promote degradation. It notes miRNAs play key roles in processes like cell differentiation and growth. The document also summarizes some of the main functions of miRNAs in controlling gene expression and development.
El documento describe el proceso de reciclaje, incluyendo qué materiales se pueden reciclar como papel, plástico, aluminio y vidrio. Explica que el reciclaje ayuda a reducir la contaminación y es beneficioso para la sociedad al reutilizar los desechos en lugar de extraer nuevos recursos. También responde preguntas sobre cuánto tiempo tardan en degradarse los plásticos, vidrios y por qué es importante reciclar.
Presentation by Deborah Ferrari about Football and its Culture. Here Deborah Ferrari explains early history of football, medieval and many other things.
This document reports on 6 cases of new onset diabetes that appeared after kidney transplantation. It finds that 30% of kidney transplant patients in the studied population developed diabetes, with an average onset of 5 months post-transplant. Risk factors for developing diabetes included older age, family history, overweight status, and immunosuppressive medications. Treatment included insulin therapy, oral medications, and adjusting immunosuppression. Good glycemic control is important for transplant outcomes, but treatment must be carefully managed to avoid rejection.
The study compared the effectiveness of oral midazolam and ketamine combination (Group A) versus oral midazolam alone (Group B) as premedication in children undergoing elective surgery. It found that the combination provided better premedication effects, with 79% of children in Group A achieving good sedation scores 30 minutes after administration, compared to 67% in Group B. Additionally, the combination allowed for easier parental separation in a significantly shorter time period (19 minutes vs 28 minutes). There were no significant differences between groups in other measures like response to anesthesia induction or emergence. The combination also had a significantly faster time to recovery. The only side effect that was higher in the combination was increased risk of PONV.
Introduction true vertigo is a type of vertigo identifieniraj57
This study compared the effectiveness of hyoscine and diazepam in treating true vertigo in 69 patients in an emergency department. Patients were randomly assigned to receive either 5 mg of hyoscine or 10 mg of diazepam. Vertigo severity was assessed before and 1 and 2 hours after drug administration in different positions. Diazepam was significantly more effective at relieving vertigo in all positions compared to hyoscine based on treatment success rates. Complete relief of vertigo occurred in 40-63% of patients given diazepam but only 2.6-12.5% of those given hyoscine. The study suggests that diazepam is a better option than hyoscine for
1) Approximately 40% of patients randomized to a non-sedation strategy in the NONSEDA trial experienced failure of non-sedation and required sedation.
2) Patients who experienced failure of non-sedation ("non-sedation failure") had similar baseline characteristics as those who did not require sedation ("non-sedation success") but had worse clinical outcomes including fewer days without sedation or mechanical ventilation.
3) Propofol was the primary rescue sedative used for patients who experienced non-sedation failure. Mortality and long-term outcomes were similar between the two groups.
Phase 1 clinical trials are the first studies conducted in humans of a new drug or treatment. They aim to determine the drug's safety and tolerability, identify the maximum tolerated dose, and understand the drug's pharmacokinetics. Phase 1 trials typically involve small groups of healthy volunteers or patients and start with low doses that are gradually increased. The results of phase 1 trials provide information needed to design subsequent phase 2 and 3 trials to further evaluate efficacy.
The document discusses premedication practices in anesthesia. It notes that while premedication was originally used to counter side effects of early anesthetics like ether, the focus is now on improving patient wellbeing and satisfaction. Benefits of premedication include reducing anxiety, nausea, acidity and autonomic responses. Key drugs discussed are benzodiazepines like midazolam and antiemetics. Optimal timing, safety considerations and special populations like pediatrics are also reviewed.
The document discusses the principles and paradigms of drug therapy, including the phases of clinical drug development from preclinical investigation through postmarketing studies. It emphasizes the importance of evaluating individual patients, understanding pharmacokinetics and pharmacodynamics, minimizing risks, and conducting well-designed clinical trials to determine drug efficacy and safety. The document also addresses topics like adverse reaction surveillance, observational studies, patient-centered therapeutics, and the importance of considering how new drugs may interact with a patient's existing medication regimen.
The document provides revised recommendations for the management of fibromyalgia based on a review of evidence from systematic reviews and meta-analyses published since the original 2005 guidelines. Key findings include:
- Exercise was the only intervention with a "strong for" recommendation based on meta-analyses showing benefits for pain, fatigue, sleep and functioning.
- A graduated four-stage approach is proposed, beginning with patient education and non-pharmacological therapies. Pharmacological therapies (amitriptyline, pregabalin, cyclobenzaprine, duloxetine, milnacipran) received "weak for" recommendations for severe pain or sleep issues.
- Growth hormone, sodium oxybate, NSAIDs, S
The document provides revised recommendations for the management of fibromyalgia based on a review of evidence from systematic reviews and meta-analyses published since the original 2005 guidelines. Key findings include:
- Exercise is the only therapy strongly recommended based on meta-analyses showing benefit for pain, sleep, and functioning.
- A graduated four-stage approach is proposed, beginning with patient education and non-pharmacological therapies.
- If non-response, further therapies such as psychological therapies, pharmacotherapy, or rehabilitation may be tailored to the individual. However, meta-analyses only found weak evidence for all potential pharmacological therapies.
- Most treatments show relatively modest effects. Future research priorities are identifying who benefits from specific interventions,
Influence of patient counseling on medication adherence in epileptic patientsSriramNagarajan17
This study examined the effects of patient counseling on medication adherence among 250 epileptic patients in Erode district, India over 6 months. The study found that treatment effectiveness increased to 70-85% in children and 60-75% in males and females after patient counseling. Adherence was lower in females potentially due to adverse drug effects and non-adherence. The study concluded that proper patient counseling and education are important for improving therapy for epileptic patients by enhancing communication between physicians and patients/caregivers.
Ambulatory short course high-dose oral amoxycillin for tto of severe pneumoni...Alindor Piña
High-dose oral amoxicillin given at home was found to be as effective as parenteral ampicillin given in the hospital for treating severe pneumonia in children. In a randomized trial of over 2,000 children in Pakistan with severe pneumonia, the risk of treatment failure by day 6 was similar between those treated with 5 days of high-dose oral amoxicillin at home (7.5%) compared to 2 days of parenteral ampicillin in the hospital followed by 3 days of oral amoxicillin (8.6%). Five children died within 14 days but treatment failure had already occurred in these cases. The study suggests that WHO recommendations for treatment of severe pneumonia may need revising to allow for effective
Prophylactic Aminophylline for Prevention of Apnea at Higher-Risk Preterm Neo...amir mohammad Armanian
1. The study assessed the prophylactic effects of aminophylline on apnea in preterm neonates with a gestational age less than 32 weeks and/or birth weight less than 1200g.
2. 52 neonates were randomly assigned to receive either aminophylline (group A) or no aminophylline (group C) for the first 10 days.
3. Primary outcomes like apnea, bradycardia and cyanosis were significantly lower in the aminophylline group compared to the control group. Secondary outcomes like need for CPAP and length of hospital stay were also lower in the aminophylline group.
The document provides information on commonly used drugs for children, including paracetamol, ibuprofen, midazolam, salbutamol, gaviscon infant, cefotaxime, caffeine citrate, morphine, and flucloxacillin. It discusses the uses, who can receive each drug, how it is administered, cautions, and side effects. Research is cited showing medication errors can occur in up to 17.8% of hospitalized children and identifying reasons for adverse drug reactions is important for prevention strategies.
Neukirch & Colagiuri, 2013 (online) - PE sleep, warning, and side effectNadine Neukirch
- The study tested whether warnings about potential side effects from medical treatment can induce those side effects via the placebo effect.
- 91 undergraduate students experiencing sleep difficulties were randomly assigned to receive either a warning about increased or decreased appetite from a new sleep medication or no warning, and then to receive placebo pills or no treatment for one week.
- Those who received placebo treatment reported significantly better sleep, showing a placebo effect, but their sleep as measured by activity monitors was unaffected.
- Those who received warnings were much more likely to report the warned-about side effect than those not warned, showing that warnings can induce side effects via expectancy even when only placebo treatment is received.
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).
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
The document describes a case study of an 18-year-old female patient who developed toxic epidermal necrolysis as a severe adverse reaction to the drug sulfasalazine, which she had been taking for ankylosing spondylitis. She was admitted to the intensive care unit and treated with high dose corticosteroids, fluid replacement, and supportive care. She improved with treatment and was discharged with only post-inflammatory hypopigmentation.
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
This study examined self-medication practices for oral health problems among dental patients in Bangalore, India. The study found that 100% of the 175 dental patients surveyed practiced self-medication. Toothache was the most common triggering factor reported. Analgesics and herbal remedies were commonly used for self-treatment. Most participants consulted pharmacists for advice on self-medication and would see a dentist only if problems persisted after self-medicating. The high prevalence of self-medication indicates a need for education programs to increase awareness of risks.
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
The document summarizes a study that tested the antibacterial activity of extracts from three species of wild ginger plants from Indonesia (Zingiber zerumbet, Zingiber amaricans, and Zingiber aromaticum) against Mycoplasma gallisepticum, a pathogen that causes respiratory disease in chickens. Phytochemical analysis revealed the presence of alkaloids, flavonoids, tannins, and terpenoids in the plant extracts. Disc diffusion and minimum inhibitory concentration assays showed that ethanol extracts of dried rhizomes had the strongest inhibitory effects against the pathogen, with minimum inhibitory concentrations ranging from 7.8 to 31.2 mg/ml. The results suggest that extracts from these wild ginger plants
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.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...
I0506046049
1. IOSR Journal Of Pharmacy
(e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219
www.iosrphr.org Volume 5, Issue 6 (June 2015), PP. 46-49
46
Efficacy and safety of two doses of oral midazolam as
premedication in paediatric patients: A prospective randomized
and comparative study.
Pooja Vaskle1
, Rashmi Pal2,
KK Arora3
1
(Department of Anesthesiology, MGM Medical College,Indore/ Jabalpur Medical University,(M.P.)India)
2
(Department of Anesthesiology, MGM Medical College,Indore/ Jabalpur Medical University, (M.P.)India)
3
(Department of Anesthesiology, SS Medical College,Rewa/ Jabalpur Medical University, (M.P.)India)
Abstract : The present study was conducted to assess and compare the efficacy and safety of two doses of oral
midazolam as premedication in pediatric patients undergoing surgeries under general anesthesia. Forty
children aged 1-5 years were enrolled and randomly assigned to one of the two groups and received oral
preparation of midazolam in two doses of 0.5 mg/kg and 0.75 mg/kg in two groups respectively, 30 minutes
before separation from parents. They were assessed for patient’s acceptance of the medication , reaction to
separation from parents, sedation scores and recovery conditions. With regard to children’s reaction to
separation from their parents, the number of comfortable children was more in group B (18,90%) as compared
to group A (15,75%). On arrival to the operation room eight children (40%) had satisfactory sedation scores in
group B as compared to 5(25%) in group A. Satisfactory sedation score was also higher in group B (10,50%) as
compared to group A (4,20%) after reversal of residual paralysis. Time to spontaneous ventilation and
extubation and time from pre-medication to full recovery were not different in two groups. Oral midazolam in a
dose of 0.75 mg/kg is an acceptable, effective and safe premedication in children aged 1-5 years.
Keywords: anesthesia, midazolam, pediatric, premedication, ,sedation.
I. INTRODUCTION
Effective premedication is an integral component of balanced anesthesia. As in adults, children also
suffer from anxiety and separation from parents which may rise autonomic hyperactivity, dysrrythmias,
hypersalivation, breath holding and laryngospasm perioperatively. Additionally it can also add to surgical stress
response. Establishment of adequate pre-anaesthetic sedation and amnesia for pre and intraoperative event has
thus assumed an important role in the anesthetic management of pediatric patients. An ideal premedication
should allay apprehension regarding anesthesia and surgery, lessen the trauma of separation from family and
facilitate induction of general anesthesia without prolonging the post-anaesthetic recovery period.[1]
As a general consensus pharmacological approach should be adopted only when behavioral (non-
pharmacologic) management techniques fail. Midazolam has been found to be good pre-anaesthetic agent and
also is the most commonly used benzodiazepine in pediatric patients. Its principal pharmacological effects are
sedation, anxiolysis, anticonvulsant actions, spinal cord mediated skeletal muscle relaxation and anterograde
amnesia. Midazolam in its syrup form has been shown to be an extremely safe premedication for children with
a dose range of 0.25 to 1.0 mg/kg. [2,3] So this prospective, randomized and comparative study was undertaken
to assess and compare the efficacy and the safety of oral midazolam in two different doses and to determine the
optimal dose as a premedication in children of 1-5 years of age undergoing surgical procedures under general
anesthesia.
II. MATERIALS & METHODS
In a randomized, prospective and comparative study, 40 children aged 1-5 years with American
Society of Anesthesiologists (ASA) I & II status presenting for various surgical procedures under general
anesthesia were included. After approval from institutional ethics committee, the study protocol was explained
to the parents and informed consent was obtained from them. The children having upper respiratory tract
infections, rhinopharyngitis, hypersensitivity to benzodiazepines, those treated with sedatives or anticonvulsants
or if parents did not give consent were excluded from the study. The study patients were randomly assigned to
one of the two groups according to the computer based randomization. Group A received oral midazolam in a
dose of 0.5 mg/kg and Group B received oral midazolam in a dose of 0.75 mg/kg, 30 minutes before the
procedure. The drug was prepared and administered by an anesthesiologist not involved in the study.
2. Efficacy and safety of two doses of oral midazolam as premedication in paediatric patients….
47
A standard general anesthesia protocol was followed for all the patients. All children were given
atropine 0.01 mg/kg intravenously and induced with ketamine 1 mg/kg and propofol 2-3 mg/kg, intravenously.
Orotracheal intubation was facilitated with intravenous succinylcholine 2.0 mg/kg. Children were taken on
controlled ventilation and anaesthesia was maintained with a mixture of O2 and NO2 :: 50%:50% supplemented
with sevoflurane (0.25-1.0%) and atracurium as and when required. Intrvenous fluids were administered as per
standard protocol. After the completion of surgery, residual neuromuscular block was reversed with neostigmine
.05 mg/kg and glycopyrrolate .01 mg/kg intravenously. Patient electrocardiogram, noninvasive blood pressure,
pulse–oximetry and temperature were monitored intraoperatively. Paracetamol 10 mg/kg was given
intramuscularly 30 minute before the end of the procedure. Tracheal extubation was done when
normoventilation was achieved and the patients regained gag and cough reflex. Thereafter all patients were
shifted to postoperative care unit and heart rate, blood pressure, arterial oxygen saturation were monitored.
Children were also observed for the acceptance of the oral medication, reaction to the separation from parents,
pre-induction and post extubation sedation scores and recovery conditions. Acceptance of the medication was
defined as swallowing without immediate regurgitation. Reaction to the separation from parents was the
response of the children when taken away from the parents, 30 minutes after the administration of the study
syrups. It was graded as inconsolable cry, complaining, quiet but awake or sleepy. The degree of sedation when
the child was first seen in the operative room and at the end after reversal of the residual paralysis was based
upon 5 point sedation Score [4] as follows:
I. Anxious agitated
II. Oriented, calm and co-operative
III. Drowsy, responding to verbal commands
IV. Not responding to verbal commands but to the painful stimuli
V. Not responding to painful stimuli
With respect to recovery conditions, the children were also observed for spontaneous ventilation after
giving the reversal and time required for establishing adequate spontaneous ventilation and extubation was
noted. Time from pre-medication to full recovery was also noted.
Statistical analysis was performed using statistical package of social science (SPSS) version 20 . The
percentage between the two groups were compared using two- sample proportion- Z test. Mean value were
compared between the groups using student’s unpaired T test. P value of < 0.05 was considered as significant.
III. RESULTS
The children in both groups were comparable with regard to age, sex, weight and ASA status. The
duration of general anesthesia was also not statistically significant [Table-1].There were no incidence of
bradycardia (heart rate< 20%), hypotension (mean blood pressure< 20% of baseline) or desaturation episodes
( o2 saturation< 95%), after premedication or in operation room. The children in both groups accepted oral
medication well and did not vomit soon after the swallowing of premedication. Although, the number of
comfortable children were more in group B (18,90%) as compared to group A (15,75%), there was no
significant difference in level of reactions to separation from parents, 30 minutes after receiving premedication
(p>.05). [Table- 2]
There was no significant difference in the preoperative sedation scores in the both groups (P >0.05).
[Table-3] There were no incidences of children responding to painful stimuli in any of the group. After reversal
of residual paralysis, the number of children with satisfactory sedation score i.e. drowsy but arousable was
higher in the 0.75 mg/kg dose group (10,50%), than in .05 mg/kg group (4,20%) (p<.05)), whereas, the number
of children with desirable sedation score i.e. oriented and calm was significantly higher in 0.5 mg/kg dose
group (15, 75%) as compared to the group B (5,25%) (p<.05). There were 5 (25%) children in group B and
none in group A, who responded to painful stimuli but not to verbal command (P<.05). [Table-4]
There was no significant difference in the time to spontaneous ventilation and extubation in both groups. Most of
the children in both groups recovered spontaneous ventilation and could be extubated within 5 minutes. Average time
interval from pre-medication to full recovery was also not significantly different in two groups(p>.05). [Table-5]
IV. DISCUSSION
As preanesthetic medication has become an essential component of current anaesthesia practice in children, several
studies have reported that it can allay anxiety preoperatively and facilitate separation of children from their parents. [5,6,7] It
has also been suggested in many previous studies that midazolam is an effective preanesthetic medication for children. When
administered either intramuscularly,[8] rectally [9] Intranasally [10] or orally.[11,12] Oral midazolam is found to be safe and
effective without altering the haemodynamics and oxygen saturation values in the pre-operative or immediate post operative
periods. It produces good anxiolysis in a dose range of 0.4-0.6 mg/kg in older children (>5 years of age) allowing parenteral
separation by 15-30 minutes.
3. Efficacy and safety of two doses of oral midazolam as premedication in paediatric patients….
48
In a comparative study done by Saarnivarra et al [13] on children (1-9 years of age) receiving oral
midazolam or chloral hydrate (in combination with atropine), they concluded that midazolam 0.4-0.6 mg/kg per
oral provided only "fair analysis in children younger than 5 years of age, but good anxiolysis in children more
than 5 years of age. In the same context, our study has tried to compare two doses of oral midazolam (0.5 mg/kg
and 0.75 mg/kg) in children of 1-5 years of age and we found that oral midazolam in the dose of 0.75 mg/kg was
similar to dose of 0.5 mg/kg with respect to children,s separation from their parents, preoperative sedation
scores and recovery conditions, whereas it was better in producing favourable sedation scores after reversal of
residual paralysis.(p<.05)
Administration of small amount of fluid (5 to 10 ml) to children prior to induction of general anesthesia
does not pose a significant risk for aspiration of abdominal contents [14]. The limited bioavailability of oral
midazolam due to its high first pass metabolism may explain the high dose requirement for sedation and
anxiolysis after the oral route of administration. This combination of sedative and anxiolytic characteristics of
midazolam is believed to create a calming effect which eases the separation of children from their parents [15].
Finley et al.[15] showed that midazolam induced decrease in anxiety was more pronounced for children with
higher baseline levels of anxiety. Oral midazolam was reported to give a more predictable and effective sedation
than oral diazepam [16]. It was also associated with a faster and smoother recovery, when compared with oral
ketamine [17]. Patel and Meakin [18] also reported greater anxiolysis after oral midazolam (0.5 mg/kg) than
after a combination of diazepam (0.25 mg/kg) with droperidol (0.25 mg/kg) or trimeparazine (2 mg/kg).
Age of the child is also an important variable. Separation anxiety usually peaks at approximately 1 year
of age, but children at the age of 1-5 years are at the highest risk for extreme preoperative anxiety [19]. Clinical
sedative effects are seen within 5 to 10 minutes of oral midazolam administration. The peak effect is achieved
in 20 to 30 minutes [20]. In present study, separation time was set at 30 minutes and we found a satisfactory
anxiolysis in 90% of children after 0.75 mg/kg dose and 75% of children in 0.50 mg/kg dose.
Preoperative oral midazolam has proved effective in treating preoperative anxiety. Orally administered midazolam
can be given in a dose of 0.25 to 1 mg/kg up to a total dose of 20 mg depending on the duration of surgery and the anxiety
level of the child. In this study, after reversal of residual paralysis, the satisfactory level of sedation score was achieved in 10
(50%) children in group B and 4 (20%) children in group A and the difference was statistically significant (p<.05), whereas
the number of oriented and calm children was higher in group A (15, 75%) than in group B (5,25%)(p<..05). There were
5(25%) children in group B and no children in group A, who were not responding to verbal command but to painful stimuli
(p<.05). Feld et al [3] also reported a superior anxiolysis 30 minutes after a 0.75 mg/kg dose of midazolam as compared to
0.25 mg/kg and 0.5 mg/kg dose or placebo. Similarly, it was reported that the use of a 0.75 mg/kg dose of oral midazolam
did not result in clinical respiratory depression or upper airway obstruction, but in some children caused an increased level of
sedation beyond simple conscious sedation. [21] Our study correlates to this study.
According to Cox et al [22] oral midazolam effectively reduced both separation and induction anxiety in children
with minimal effect on recovery times. There was no significant delay in recovery time of both groups in our study. Small
sample size has been the limitation of our study and statistically significant difference could have been drawn with a
relatively larger sample with respect to chlldren’s reaction to parent’s separation and preoperative sedation score as well.
V. CONCLUSION
It can be concluded that oral midazolam in a dose of 0.75 mg/kg is an optimal and effective premedication drug in
children of 1 to 5 years of age with minimal effects on recovery time. There were no hemodynamic alterations and
respiratory depression reported in this dose of midazolam. Other side effect like nausea, vomiting and hiccough were also
not reported.
Table 1 : Demographic Profile
Variable Group A Group B
Age (years) 2.74±1.54 2.86±1.65
Sex (M/F) 13/7 12/8
Weight(kg) 15.25±6.98 14.78±6.28
ASA I/II 16/4 15/5
Duration of general anesthesia 62.0±21.4 54.8±23.5
Values are expressed as mean±standard deviation.
Table 2 : Reaction to parents separation
Reaction Group A
(0.5 mg/kg)
Group B
(0.75mg/kg)
P value
Inconsolable cry 1(5%) 0(0%) 0.305
Complaining 4(20%) 2(10%) 0.371
Total number of uncomfortable children 5(25%) 2(10%) 0.203
Quiet-but-awake 13(65%) 13(65%) 1.000
Sleepy 2(10%) 5(25%) 0.203
Total number of comfortable children 15(75%) 18(90%) 0.203
4. Efficacy and safety of two doses of oral midazolam as premedication in paediatric patients….
49
Table 3: Preoperative Sedation score in operation room
Score Group A
(0.5 mg/kg)
Group B
(0.75mg/kg)
P value
Anxious 3(15%) 0(0%) 0.060
Oriented, calm 11(55%) 8(20%) 0.337
Drowsy-RVC 5(11%) 8(20%) 0.305
Not RVC but to painful stimuli 1(5%) 4(20%) 0.141
Not responding to painful stimuli 0(0%) 0(0%)
Table 4: Sedation score on reversal of residual paralysis.
Score Group A
(0.5 mg/kg)
Group B
(0.75mg/kg)
P value
Anxious 1(5%) 0(0%) 0.305
Oriented, calm 15(75%) 5(25%) 0.000*
Drowsy-RVC 4(20%) 10(50%) 0.036*
Not RVC but to painful stimuli 0(0%) 5(25%) 0.010*
Not responding to painful stimuli 0(0%) 0(0%)
*= significant (p<.05)
Table 5 : Recovery profile.
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Time Group A
(0.5 mg/kg)
Group B
(0.75mg/kg)
P value
Time to spontaneous ventilation and extubation <5 min 18(90%) 16(80%) 0.371
Time to spontaneous ventilation and extubation 5–10 min 2(0%) 2(10%) 1.000
Time to spontaneous ventilation and extubation 10–40 min 0(0%) 2(10%) 0.136
Time from premedication to full recovery (hours) 97.5±21.0 92.3±25.7 0.483