Open Access Short Communication

Telemedicine in Covid-19: Challenges and Opportunities

Imrana Masood, Ummul Baneen, . Nivedita

Asian Journal of Research in Medical and Pharmaceutical Sciences, Page 32-35
DOI: 10.9734/ajrimps/2021/v10i230160

The pandemic of COVID -19 is a healthcare emergency of International concern. It originated in Wuhan, China in December 2019 and was declared as pandemic by WHO on 12 March 2020. Since then it is raging relentlessly across the world with staggering more than 60 lakh cases in India currently. This has put a tremendous strain on already frail and overburdened Indian healthcare system and aggravated concern in the accessibility to healthcare by common mass due to prevailing lockdown conditions. This has sparkled to re-think and renew the policy on healthcare and focus on relevance, reach and utilize the potential of telemedicine services for the delivery of healthcare to community. This term telemedicine has been in use since 1970s but became fully operational globally in early 2000. Now about 20 years later we find a revolutionary change in the focus of health services delivery towards community healthcare and wellbeing In this article we aim to analyze the difficulties and hurdles faced by non COVID patients and challenges in front of the government to dispense basic healthcare to those in need. We need to tap all our resources particularly ICT for healthcare delivery and use this adversity of COVID 19 pandemic as an opportunity to build on our capacity and expertise in the area of Telemedicine for the betterment of community healthcare.

Open Access Original Research Article

Factors Associated with Prognosis of Non-Alcoholic Fatty Liver Disease

Muamar M. A. Shaheen, Mohanad Saleh, Deema Sider, Reem Al Natsheh, Raghad Dweik

Asian Journal of Research in Medical and Pharmaceutical Sciences, Page 1-12
DOI: 10.9734/ajrimps/2021/v10i230158

Background: At the junction between obesity, metabolic syndrome and liver failure, lies Non-alcoholic fatty liver disease. Recent studies elaborated on role of metformin in patients with non-alcoholic fatty liver disease. This observation has not been studied at a global scale, neither it was investigated in different ethnical groups.

Objectives: We aim at determining the risk factors associated with prognosis of non-alcoholic fatty liver disease among a cohort of patients in Southern West Bank, Palestine.

Methods: A retrospective cohort study involving 300 NAFLD patients who visited the internal medicine department at Hebron Governmental Hospital from October 2017 till September 2018. Two hundred and three patients diagnosed with non-alcoholic fatty liver disease, were included in this study. Lab test results within the past 6 months, comorbidity and medication history were collected from patients` profiles. Data was analyzed using SPSS V20. Liver Fibrosis score was determined by using non-alcoholic fatty liver disease fibrosis score calculator.

Results: Two hundred and three non-alcoholic fatty liver disease patients (58.6% females), 54.78 (±12.27) years old were included in the study. Almost 65.5% of these patients have BMI >30 Kg/m2. It was found that, 62.25% of the 58 diabetic patients in this study had liver fibrosis score > 0.676 comparing to non-alcoholic fatty liver disease patients who are non-diabetic. There was a significant relationship between diabetes and fibrosis score, α=0.000. There was also a significant relationship between hyperlipidemia and fibrosis score of non-alcoholic fatty liver disease patients, α=0.023. We found a significant relationship between fibrosis score and hypertension, α=0.000. In the same context, there was a significant relationship between NAFLD patients who were on statin therapy and those who were not using statin therapy, α= 0.015. Metformin was not associated with significant relationship between users and non-users non-alcoholic fatty liver disease subjects.

Conclusion: Diabetes mellitus, hypertension, hyperlipidemia and statin use were associated with  NAFLD prognosis.

Open Access Original Research Article

Evaluation of the Binding Properties of a Polymer Obtained from Modification of Triticum aestivum Starch in Metronidazole Tablets Formulation

Nkemakolam Nwachukwu, Kenneth Chinedu Ugoeze, Azuka Ijoma Alumona

Asian Journal of Research in Medical and Pharmaceutical Sciences, Page 13-31
DOI: 10.9734/ajrimps/2021/v10i230159

Aim: The binding properties of a polymer obtained from modification of Triticum aestivum (TA) starch in metronidazole tablets formulation were evaluated.

Study Design: Experimental design.

Place and Duration of Study: Department of Pharmaceutics and Pharmaceutical Technology, University of Port Harcourt, Choba, Rivers State, Nigeria from January to July, 2018.

Methods: TA seeds were steeped for 72 h, wet milled and the native Triticum aestivum starch (NTS) extracted. NTS (1kg) was oxidized by slurring in 4 L of 3.50% w/v sodium hypochlorite, washed to neutral pH with 95% v/v ethanol (MTS). MTS was dried at 60°C for 3 h, milled and classified (250 μm). The starches were characterized using standard methods and applied as binders at 1, 2 and 3% w/w in formulating metronidazole tablets using wet granulation. Methylcellulose and gelatin at similar concentrations were used as standards.

Results: The granules and tablets were evaluated using standard methods. NTS and MTS had similar properties with starch. The modification improved the densities, hydration capacity and flow properties of MTS. The granules flowed and compressed well. The tablets had minimal weight variation, hardness (≥ 4 kgF), friability (<1%) and disintegration (<15 min). Metronidazole release (≥ 85%) within 60 min existed in all the batches except batches containing 1% methylcellulose and 3% gelatine.

Conclusion: The results met with United States Pharmacopoeia specifications for oral uncoated metronidazole tablets. MTS performed better than NTS and compared well with methylcellulose and gelatin as binder in metronidazole tablet formulation.

Open Access Original Research Article

Predictors of Severe Perineal Tear during Delivery in Yenagoa, Southern Nigeria

Ikobho Ebenezer Howells, Isaac Joel Abasi

Asian Journal of Research in Medical and Pharmaceutical Sciences, Page 42-51
DOI: 10.9734/ajrimps/2021/v10i230162

Background:Perineal tear is a very common complication of vaginal delivery, and it is often mild. However, when severe, it could result in torrential life threatening hemorrhage and anal sphincter injury, with fecal incontinence.

Objective: The objective of this study is to determine the predictors of severe perineal tear (3rd and 4th degree tear), using mild perineal tear (1st and 2nd degree) as control. It would also determine the rate of perineal tear, and the maternal and fetal demographic risk factor associated with it.

Materials and Methods: This was an analytic observational study of 186 women who had perineal tear during vaginal delivery. Out of these, 19 women had severe (3rd and 4th degree) perineal tear, also known as obstetrics anal sphincter injury (OASI). This was compared to 167 women who had mild perineal tear (1st and 2nd degree) during the study period.

Maternal demographic information retrieved was maternal age, parity, educational level, and occupation. Obstetrics factors were booking status, gestational age at delivery, mode of delivery, rank of the accoucheur (nurse or doctor), and degree of perineal tear. Fetal demographic data was birth weight and fetal sex.

Categorical variables were compared with odds ratio, difference in mean was compared with student’s t-test, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis. Confidence interval was set at 95%, and statistical significance was set at p value of < 0.05.

Results: The prevalence of OASI (3rd and 4th degree perineal tear) in Yenagoa was 1.1%. The significant risk factors were women of younger age, odds ratio = 1.04(0.37, 2.87) with p = 0.04, low parity, odds ratio = 0.20(0.07, 0.55) with p = 0.008, low educational background, odd ratio = 18.9(5.92, 60.81), and birth weight ≥ 4kg, odds ratio = 0.30[0.09, 1.06] with p = 0.04.

Using simple liner regression, the most significant predictors for severe perineal tear were mode delivery (r2 = 65.5%), and educational level (r2 = 30.0%). However, on stepwise multivariate analysis, these two factors accounted for 68.5%.

Conclusion: The rate of severe perineal tear is relatively low in Yenagoa, Nigeria, and comparable to what obtains in many countries. The most significant predictors were mode of delivery and educational level. Careful selection of the mode of delivery, especially instrumental vaginal deliveries, and women empowerment could minimize the rate in our environment.

Open Access Review Article

Orodispersible Films as a Solution to Drug Acceptability Issues: A Short Review

Mohamed Yafout, Hicham Elhorr, Amine Ousaid, Ibrahim Sbai El Otmani, Youssef Khayati

Asian Journal of Research in Medical and Pharmaceutical Sciences, Page 36-41
DOI: 10.9734/ajrimps/2021/v10i230161

Despite the fact that the tablets are the most widely used dosage form, they are not suitable for young children and patients with swallowing difficulties, especially the elderly. Orodispersible films (ODFs) dissolve rapidly in the mouth and deliver an accurate amount of the active ingredient, which makes them an easy-to-use dosage form that can improve drug acceptability and, therefore, treatment adherence. The findings of the 4 studies that we discussed in this review prove that ODFs have experimentally-proven good acceptability in all age groups and that they are clinically superior to tablets and syrups in terms of acceptability. Therefore, despite some limitations, ODFs are still an innovative and patient-centered dosage form that can contribute to improving drug acceptability and treatment adherence particularly in children and elderly patients. Pharmaceutical companies should focus on developing more ODF-based drugs and also other innovative dosage forms that can make the drug-taking experience even-easier.