Issues in pharmacy education.

The practice of pharmacy differs in different countries. Similarly pharmacy education differs in addressing the needs of the practice. In some countries there is a clear separation of dispensing and prescribing between pharmacists and the physician, in others this separation is not that clear cut. In certain countries pharmacists are not allowed at all to examine patients and this may even be an offence under the la

Ethical responses to modern clinical trials on human subjects: a comparative perspective

With the modern advances and technological breakthroughs in biomedicine, scientific experiments involving human subjects had increased. Since the American gynecologist Marion Sims (d.1883), who conducted a scientific research on some selected African women suffering from prolapsed uterus disease, or American physician Walter Reed’s (d.1902) team who gave germs of yellow fever to 22 human subjects to test if fever is transmitted by particularly mosquito species, as well as the Tuskegee Syphilis Study that was conducted from 1932 until 1972, or the scientific experiments conducted by Nazis of Germany on large numbers of prisoners, clinical trials on human subjects have become part of the scientific activities. These and many other scientific experiments conducted on human subjects had shown the extent of potential threats of unregulated scientific experiments on human life. Serious moral and legal concerns are then raised towards the morality of these activities. These concerns covered four major areas; safety, sanctity of the human body, consent and validity of experiment. This paper uses textual and analytical methods and aims to review Muslim jurists’ opinions on the permissibility of conducting clinical researches that uses human subjects. The opinions of the Muslim jurists are then compared to that of bioethical codes and declarations such as the Nuremberg Code, coined in (1947) and the Helsinki Declaration that was formulated by World Medical Organization in 1964. Fiqh and legal literature on this subject is exposed, and the moral contents of such writings are analyzed. The study is expected to come up with a comparative account of conventional and Islamic responses to modern clinical trials on human subjects

Angiotensin II receptor blocker valsartan enhances glucose-induced insulin secretion

A number of antihypertensive drugs are known to be diabetogenic. This may contribute to less than expected decrease in the incidence of coronary heart disease with reduction in blood pressure with treatment in hypertensive patients. This study was aimed to determine the effects of a member, Valsartan, of a new class of drugs, angiotensin II receptor blocker, on glucose induced insulin secretion. Male albino rat pancreases were used. The isolated ancreases were perfused with Kreb's solution containing bovine albumin (200 mg/dl) with low glucose (60 mg/dl) followed by high glucose (300 mg/dl) at a rate of 4 ml/min. The dose of Valsartan used was based on the peak plasma level achieved in human at standard single oral dose of 80 mg daily, which was 1.64 mg/L. Five treatment groups were used: Control group, Valsartan at 10%, Valsartan at 100% and Valsartan at 10 times of the 1.64 mg/L, and Diazoxide 10 μg/ml group. Insulin levels in the perfusate were measured by radioimmunoassay. Valsartan at all concentrations significantly increases glucose induced insulin secretion (p < 0.05). Valsartan at 10 %, Valsartan at 100% and Valsartan at 10 times of the 16.4 mg/L, increases glucose induced insulin secretion by 226.4 %, 161.7 % and 156.3 %, respectively. Diazoxide, significantly inhibits glucose induced insulin secretion (p < 0.05). Valsartan at all concentrations enhances glucose-induced insulin secretion in isolated rat pancreas technique

Blood pressure and 10-year cardiovascular risk profile of young hypertensives in Malaysia; a single centre study

: Introduction: Hypertension is being identified in younger population and the need for earlier diagnosis and intervention has resulted in the introduction of prehypertension in the classification of hypertension. Hypertension prevalence is at 33% and they contribute to a rising incidence of cardiovascular disease. The objective of the study is to assesses the 10-year cardiovascular risk profile of young hypertensieves from a single centre in Malaysia. Methodology: A total of 484 subjects were screened at a primary health care clinic in Kuantan, Malaysia. 57 subjected between the ages of 20 and 40 with systolic and diastolic blood pressure ranges of between 120-159 mmHg and 80-99 mmHg respectively were enrolled into a cross-sectional observational study. The cardiovascular risk-factor profile was assessed and the 10-year cardiovascular risk determined. Results: The mean age of the subjects were 32.74 ± 5.78 years. The mean systolic arterial pressures were 132.38 ± 10.34, 87.17 ± 7.55 and 102.06 ± 7.37 mmHg respectively. The mean fasting blood sugar 4.67 ± 0.75 mmol/L, total cholesterol 5.82 ± 0.96 mmol/L , low-density lipoprotein 3.73 ± 0.86 mmol/L, high-density lipoprotein 1.40 ± 0.37 mmol/L and body mass index 28.72 ± 5.24 kg/m2. The mean cardiovascular risk point was 4.07 ± 5.35 wherein 91.23% were in the low 10-year Coronary Artery Disease risk category ( Framingham CV Risk Score ) Conclusion: A great majority of young subjects within the prehypertension and stage 1 hypertension range had a low 10-year Coronary Artery Disease risk. They did however show higher than normal total cholesterol, low-density lipoprotein and body mass index levels

Prehypertensive state, mild hypertension, metabolic syndrome and cardiovascular risk factors among young adults in rural Malaysia

Introduction: Prehypertension precedes overt hypertension and has been acknowledged by many guidelines. Hypertension is an important risk factor for cardiovascular disease in Malaysia. Hypertension prevalence is at 42.6% and population-based control is poor at 26.8%. The objective of the study is to ascertain the cardiovascular risk profile of prehypertensive and mildly hypertensive young adults against age-matched controls in rural Malaysia. Methods: 484(four hundred and eighty four) subjects attending primary care clinic were screened. 91 (Ninety one) young adults with pre/mild hypertension and normotensive, age-matched controls were enrolled. The blood pressure and biochemical profiles for both groups were assessed and compared. Results: Fifty-four subjects and 37 controls were enrolled. Amongst subjects, 46.3% had prehypertension and 53.7% had mild hypertension. Mean values compared to age- matched controls for MAP were 102.68 ± 7.48 vs 83.25 ± 6.08 mmHg (p< 0.001), LDL 3.75 ± 0.95 vs 3.32 ± 0.93 mmol/L (p=0.03), FBG 4.65 ± 0.54 vs 4.33 ± 0.42 mmol/L (p=0.03), BMI 28.81 ± 5.16 vs 24.12 ± 4.91 (p< 0.001). The mean BP was significantly associated with BMI, FBG, triglycerides, HDL and the TC/HDL ratio. Conclusions: Greater BMI, FBG, HDL, triglyceride levels and TC/HDL ratio characterised the young adults with pre/mild hypertension. The data suggests that hypertension in young adults is secondary to metabolic syndrome

Analgesic synergism of gabapentin and carbamazepine in rat model of diabetic neuropathic pain

Purpose: To evaluate synergy in the analgesic effects of a combination therapy of carbamazepine (CBZ) and gabapentin (GBP) in diabetic neuropathic pain. Methods: Neuropathic pain was produced in rats by a single intraperitoneal injection of streptozotocin (STZ) at 60 mg/kg. CBZ, GBP, and their combination were orally administered at varying doses (GBP 30 - 180 mg/kg; CBZ 20 - 40 mg/kg) comparable to their therapeutic doses in humans. Nociceptive responses in the diabetic rats were assessed using hot plate test. Results: Hot plate latency significantly increased with oral administration of GBP at a dose of 180 mg/kg when compared with control group (p < 0.05), while at a dose of 90 mg/kg, the increase was not significant. Oral administration of CBZ at doses of 20 and 40 mg/kg did not produce any significant impact on hot plate latency. However, a combination of GBP at 90 mg/kg and CBZ at 20 mg/kg produced significant increase in latency, compared with control group and other groups (p < 0.05), except the group that received 180 mg/kg GBP. The combination of low dose GBP 30 mg/kg and carbamazepine 30 mg/kg had no significant effect on latency (p > 0.05). Conclusion: The results obtained in this study provide useful information on the combination therapy of GBP and CBZ, which may be applied in the treatment of pain in diabetic neuropathy

In-Utero effects of the crude ethanolic extract of the leaves of mitragyna speciosa on neural tube formation in rats

The developmental effects of in-utero administration of the crude ethanolic extract of the leaves of itragyna speciosa (MS) on neural tube in fetal rats were investigated. Pregnant Sprague-Dawley rats were dosed orally once daily by gavage, with graded (500, 1000 and 1500 mg/kg) doses of the extract between the 8th and 13th day prenatally. The control group received corn oil used as vehicle for the extract. On the 18th day of gestation, mothers were sacrificed and embryos removed and stained under established procedures. The embryos were then analyzed for the presence of neural tube defects (NTD) through measurements of the extent of vertebral arch closure and brain size. Results indicate that the medium (C) and high (D) (1000 & 1500mg/kg) doses but not the low (B) (500mg/kg) dose in comparison with control (A) group, significantly (p10.001) produced a widening of the vertebral arch in the thoracic, lumber and cervical regions of the spinal cord. The brain transverse diameter was also significantly (p10.05) increased by the high dose only. These effects were seen in the absence of any significant differences in litter size and other gross physical abnormalities. This study indicates that the crude extract of the leaves of MS is capable of selective neurotoxicity and producing spina bifida like NTD as characterized by altered brain size and neural tube formation, a finding that may have an important implication in the dependence liability associated with its use

A comprehensive study of chronic diabetes complications in streptozotocin-induced diabetic rat

Objective: The purpose of this study was to provide a reference of chronic diabetes complications by investigating the prolonged hyperglycemia effects on hematological, biochemical and histopathological changes (liver, kidney, spleen, cardiac muscle, adrenal gland, and endocrine pancreas) in diabetic rats induced by streptozotocin. Methods: Ten adult female Sprague-Dawley of uniform age were divided into two Groups. Group 1 was made diabetic by single intraperitoneal injection of streptozotocin (60 mg/kg/bw) whereas Group 2 served as control. After six months, the rats were anesthetized using pentobarbital. Cardiac puncture was performed to get 3 ml of the blood sample; following 12 hours of an overnight fast. Serum chemistry test and complete blood analysis for lipid profile and blood glucose test; liver and renal functions were performed. Tissue specimens of liver, kidney, spleen, cardiac muscle, adrenal gland, and endocrine pancreas were fixed in 10% formal saline and processed for histological study. Results: There were severe histopathological changes in the affected organs; and the presence of a significant abnormality of lipid profile, liver, and renal functions. Conclusions: The presence of histopathological changes with abnormal biochemical changes is related to the chronic absence of insulin production in the destroyed β –cells which reflect the diabetic complications in a human being

A cross-sectional study on the quality of life of patients with peripheral diabetic neuropathy pain in Hospital Tegku Ampaun Afzan, Kuantan, Malaysia

Purpose: To evaluate the quality of life of patients with peripheral diabetic neuropathy pain (PDNP) in Hospital Tegku Ampaun Afzan (HTAA), Kuantan, Malaysia.Methods: Ninety (90) participants were selected from the Medical Outpatient Department (MOPD) clinic of HTAA. The study adopted a cross-sectional design, and the self-administered Douleur Neuropathy 4 (DN4) and Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaires were used for data collection.Results: The negative impact of diabetes on QoL was clearly reflected in the fact that every domain had a negative mean value. Overall, 27.8 % of the participants reported that DM negatively affected their QoL and 37.8 % expressed the opinion that their QoL would have been higher if they were not diabetic. QoL correlated with marital status and age, with married participants and participants in the age range 50 - 59 years old showing QoL negatively affected (p &lt; 0.05) by DM with PDNP. Apart from diabetes type, all other characteristics significantly affected participants QoL as reflected by the various related domains (p &lt; 0.05).Conclusion: Based on the findings of this study, it seems that individuals with diabetes and PDNP have a low QoL, with regard to “freedom to eat”, “freedom to drink”, “physical health”, “family life”, and “living condition”.Keywords: Quality of life, Diabetes, Peripheral neuropathy pai

Periodic assessment of antenatal and post natal serum Endothelin-1 (ET-1) and Nitric Oxide (NO) levels in hypertensive disorders of pregnancy (HDP)

Hypertensive Disorders of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with endothelial dysfunction postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in HDP. Disturbances in nitric oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. The study aims to determine serial ET-1 and NO levels in patients with HDP and its role in persistent endothelial dysfunction. Materials and Methods: Thirty-six pregnant women from the following categories (i) normal pregnant women (Control) (ii) chronic hypertension during pregnancy (CH) and (iii) pregnancy induced hypertension (PIH) participated in this study. Blood pressure indices measurements and sample collection were done at antepartum (32 weeks) and postpartum (8 weeks and 12 weeks). ET-1 and serum NO were measured using the Human ET-1 (Endothelin-1) ELISA Kit and Nitric Oxide (total) detection kit respectively. Results: Serum ET-1 was significantly higher in patients with CH (55.3 pg/ml) and PIH (35.6 pg/ml) compared to Control (11.8 pg/ml) during antenatal until 3 months postpartum (CH 38.3 pg/ml, PIH 29.5 pg/ml, Control 1.9 pg/ml). This was accompanied by significantly lower levels of serum NO in HDP patients. Conclusion: Persistently higher than normal levels of ET-1 and lower than normal levels of NO up to 3 months postpartum in patients with history of HDP indicate presence of persistent endothelial dysfunction despite BP normalisation in PIH patients. Long term NO/ET-1 imbalance may account for the increased CVS disease risk