Open Access Original Research Article

In-vitro and In-vivo Relationship of Gabapentin from Floating and Immediate Release Tablets

E. E. Zien El-Deen, H. A. Yassin

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/jammr/2019/v30i630200

Gabapentin is effective against post-traumatic spinal injury-induced neuropathic pain. It requires high dosage and frequency in the management of neuropathic pain. The present research work was an attempt to formulate and evaluate gabapentin gastro-retentive tablets to prolong gastric residence and increase drug absorption and further increase bioavailability. The floating tablets of gabapentin were prepared in two doses (300 and 600 mg) by using two polymers (hydroxyl propyl methyl cellulose and hydroxyl propyl cellulose). Immediate release tablets of gabapentin containing the same doses were prepared and used as reference formulations. The physicochemical characteristics of the prepared tablets were determined (drug content, weight variation, friability, hardness, thickness and diameter).  Drug release from the prepared tablets was followed and found that by increasing drug concentration in the tablets release rate increases. Floating tablets showed prolonged drug release (over 96%) to more than 15 hrs. Immediate release tablets showed over 97% drug release within 48 min. In-vivo results showed that plasma exposure to gabapentin in animals receiving the drug does not dose proportional and therefore may not reach therapeutically useful levels. AUC0-24 and Cmax in case of 300 mg tablets are more than those in case of 600 mg tablets. The in-vivo release of gabapentin does not correlate with the in-vitro release of the drug.

Open Access Original Research Article

Comparison of Blood Pressure Measurement with Two Digital Sphygmomanometers

Yamile Ariadna Triunfo-Méndez, Nicolas Padilla-Raygoza, Vicente Beltrán-Campos, Cuauhtémoc Sandoval-Salazar, Verónica Benítez-Guerrero, Xiomara Arteaga-Herrera

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v30i630201

Aims: Identify the correlation between systolic and diastolic blood pressure measurement with digital arm and wrist baumanometers in young adults aged 18 to 40 at the Public University of Celaya, Guanajuato, Mexico.

Study Design: Observational, analytical, quantitative, correlational, diagnostics.

Place of Study: Public University of Celaya, Guanajuato, Mexico.

Methodology: We included 397 participants of an age range between 18 and 40 years; which 287 were women and 110 were men; with an average weight of 65.28 ± 15.08, and of stature 1.63 ± 0.09. Two types of digital, wrist and arm baumanometers were used to measure the systolic and diastolic blood pressure to observe the effectiveness of the values recorded during the measurement.

Results: The correlation between the 3 measurements of the systolic blood pressure was repeated in the first and third measurements (r = 0.46) and varied in the second (r = 0.39), in all three the value recorded by the highest arm baumanometer was found. In the 3 measurements of the diastolic blood pressure the correlation varied (r = 0.54, r = 0.50, r = 0.59); registering the highest value in the measurement with the arm baumanometer.

Conclusion: The correlation between the measurements with the baumanometers was not perfect, however it was good, it was considered that the measurement of blood pressure with the wrist baumanometer should be done with the wrist at the level of the heart; as well as movements of arm, hand or fingers will alter the result.

Open Access Original Research Article

Correlational Analysis of Interleukin 6, Adiponectin and Lipid Indices in Women with Uterine Fibroids

Isaac Oluwole Adediji, Ayodele Ademola Adelakun, John Osaigbovoh Imaralu, Emmanuel Olusegun Ileoma, Esther Ngozi Adejumo, Adeolu Sunday Oluremi, Muibat Adesola Adeniran, Chioma Diana Okam, Oluwadamilola Gbemisola Aweda

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2019/v30i630202

Background: Uterine fibroids are the most common benign, monoclonal tumours affecting women of reproductive age.

Aim: This study investigated the association between interleukin-6 (IL-6), adiponectin (ADP) and lipid indices in women with uterine fibroids.

Subjects and Methods: Sixty (60) participants were recruited for this study. They comprised thirty (30) subjects who had ultrasonographic evidence of uterine fibroids and thirty (30) subjects who had no ultrasonographic evidence of uterine fibroids. Subjects were recruited from the Gynaecology out-patient clinic of LAUTECH Teaching Hospital Ogbomoso, Nigeria. Anthropometric measurements were performed using standard method. About 5 mL of venous blood was collected from each study participant and was dispensed into a plain bottle. Serum was obtained after clotting and centrifugation and was aliquoted into a small vial which was stored at     -20°C until time of analysis. Interleukin-6 (IL-6), adiponectin (ADP), total cholesterol (TC), triglycerides (TG) and high density lipoprotein (HDL) were determined using enzyme linked immunosorbent assay (ELISA) and colorimetric method as appropriate. Low density lipoprotein (LDL) was estimated using Friedewald’s equation. Data analysis was done using Student’s t-test for comparison of variables and Pearson’s correlation was used to determine the relationship between variables. P–value less than 0.05 was considered significant.

Results: Women with uterine fibroids had significantly elevated body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) when compared with the controls (P<0.05). The mean values of TC, TG, LDL and IL-6 were significantly elevated in women with uterine fibroids when compared with the control subjects (P<0.05). Women with uterine fibroids had significantly reduced levels of ADP when compared with controls (P<0.05) and there was no significant difference in the levels of HDL when both case and control subjects were compared (P>0.05). Interleukin-6 had a significant positive correlation with BMI, WC, WHR, TC, TG and LDL. Interleukin-6 also had a significant negative correlation with HDL and ADP.

Conclusion: This study demonstrated a significant direct relationship between IL-6 and dyslipidemia in women with uterine fibroids. Also, we observed a noteworthy inverse relationship between IL-6 and adiponectin in women with uterine leiomyomas, thus emphasizing the low grade chronic inflammatory state, associated with uterine leiomyomas.

Open Access Original Research Article

Ultrasound Measurement of the Abdominal Aortic Diameter in a Normotensive and Hypertensive Adult Nigerian Population in Enugu

O. D. Agu, F. U. Uduma, N. R. Njeze, S. O. Mgbor, E. N. Obikili, K. C. Eze

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v30i630203

Background: Hypertension has direct effect on abdominal aortic diameter. Some of its manifestations are aortic aneurysm and dissection.

Aims: To compare the AAD among adult normotensive and hypertensive subjects as well as correlating with age, sex and blood pressure.

Materials and Methods: Participants will be randomly selected from hypertensives attending Cardiology Clinic, in University of Nigeria teaching hospital (UNTH) Enugu, Nigeria.  Controls will be apparently healthy normotensive volunteers. Participants’ demographics, weight, height and blood pressure will be documented. Ultrasound measurements of infrarenal AAD will be taken at 2 cm below the origin of the superior mesenteric artery.  Data will be statistically analyzed and a p-value of ≤ 0.05 will be considered significant.

Results:  300 participants: comprising of 150 normotensives and 150 hypertensives were studied. The mean values for AAD in normotensive males and females were 16.66 ± 2.04 mm and 15.36 ± 1.97 mm respectively. Whereas the values for hypertensives, changed to 18.89 ± 2.64 mm and 16.57 ± 2.54 mm respectively. The AAD showed a positive correlation with systolic blood pressure (r2 = 0.317, P ≤ 0.001) but not with diastolic blood pressure.

Conclusion: Abdominal aortic diameter was significantly larger among hypertensives than normotensives. The diameter increased with age in both normotensive and hypertensive subjects.

Open Access Original Research Article

Empirical Antibiotic Prescription Pattern among Patients in a Nigerian Tertiary Hospital, is There Evidence of Irrationality?

Onah Otor Paul, Ahmed Abdulmalik

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2019/v30i630204

Background: Resistance to antibiotics is spreading rapidly around the world with its associated morbidity and mortality. Infections are becoming increasingly difficult to treat resulting in increased cost of medical care. In low income countries with high infectious disease burden, antibiotic resistance is reported to be accelerated by irrational prescriptions in health facilities. In the absence of adequate resources, many clinicians engage in empirical antibiotic prescriptions some of which their appropriateness is questionable. There is need for laboratory evidence to justify empirical antibiotic use in the light of increasing resistance to commonly prescribed antibiotics.

Aims: This study aims to determine empirical antibiotic prescription pattern and to determine rationality using resistance profile of common bacterial isolates in hospitals.

Methods: Antibiotic prescriptions in the NHIS department and antibiogram records were obtained from pharmacy and laboratory records respectively. Analysis was carried out using descriptive statistics and comparison between antibiotics prescribed and their respective resistance pattern were compared to determine rationality.

Results and Discussion: The Penicillins and Quinolones were the most prescribed class of antibiotics and resistance range between 30 – 90% and 3 – 23% respectively. Resistance to other antibiotics was high thus making empirical prescriptions irrational in most of the cases. These findings have been consistently reported in several studies so widespread empirical antibiotic prescriptions are not in tandem with principles of rational drug use.

Conclusion: Antibiotic resistance is common among hospital isolates, so there is need to emphasize that prescriptions be based on laboratory evidence of microbial sensitivity.

Open Access Original Research Article

Socio Demographic Distribution of Ocular Axial Length in Port Harcourt, Nigeria

I. N. Aprioku, A. O. Adio, C. S. Ejimadu, B. Fiebai

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2019/v30i630205

Aim: To determine the socio demographic distribution of ocular axial length (AL) for use in estimating intraocular lens power, detect abnormal values and possibly associate them with pathological conditions.         

Methods: This is a community based descriptive study carried out in Port Harcourt City LGA, Nigeria of subjects 18 years of age or older and with Visual Acuity > 6/18. The major ethnic/linguistic groups in Rivers state are Ikwerre, Ogoni, Ekpeye Kalabari, Okrika, Ogba, Igbani, Obolo and Etche. Socio demographic data was obtained through a proforma. Ocular examinations done included visual acuity, applanation tonometry, and ophthalmoscopy. Axial length (AL) was measured using Amplitude (A) scan ultrasonography (SONOMED PACSCAN 300AP). Data analysis was by SPSS (Version 17), and p value was set at ≤ 0.05.

Results: Four hundred and sixty six (466) subjects participated in the study made up of two hundred and twelve (212) males (45.5%) and two hundred and fifty four (254) females (54.5%) with M: F ratio of 1:1.2. The age range was 18-92 years and mean age of the subjects studied 43.0±14.2 years. Findings revealed mean AL to be 23.2±1.0 mm which was greater in males than females. The longest mean AL in males was seen among age group 51 and 60 years and that for females was seen in age group 41 and 50 years after which in both gender there was noticed to be a decline in mean axial lengths. There was no statistically significant relationship between age and axial length. Axial length was found to be longer in subjects with higher level of education and this pattern was statistically significant.

Conclusion: AL was significantly longer in males and has a positive relationship with the level of education of the study population. The longest mean AL in males was seen among age group 51 and 60 years and that for females was seen in age group 41 and 50 years after which in both gender there was noticed to be a decline in mean axial lengths.

Open Access Original Research Article

Evaluation of Hilo® Versus Daflon® in Patients Suffering from Hemorrhoids: A Randomized, Controlled, Open-labelled, Multicentric Study

Bhupesh Dewan, Sarita Prabhu

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/jammr/2019/v30i630206

Aims: To evaluate and compare the efficacy of Hilo® and Daflon® 500 mg, in the treatment of hemorrhoids.

Study Design: It is a multicentric, randomized, comparative clinical trial conducted for the period of 15 days.

Place and Duration of Study: Janta Hospital and Maternity Centre, Varanasi; King George Memorial Hospital, Lucknow; Vijan Hospital and Research Centre, Nasik and Santosh Hospital, Bangalore between May 2018 and December 2019.

Methodology: 201 patients were screened and 200 patients with hemorrhoids (proctoscopy proven Grade I to III) were randomly assigned to receive either Hilo® capsules (n = 99) or Daflon® 500 mg tablets (n = 101). Assessment of hemorrhoidal symptoms was carried out in all patients on Day 7 and Day 15. Proctoscopic examination was carried out before the start of treatment i.e. on day 0 and at the end of treatment duration i.e. on day 15.

Results: The patients treated with Hilo® showed a statistically significant improvement in the clinical symptoms of bleeding, pain, itching, soiling, tenesmus, irritation after defecation and constipation on day 7 and day 15 as compared to baseline. The “mean total symptom score” reduced by 4.55 ± 2.07 vs 3.44 ± 2.00; P < .0001 on day 7 and 7.56 ± 2.40 vs 6.22 ± 2.55; P < .0001 on day 15 in the patients treated with Hilo® and Daflon® respectively. In Hilo® Group, 82.83% of patients assessed that the treatment with Hilo® made them ‘A lot better’ as compared to only 48.51% in Daflon® group. In the Hilo® group 20.2% of patients’ treatment outcome was assessed as ‘Excellent’ by the investigators as compared to only 0.99% of patients in Daflon® group. No major adverse events were reported in the study with the use of either product.

Conclusion: Hilo® is found to provide better reduction in clinical symptoms of patients suffering from hemorrhoids as compared to Daflon®.

Open Access Review Article

Heterotopic Ossification of the Elbow: A Literature Review

Sohail Qazi, John Reynolds, Hesham Abdelfattah, Joseph Thoder

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2019/v30i630207

Background: Aberrant ectopic bone formation of the elbow is a common clinical presentation after neurologic, burn, and traumatic injuries to the joint. This represents a significant source of patient burden, delayed recovery times and increased medical costs. Although there is an abundance of literature on heterotopic ossification (HO) of the hip, there is little literature on HO of the elbow in comparison.

Aims: This literature review seeks to summarize consensus regarding the appropriate system of classification, pathophysiology, clinical presentation, risk factors, and prophylactic treatment options associated with HO formation of the elbow. Clinicians may utilize this information to identify high risk patient populations for potential prophylactic therapy to prevent the occurrence/complications of HO at the elbow.

Methods: A PubMed literature review was conducted using combinations of the key words “heterotopic ossification,” “elbow,” and “fracture/dislocation.” All study types were considered and relevant articles were utilized for this review.

Results: Higher levels of injury, severe neurologic and burn injuries, delay to surgery, delay in fixation/stabilization of the elbow, multiple surgical treatments, and genetics were correlated with ectopic bone formation. Single dose pre/postoperative radiotherapy with 700cGy or preoperative NSAID regiments were found to be the main prophylactic treatments.

 Conclusion: Clinicians must consider the HO risk profile of their patients as well as the risk factors of treatment before deciding on prophylactic options. Surgical resection is reserved for the most severe cases.