INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES

507-510

Authors: Dr. Syed Fasih Ahmed Hashmi* 1 , Dr. Mashooq Ali Dasti1 , Dr. Zulfiqar Ali Qutrio Baloch2 and Dr. Hamid Nawaz Ali Memon

OBJECTIVE: To evaluate the cardiac manifestation in patients with hyperthyroidism. PATIENTS AND METHODS: This descriptive study was conducted from January 2015 to June 2015 on subjects with clinical manifestation of hyperthyroidism. The inclusion criteria of the study were patients, of ≥12 years of age, either gender with hyperthyroidism. The subjects were further evaluated for cardiac manifestations by advising Xray chest, ECG and echocardiography. The frequency / percentages (%) and means ±SD computed for study variables. RESULTS: Total fifty patients of hyperthyroidism were identified to have cardiac manifestations and were evaluated and enrolled in the study. The mean ±SD for whole population was 48.87±5.86 while the mean free T3, T4 and TSH was 720.87±10.96 pg/d, 4.98±1.84 ng/dl and 0.23±1.20. The male population was predominant (60%) while the common symptoms observed were palpitation, dyspnoea, chest pain and tachycardia. The ECG, echocardiograph and chest X-ray was abnormal in 41(82%), 23(46%) and 18(36%). The ECG findings were sinus tachycardia, LVH and atrial fibrillation while the echocardiographic findings were chamber enlargement, MR and AR where as X-ray shown cardiomegaly. CONCLUSION: The patients of hyperthyroidisms should be carefully evaluated as early detection and appropriate treatment is a best strategy to reduce cardiovascular complications associated with hyperthyroidism Keywords: Hyperthyroidism, Thyrotoxicosis and Cardiac complications.

516-519

Authors: Dr. Zubair Ahmed Yousfani* 1 , Dr. Jabeen Atta2 , Dr. Imran Karim3 , Dr. Hamid Nawaz Ali Memon4 , Dr. Samar Raza3 and Dr. Zulfiqar Ali Qutrio Baloch

OBJECTIVE: To evaluate the anatomical and histopathological pattern of large intestinal tumors PATIENTS AND METHODS: This descriptive case series study of two years was conducted at Liaquat University Hospital Hyderabad. The inclusion criteria of the study were patients ≥12 years of age, either gender, diagnosed as large intestine malignancy were recruited and enrolled in the study. All surgically resected intestinal specimens were grossly observed and after kept in 10% formalin sent to laboratory for histopathological examination. The data was recorded on pre-designed proforma and analyzed in SPSS 16. The frequency, percentages and mean ±SD was computed for study variables. RESULTS: During two year study period, total 30 patients diagnosed as intestinal malignancy. The mean age ± SD for whole population was 58.75±6.51 with female gender predominance. The rectal malignancy was commonly observed 15 (40%) followed by transverse colon 3(10%). The adenocarcinoma was predominant 22 (73.3%) well differentiates 24 (80%) and ulcero-infiltrative 12 (40%) pattern. CONCLUSION: Tumors of the digestive tract show a wide variation in the anatomical and histological type, thus early evaluation is beneficial for appropriate management. Keywords: Intestinal tumors, Rectum carcinoma and Histopathology.

524-527

Authors: Dr. Jabeen Atta* 1 , Dr. Zubair Ahmed Yousfani 2 , Dr. Syed Zulfiquar Ali Shah3 , Dr. Hamid Nawaz Ali Memon4 and Dr. Zulfiqar Ali Qutrio Baloch5

OBJECTIVE: To determine the frequency and pattern of choriocarcinoma at tertiary care and private hospital. PATIENTS AND METHODS: This descriptive case series study of six years was conducted at Liaquat University Hospital Hyderabad and simultaneously at private hospital as well. The pregnant ladies (19-40) years of age had non-specific symptoms as vagina bleed and abdominal pain were enrolled and evaluated for choriocarcinoma. The material consisted of hysterectomy specimen and the expelled products from the uterus, uterine curetting; suction evacuation. The specimens detail was obtained from the histopathology reports while the data was saved on pre-designed proforma and analyzed in SPSS 16. The frequency and percentages and mean ± SD was calculated. RESULTS: During six years study period, the histopathological biopsies and hysterectomy specimens revealed 16 patients with choriocarcinoma. Among sixteen cases of choriocarcinoma 12 cases (75%) had past history of hydatidiform mole and four patients (25%) had spontaneous abortion. The hysterectomy specimens in all cases consists of uterus cervix with adnexa measuring from 7 x 4 x 4 to 10 x 6 x 5.3 cms. Among these eight cases shown diffuse grayish black mass with surrounding margins of hemorrhage while the other eight cases had huge hemorrhagic areas with endometrial cavity necrosis. Microscopically the neoplasm shown abnormal proliferation of cyto and syncytiotrophoblast without formation of any villi. CONCLUSION: The incidence of choriocarcinoma is a major health trouble, thus the proper evaluation, diagnosis and followup of these patients is necessary for the early management. Keywords: Gestational trophoblastic disorders, choriocarcinoma and Hydatidiform mole.

533-537

Authors: Dr. Aqeel Ahmed Channa1 , Dr. Madiha Shah2 , Dr. Nisar Ahmed Shah2 *, Dr. Hamid Nawaz Ali Memon3 , Dr Imran Karim2 and Dr. Zulfiqar Ali Qutrio Baloch

OBJECTIVE: To determine the frequency of vitamin B12 deficiency in patients with type 2 diabetes mellitus on metformin therapy. PATIENTS AND METHODS: This cross sectional descriptive study of six was conducted at Liaquat university hospital Hyderabad & Govt. Lyari general hospital Karachi. The inclusion criteria of the study were diagnosed type 2 diabetic patients of ≥01 year duration, already on metformin therapy, of 35-60 years of age, both gender regardless on treatment and their glycemic status. All the diabetic individuals were further evaluated for vitamin B12 deficiency. The data of all patients was analyzed in SPSS version 16.00. The frequency and percentage (%) will be calculated for vitamin B12 deficiency in type 2 diabetes mellitus on metform therapy. The mean and standard deviation (SD) will be calculated for age, duration of diabetes mellitus and vitamin B12 level. RESULTS: During six months study period total one hundred diabetic patients on metformin therapy were evaluated for vitaminB12 deficiency. The mean ± SD for age, fasting and random blood glucose, hemoglobin A1C and vitamin B12 level for overall population was 52.87±6.87, 159.74±6.96 and 266.32±8.92, 9.08±2.74 and 85.23±72.54 respectively. The vitamin B12 deficiency was observed in 61% with male gender predominance (63%). The hemoglobin A1c was raised in 47 (68.1%) vitamin B12 deficient individuals. CONCLUSION: Type 2 diabetics on metformin therapy were observed to have low vitamin B12 level Keywords: Diabetes mellitus, Vitamin B12, and Metformin

550-557

Authors: Ananda Kumar. Chettupalli*, Vivek Kunduru, Narender Boggula, Vasudha Bakshi

A new precise accurate and reliable validated method for the determination of Capecitabine was developed by using reverse phase high performance liquid chromatography in pharmaceutical dosage forms. Spectrophotometer determination was carried out at an absorption maximum of 240nm by using methanol. The linearity was over the concentration range of 20-120 µg/ml with correlation coefficient 0.999. Chromatographic separation was carried out by using a mobile phase of methanol: Acetonitrile: water (80:20:80 V/V) on Waters 2487 dual absorbance column in an isocratic mode at a flow rate of 1.1 ml/min with UV detection at 240 nm. The developed methods were found to be precise and accurate for the estimation of Capecitabine in pharmaceutical dosage forms and could be used for routine analysis. Keywords: Capecitabine, RP-HPLC, Spectrophotometry, Waters 2487 dual absorbance detector, Nova pack 300 × 3.9mm 5μ as column, 240nm

562-574

Authors: Revathy Ravichandran, Radha Prabhu* and Prabhu Muthaiyan

The human immunodeficiency virus (HIV) infects the immune system that leads to immune deficiency. Acquired immunodeficiency syndrome (AIDS) is defined as the most advanced stages of HIV infection. It is defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers. According WHO and UNAIDS estimation, 36.7 million people were living with HIV globally by the end of 2015. 2.1 million People became newly infected, and 1.1 million died of HIV-related causes at the same year. HIV-1 protease plays a vital role in the maturation of virus in order to produce the infectious viral particles. In this study, molecular docking was performed on various imidazole derivatives by Autodock 4.2 into active sites of HIV-1 protease (PDB ID: 4RVI). Key Words: Human immunodeficiency virus, HIV-1 Protease, 4RVI, Molecular Docking, Imidazole derivatives

578-586

Authors: Swathi G *1 , K. P. R. Chowdary2 and A.Muralidhar Rao.3

The objective of the present study is optimization of valsartan floating tablet formulation by 23 factorial design and to evaluate the optimized valsartan floating tablets for in vitro drug release, preclinical pharmacokinetics and also for in vitro – in vivo correlation (IVIVC). Valsartan is an orally active anti-hypertensive drug, majorly absorbed from stomach and upper small intestine. Formulation of sustained release floating tablets of valsartan is needed because of its poor oral bioavailability and short biological half-life. Valsartan floating tablets were formulated as per 23 factorial design and were evaluated. Valsartan floating tablets prepared as per 23 factorial design were non-disintegrating in water and aqueous acidic (pH 1.2) and alkaline (pH 7.4) fluids and were of good quality with regard to drug content, hardness, friability and suitable for controlled release. Formulations Fa, Fab, Fac and Fabc exhibited excellent floating over >12 h with a floating lag time in the range 12-40 seconds. Higher levels (20 %) of sodium bicarbonate gave shorter floating lag time. Valsartan release from the floating tablets prepared except formulation Fa was slow and spread over 12 h and dependent on the composition of the tablets. Drug release from formulation Fa was very rapid. Valsartan release from the floating tablets was by non-fickian diffusion mechanism in all the cases except Fa. In the case of formulation Fa that gave rapid release of drug fickian diffusion was the drug release mechanism. Optimization of valsartan floating tablet formulation was done taking floating lag time as the parameter for optimization. For optimization, floating lag time was taken as response (Y) and level of sodium bicarbonate as (X1), level of bees wax as (X2) and level of starch acetate as (X3). The polynomial equation describing the relationship between the response, Y and the variables, X1 , X 2 and X3 based on the observed data was found to be Y = 8.996 - 8.596 (X1) + 2.396 (X2) – 2.431 (X1 X2) + 0.561 (X3) - 0.521 (X1 X3) + 0.396 (X2 X3) - 0.271 (X1 X2 X3). Based on the polynomial equation developed, the optimized valsartan floating tablet formulation with a floating lag time of 20 seconds could be formulated employing sodium bicarbonate (160mg/tablet), beeswax (28mg/tablet) and starch acetate (10mg/tablet). The optimized formulation (Fopt) exhibited a floating time of 12-14 h with a lag time of 21 seconds fulfilling the target floating lag time set indicating validity of the optimization technique employed. Formulations Fopt and Fab prepared exhibited excellent floating characteristics (floating over 12 h with a lag time of 21 and 12seconds respectively) and good sustained release of valsartan over 12– 14h. The optimized valsartan tablets formulated at two strengths 80 mg/tablet and 40 mg/tablet gave slow, gradual and complete release of valsartan in 12h. Valsartan was absorbed rapidly from IR tablets and slowly over longer period of time from floating tablets. Based on (AUC)o α , the relative bioavailability ( BA) of Valsartan from FTs was 166.0 % when compared to Valsartan IR tablets (100%). A good level A correlation (r = 0.961) was observed between percent drug released (in vitro) and (AUC)o α (in vivo) Key words: Cross Linked starch Urea, Floating tablets, Valsartan, Optimization, Preclinical, Pharmacokinetics.

593-598

Authors: Dr. Rasool Bux Behan* 1 , Dr. Adnan Ahmed2 , Dr. Mushtaque Ali memom3

Objective: Determine the clinical presentation and diagnosis of the cervical lymphadenitis at tertiary care Hospital. Material and methods: This was a descriptive and case series study and was carried out at general surgery department of LUMHS Hyderabad/Jamshoro. Study was conducted with duration of on years from 2015 to July 2016. Both genders were selected. Complete relevant laboratory investigations were carried out. All patients were underwent FNAC, and also incisional biopsies were carried out under the local anesthesia in some cases where it was needed for proper diagnosis. I cases having abscess, the biopsies were done from walls of lymph nodes and puss was drained. All the specimens were sent to diagnostic laboratory for histopathological diagnosis. All the data was entered in the predestined proforma. RESULTS: Total 46 cases were selected in this series with presentation of cervical lymphadenitis, patient’s mean age was found 34.21+5.12 years. Female gender was found in the majority 28(40.87%). Fever was commonest clinical feature in 76% cases. Following by swelling, abscess, solid nodes, weight loss, loss of appetite and others were noted with percentage of 55.69%, 39.13%, 45.65%, 58.69% and 21.73% respectively. Tuberculosis was found commonest diagnosis in 57.14% cases, reactive hyperplasia in the 02(04.34%), Metastasis in 1 case, Lymphoma in 10.86% cases, Kikuchi in 1 case, non-specific was found in 10.86% cases while SCC was noted only in 1 case. CONCLUSION: Cervical lymphadenitis was most frequent in females. Commonest clinical features were Fever, swelling, weight loss, loss of appetite and abscess. Most common histopathological diagnosis was tuberculosis and lymphoma, while malignancy was only in one case. Key words: Cervical lymphadenitis, clinical pattern, diagnosis

604-613

Authors: Fazal ur Rehman Khilji1 , Marvi Baloch1 , Qaiser Iqbal1 , Fahad Saleem* 1 , Nisar A. Shahwani1 , Shehla Iftikhar

Objective The current research was conducted to evaluate episodes of Congestive Heart Failure (CHF) among dialysis patients; it`s frequency and prognosis in patients attending public healthcare institutes of Quetta city, Pakistan. Methods This is a multicenter cohort study conducted at two public healthcare institutes of Quetta city, Pakistan. Data of 117 patients for one year was screened from the official records and evaluated retrospectively to identify variables of interest. Data was collected through a validated information sheet. SPSS v.20 was used for data analysis and data was described descriptively. Results All patients had End-Stage Renal Disease (ESRD) and were on regular maintenance hemodialysis therapy. Out of all selected patients, 7.7 % patients had Non-Insulin Dependent Diabetes Mellitus, 4.3% patients had Ischemic Heart Disease, 78.6% had Left Ventricular Hypertrophy and 80.34% had Cardiomyopathy. Forty five patients (38.46%) were confirmed with CHF. Thirty seven (31.6%) of those had systolic dysfunction, 8 (6.8%) had diastolic dysfunction and 4 (3.4%) had both systolic and diastolic dysfunction. Additionally, 13 (28.9%) patients developed de novo CHF. Recurrence of CHF was observed in 26 patients (57.7%) whereas among the CHF group, eleven patients died during the study period presenting a mortality rate of 24% in CHF group (Table 5). Conclusion The incidence of CHF was relatively high in our study population of ESRD. Frequent recurrence of the disease, rehospitalization and enhanced mortality in our study population is evident of adverse prognosis of CHF in ESRD population.

619-625

Authors: Lakshmanarao.P 1 , Chowdary K.P.R2 and Prasad S.V.U.M

The objective of the present study is optimization of telmisartan tablet formulation employing HPβCD, Primojel, and Tween 80 by 23 factorial design to achieve NLT 85% dissolution in 10 min. Eight telmisartan tablet formulations were prepared using selected combinations of the three factors as per 23 factorial design. Telmisartan tablets were prepared by direct compression method and were evaluated. ANOVA of K1 values indicated that the individual and combined effects of HPβCD (Factor A) and Primojel (Factor B) in influencing the dissolution rate of telmisartan tablets are highly significant (P < 0.01). The effect of Tween 80 (Factor C) and the combined effects of AC, BC and ABC are not significant (P˃0.05).Telmisartan tablet formulations Fb, Fbc and Fabc disintegrated rapidly within 1 min and gave very rapid dissolution of telmisartan more than 90% in 10 min . The increasing order of dissolution rate (K1) observed with various formulations was Fc< F1< Fac< Fa< Fabc< Fab< Fb< Fbc. The polynomial equation describing the relationship between the response, percent drug dissolved in 10min (Y) and the levels of HPβCD (X1) , Primojel (X2) and Tween 80 (X3) based on the observed results was found to be Y = 56.097 + 3.663(X1) + 38.036(X2) – 9.146(X1X2) – 3.77(X3) – 3.38(X1X3) + 2.073(X2X3) + 1.767(X1X2X3).Based on the above equation, the formulation of optimized telmisartan tablets with NLT 85% dissolution in 10 min require HPβCD at 1:3.5 ratio of drug: HPβCD, Primojel at 26.626% of drug and HPβCD content , and Tween 80 at 1% of drug and HPβCD content. The optimized telmisartan tablet formulation gave 85.55% dissolution in 10 min fulfilling the target dissolution requirement. Formulation of telmisartan tablets with NLT 85% dissolution in 10 min could be optimized by 23 factorial design. Key words: Telmisartan tablets, Optimization, Hydroxy propyl β-cyclodextrin, Primojel, Tween 80, Factorial Design

636-644

Authors: Sajid Nabi1 , Kaleemullah* 1 , Yasser M.S.A. Al-Kahraman2 , Bibi Tahira1 , Bibi Hajira1 , Amir Rasool3 , Amir Muhammad1

Medicinal plants believed to have some medicinal properties and are extensively being used in herbalism. In tribal and rural areas for healthcare purposes they are the easily available source. A distinct branch of natural science which deals with numerous aspects such as archaeology, medicine and economics, cultural, religious, ecology, anthropology, botany and a number of other disciplines is called Ethnobotany. Worldwide greater importance in the above given studies of traditional remedies and herbal drugs is indicated and increase in the scientific investigation has been seen in this area. About 80% of world’s population rely upon these medicinal plants products, because they are thought to be as economical, effective and safe. Herbal plant Juniperus excelsa is extensively used as condiments, spice, herb and also use for the treatment of variety of diseases in traditional system. To review the ethnobotanical properties of Juniperus excelsa plant the present study was aimed. Different tribal communities widely uses various parts of this plant. The leaves of plant are used to lowering blood pressure, wound healing, intestinal worms, liver disease, bronchitis, treatment of hyperglycemia, ulcers, pneumonia and tuberculosis in traditional medicine. Researchers made numerous efforts through scientific biological screening to verify the efficacy of the plant. Some important pharmacological activities of the plant revealed after scrutiny of literature such as cytotoxic activity, antioxidant property, antifungal, antibacterial, anticholinesterase, antitumor, antileishmanial and antifouling potential and many more medicinal values.

651-669

Authors: Febi S Kuruvila1* , Flowerlet Mathew 2 ,S Kuppuswamy3

Developments in recent drug discovery programs, yields a large proportion of novel pharmacologically active molecules that are lipophilic and poorly soluble ,which is a major challenge for pharmaceutical researchers to enhance the oral bioavailability of such drug molecules. Compared to conventional oral dosage forms, Self nanoemulsifying drug delivery systems (SNEDDS) possesses potential advantages like ease of manufacture and scale up, quick onset of action, reduction in drug dose, reduction in inter and intra subject variability and food effects and minimize problems associated with filling of liquid SNEDDS in capsules. Several recent works on Self nanoemulsifying drug delivery systems suggests the commercial suitability of the system in improving the solubility and bioavailability of such drugs. The physicochemical properties, drug solubilization capacity and physiological fate considerably helps in the selection of the SNEDD components. The composition of the SNEDDS can be optimized mainly with the help of phase diagrams, whereas statistical experimental design can be used for further optimization. The transition of liquid SNEDDS to solid SNEDDS has also been accomplished by researchers. Solidself nanoemulsifying drug delivery system focus on the incorporation of liquid/semisolid self nano emulsifying ingredient into solids by different solidification techniques like adsorption to solid carrier, spray drying, melt extrusion, nanoparticle technology and melt granulation. The present article gives more specification on spontaneous/rapid forming nanoemulsions or self nanoemulsifying systems for oral drug delivery by adsorption technique and gives complete information about formulation, method of preparation, characterization and application in solid dosage form of self nanoemulsifying drug delivery system. Keywords:Solid-self nanoemulsifying drug delivery system , Pseudo ternary phase diagram, Bioavailabilit,solubility,permeability.

688-697

Authors: Iroha I. R1 , Ariom T. O1 , Moses I. B * 1 , Ejikeugwu P. C 1 , Nwuzo A. C 1 , Afiukwa F. N 1 , Nwakaeze E. A 1 , Iroha C. S

This study was aimed at isolating and characterizing vancomycin-resistant Staphylococcus aureus from clinical and community samples in Abakaliki, Ebonyi State, Nigeria. Seven hundred and nine (709) clinical and community samples were obtained for this study. Antibiotic susceptibility test was done using Kirby Bauer disc diffusion method. Vancomycin resistant Staphylococcus aureus (VRSA) isolates were detected using Kirby-Bauer disc diffusion method with vancomycin antibiotic disc (30 μg). Isolates were also screened for β-lactamase enzyme production. A total of 84 (27.7 %) and 120 (29.5 %) Staphylococcus aureus isolates were obtained from the clinical and community samples respectively using standard microbiological techniques. Results showed that 55 VRSA isolates were obtained from the samples with prevalence frequency of 36.9 % and 20 % for clinical and community isolates respectively. The clinical isolates were completely resistant (100 %) to nitrofurantoin, clindamycin, ceftazidime, tetracycline and penicillin. Gentamicin was the most effective antibiotic against the S. aureus isolates obtained from clinical samples as all the isolates were completely susceptible (100 %). Ciprofloxacin was the most effective antibiotic against the S. aureus isolates obtained from community samples with a susceptibility frequency of 100 %. This was closely followed by gentamicin (75 %) and erythromycin. Exactly 38.1 % and 24.2 % of the clinical and community S. aureus isolates were positive for beta-lactamase production respectively. The HA-VRSA and CA-VRSA isolates had MARI values within the range of 0.5 to 1.0. This present discovery of multi-drug resistant VRSA with high multiple antibiotic resistance indices is in Abakaliki is a serious public health issue. Therefore, there is an urgent need to keep a strict watch on VRSA emerging from Abakaliki. Keywords: CA-VRSA, HA-VRSA, MARI, beta-lactamase, antibiotics

706-712

Authors: S.Lakshmi Sravani*, V. Saikishore1 , M.V.Saikrishna2

In the present study, an effort was made to develop the pulsatile drug delivery of Losartan potassium to the colon. A time delayed capsule was prepared by sealing the microspheres inside the insoluble hard gelatin capsule body with erodible hydrogel plug. The microspheres were prepared by emulsion solvent evaporation technique.. Optimized microsphere formulations were selected based on dissolution studies. The entire device was enteric coated, so that the variability in gastric emptying time can be overcome and a colon-specific release can be achieved. Hydrogel plug (HPMCK100 and lactose in 1:1 ratio) having 4.5kg/cm2 hardness and 100 mg weight was placed in the capsule opening and found that it was satisfactory to retard the drug release in small intestinal fluid and to eject out the plug in colonic fluid and releasing the microspheres into colonic fluid after a lag time criterion of 5 hours. In order to simulate the pH changes along the GI tract, three dissolution media with pH 1.2, 7.4 and 6.8 were sequentially used. FTIR study confirmed that there was no interaction between drug and polymer. Among all the formulations Losartan potassium micropheres prepared with cellulose acetate in 1:2 ratio shown prolonged release for a period of 12 hours. The obtained results revealed the capability of the system in delaying drug release for a programmable period of time and can prevent a sharp increase in the blood pressure during the early morning hours, a time when the risk of hypertension is the greatest. Keywords: Losartan potassium; Hypertension; Pulsatile;Microspheres; Hydrogel Plug; Solvent evaporation

720-725

Authors: Faezeh Sahbaei

Background and Purpose: Coronary artery bypass grafting [CABG] is currently performed to relieve coronary artery disease. This study evaluates the effects of two self-care approaches of hospital routine technique and social networks on the quality of life of patients undergoing CABG. Methods: One hundred candidates of CABG were enrolled in this study who then completed the questionnaires of demographic characteristics and MacNew heart disease health-related quality of life. Before hospital discharge, patients attended a 20-30 min self-care education session, held by the researcher and received a selfcare booklet after CABG. Afterwards, participants were randomly divided into two groups of intervention and control. The intervention group received self-care education for four weeks after the surgery through a “Telegram Group”. Subjects of both study groups filled the questionnaires again after six weeks. Data analysis was performed with SPSS version 21 using descriptive and inferential statistics. Results: Both study groups were homogenous regarding demographic characteristics. According to the results of paired t-test, quality of life and its dimensions increased in both intervention and control groups after the intervention. On the other hand, results of independent t-test, used to compare the study groups, revealed lower quality of life in the intervention group before the test and no statistically significant difference between the groups after the test. Conclusion: Although the quality of life was at a lower level in the intervention group before the tests, the post intervention quality of life increased in this study group so that reached the mean quality of life of the control group. It seems that education in any form could improve the quality of life. Keywords: self-care education, approach, hospital routine, social networks, quality of life, coronary artery bypass graft.

730-733

Authors: *Farhana Iftikhar , Ayesha Sheikh and Dr. Saleha Sadeeqa

The objective of the study was to develop a relationship between nonsteroidal anti-inflammatory drugs and enlarged prostate. This report emphasizes the use of nonsteroidal anti-inflammatory drugs in benign prostatic hyperplasia both clinically and by changing the lifestyle. A questionnaire based study was carried on 50 benign prostatic hyperplasic patients from July to September 2016. The study was done at Mayo hospital and Services hospital, Lahore. The patients aged between 40-80 years were selected randomly and interviewed face to face. BPH is characterized by inflammation. So, anti-inflammatory drugs NSAIDs have beneficial effect in prostatic diseases such as prostatic hyperplasia. These medications were observed to lessen the symptoms and prevalence of BPH. The relation of NSAIDs and BPH is still controversial. These drugs are used to treat BPH but their prolonged use exerts some unwanted effects. Patients were advised some life style changes to minimize the risk. Keywords: Benign prostatic hyperplasia, NSAIDs, Nocturia, Inflammation.

740-746

Authors: Uzma Bashir, Marvi Baloch, Javeid Iqbal, Sajjad Haider, Fahad Saleem*

Objective: Pakistan is ranked 5th in the world in terms of having immense Tuberculosis (TB) burden. During the course of TB treatment, adverse drug reactions (ADRs) due to anti-TB drugs are a killer problem. Therefore, the present study was conducted on 200 TB patients to explore the incidence of ADRs due to anti-TB drugs. Methods: This is a multicenter study conducted at two public healthcare institutes of Quetta city, Pakistan. Data of 200 patients was screened from the official records and evaluated to identify variables of interest. All necessary diagnostic tests were performed before starting the therapy and after every 2 months during the study. Data was collected through a validated information sheet. Descriptive SPSS v.20 was used for data analysis. Results: A total of 200 patients were enrolled in the study. In this study, most frequently reported ADR was fever (163, 84.5%) followed by nausea (152, 76%) and epigastric pain (117, 58.5%). Interestingly, the most commonly reported ADR in literature (constipation and weight gain) were least reported in the current study. Thirty nine (19.5%) patients were admitted to hospital during the study because of the observed ADRs. During the study, 46 (23%) patients were given re-challenge to ADRs and were managed by giving additional medicines with TB drug treatment regimen. One hundred and eighty three I(91.5%) patients from both hospitals were given a complete 6 months therapy. However, 5 (2.5%) patients died during the therapy and 12 (6%) patients underwent therapy discontinuation because of unidentified reasons. Conclusion: Majority of the patients experienced ADRs and the management of most ARDs was done by therapy modifications. It was also observed during the study that some patients did not report common and clinically mild ADRs, so it is the duty of health practitioners to interrogate and investigate the patients keenly. Health practitioner should also take immediate actions to combat the ADRs and improve the patient’s quality of life. Keywords: Pulmonary tuberculosis, anti-tuberculosis, adverse drug reactions, Baluchistan, Pakistan

754-759

Authors: Dr. Muhammed Khalid Shaikh1 , Dr. Akber Yousfani1*, Dr. Hamid Nawaz Ali Memon2 , Dr. Imran Karim1 , Dr. Zulfiqar Ali Qutrio Baloch 3 and Dr. Sumera Bukhari4

OBJECTIVE: To determine the demographical, etiological and clinical profile of patient with community acquired pneumonia in elderly population. PATIENTS AND METHODS: This cross sectional study of six months was conducted at tertiary care hospital Hyderabad. The inclusion criteria of the study was patients ≥ 60 years of age, either gender presented with clinical symptoms of fever, chest pain, cough with or without expectoration, shortness of breath and sensorium alteration were recruited in the study. The routine investigations along with radiological evaluation and sputum studies were the major tools to detect the pneumonia. The patients were management accordingly and observe the outcome as well while the data was collected on pre-designed proforma and analyzed in SPSS 16. The frequency and percentages was calculated while the numerical statistics were used to compute mean ±SD. RESULTS: During six months study period total fifty patients with community acquired pneumonia was detected and studied demographically, etiologically and clinically. The mean ±SD for whole study population was 72.97±7.85. The male population was predominant 74%; the common co-morbidities observed were COPD (38%), diabetes mellitus (44%), hypertension (24%) and congestive cardiac failure (20%) while the smoking and alcoholism was detected in 44% and 22% population. The sputum Gram positive cocci and mixed pattern was identified in 40% and 44% while Streptococcus pneumonia, Klebsiella pneumonia and Pseudomonas aeruginosa was observed in 64%, 8% and 8% elderly population. On radiology, the lobar and bronchopneumonia was detected in 64% and 20% patients while the common complications identified were septic shock (37.5%), pleural effusion (25%) and acute respiratory distress syndrome (12.5%) whereas the mortality was observed in 12% elderly pneumonic patients. CONCLUSION: Community acquired pneumonia in elderly population is a major health issue has varying clinical presentation and higher mortality rate Keywords: Pneumonia, Community acquired pneumonia, Consolidation