Open Access Original Research Article

Do Iron Chelators Affect Fertility in Thalassemic Men?

Shahla Ansari, Azadeh Kiumarsi, Azita Azarkeivan, Mohammad Mahdi Allameh, Maryam Razzaghy-Azar, Davoud Amirkashani

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-7
DOI: 10.9734/JAMPS/2017/33728

Background: Iron overload is a major complication in patients with thalassemia, however, development of iron-chelating therapy has partly overcome this problem.

Objectives: The aim of this study was to evaluate the effect of iron chelator drugs on testicular volume, semen parameters and serum FSH, LH, and Testosterone concentrations in 62 young male patients with major and intermedia thalassemia.

Materials and Methods: Sixty two young male patients with major and intermedia thalassemia, aged 18–41 years who had different iron chelator drug using status were evaluated.

Results: At the time of the study their serum ferritin levels ranged from 182 to 11053 ng/mL (mean 2067 ng/mL). The mean volume of patients’ ejaculate was 2.3 cc. The mean concentration of sperm was 61.04 million per milliliter. The mean size of right testis was 11.4 cc and the mean size of left testis was 11.7 cc. Hypogonadism and hypothyroidism were seen in 22.6% and 17.7% of patients, respectively. The mean level of FSH was 3.7 mIU/ml, LH was 4.6 mIU/ml, and Testosterone was 4.8 ng/dl. The mean level of serum ferritin was 2067 ng/dl.

Conclusion: This study suggests that in thalassemic men, concentrations of serum Testosterone, LH, FSH has significant correlation with sperm parameters and testicular volume but iron chelators mostly do not impact the elements of fertility in these patients.

Open Access Original Research Article

Pattern of Adverse Drug Reaction to Antiepileptic Drugs at a Tertiary Hospital in North-Central Nigeria: A Prospective Observational Study

Emeka U. Ejeliogu, Aderonke Uhunmwangho-Courage

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-9
DOI: 10.9734/JAMPS/2017/35337

Background: Epilepsy is a common neurologic condition affecting 0.5-1% of the popula­tion. Adverse drug reactions (ADRs) are a major health problem to the individual as well as for the society. There is insufficient awareness and inadequate training on drug safety monitoring among healthcare workers in Nigeria.  

Aim: To determine the prevalence and pattern of adverse drug reactions in children on antiepileptic drugs.

Study Design: This was a prospective observational study.

Place and Duration of Study: Pediatric neurology clinic, Jos University Teaching Hospital, Nigeria between January 2011 and December 2015.

Methodology: We recruited consecutive newly diagnosed children with epilepsy that were initiated on antiepileptic drugs. We performed thorough symptom checklist and physical examination before initiating antiepileptic drugs. Electroencephalogram, complete blood count, liver function test, and serum electrolytes, urea and creatinine were also done. Patients and their caregivers were counseled on the adverse drug reactions of the drugs being initiated and asked to return to the clinic immediately they observe any of the reactions. Patients were assessed for adverse reactions on each visit. Further laboratory evaluations were done for those with adverse reactions if necessary. Causal relationship between adverse drug reaction and treatment was assessed with the Naranjo Algorithm.

Results: Four hundred and nine patients were initiated on antiepileptic drugs within the study period. Two hundred and twenty-one (54.0%) were on monotherapy while 188 (46.0%) were on polytherapy. The most frequently prescribed drugs were carbamazepine (34.7%), carbamazepine+valproic acid (33.7%) and valproic acid (15.2%). A total of 113 (27.6%) patients had 193 different adverse drug reactions. The commonest adverse drug reactions were sleep disorders (33.7%), skin rash (10.9%), dizziness (7.8%), fatigue (10.7%) and nausea (6.75%). Those on polytherapy were significantly more likely to have adverse drug reactions compared to those on monotherapy (Relative Risk = 1.65, 95% confidence interval 1.20-2.27; P = 0.002).

Conclusion: Adverse drug reactions are common in children on antiepileptic drugs. Pharmacovigilance is very important in children on antiepileptic drugs so that adverse drug reactions can be identified early and managed appropriately.

Open Access Original Research Article

The Phytochemical and Antimicrobial Potentials of the Crude Extracts of Bridelia ferruginea and the Extracellular Biosynthesized Silver Nanoparticles

Temitayo Omotola Akinsete, Bukola Christianah Adebayo-Tayo, Abimbola Olumide Adekanmbi

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-13
DOI: 10.9734/JAMPS/2017/34172

Bridelia ferruginea has been used in African folk medicine for the treatment of several ailments especially throat infections. In this study, the phytochemical analysis, fractioning using different solvents, antimicrobials and silver nanoparticles (SNPs) produced by the ethanolic extract of the bark of B. ferruginea were investigated. The bark extract of the plant was used for the extracellular biosynthesis of SNPs; and characterized using visual observation, UV-Visible Spectrophotometer, Scanning Electron Microscope (SEM) and FTIR analysis. The antimicrobial potential of the characterized SNPs against some pathogenic microorganisms was also determined.

Flavonoids (987 mg/100 g), alkaloids (762 mg/100 g), saponins (437 mg/100 g) and tannins (209 mg/100 g) were the major bioactive compounds present in the plant while phenols and terpenes were absent. All the test organisms were sensitive to the crude extract of B. ferruginea with the highest zone of inhibition observed for Klebsiella pneumoniae (23 mm). In addition, all the test organisms were susceptible to the ethyl acetate fraction of B. ferruginea with Actinobacillus sp. having the highest zone of inhibition (18 mm). The SNPs has a pentagonal shape and the size ranged from 0.0 – 9.4 nm. The antibacterial activities of the crude and synthesized SNPs of B. ferruginea showed that the crude extract exhibited higher activity than the SNPs on the test bacteria with a range of 15-23 mm as against 13-21 mm observed for the SNPs.

In conclusion, the crude ethanolic extract, partitioned fractions, and SNPs of the bark of B. ferruginea had very good potential as antibacterial against some test bacteria.

Open Access Original Research Article

The Use of Modular Distal Aiming Device (MODAD) System for Locked Intra-medullary Nailing for Fixation of Fractures in Nigeria: A Prospective Observational Study

S. E. B. Ibeanusi

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-9
DOI: 10.9734/JAMPS/2017/34680

Locked intra medullary nailing has been accepted globally as the gold standard for treating fractures of the shaft of long bones. The method provides acceptable stabilisation of the fracture, controls alignment, axial translation and rotational deformity at the fracture. The challenges of closed locked intra medullary nailing of fractures include the availability of resources such as operation equipment, skilled manpower required for such practice as well as the risk of irradiation exposure from the use of Image intensifier for the procedure. To obviate these challenges, option to achieve locked intra medullary nailing of fractures using various devices have been developed including the modular distal aiming device.

Aim: The aim of this study is to evaluate the early experience with the use of the modular distal aiming device for locked intra medullary nailing in various hospitals across Nigeria.

Methods: Evaluation of prospectively collected data of patients with long bone diaphyseal fractures treated with Synthes modular distal aiming device between January 1, 2007 and May 15, 2014 in various hospitals across Nigeria. Data was analysed and results are presented and discussed.

Results: During the period under study, 71 fractures were treated with the device in various hospitals across the country with the majority (54 {76%}) of the fractures treated at Teme Hospital Port Harcourt, Nigeria. Most of the fractures resulted from Road Traffic Crashes. The median total duration of surgery was 1 hour 54 minutes (IQR, 40 mins – 4 hour 10 mins) whereas the median time to locking distal holes was 47 mins (IQR, 25 – 2 hour 25 mins). The total average estimated intra-operative blood loss (including fracture haematoma) was 452 mls ±128 mls) requiring blood transfusion of 25 units of blood for all patients. The post operative infection rate was 5 (7%) including superficial infection, deep infection and overt chronic osteomyelitis.

Conclusion: Modular distal aiming device is a good tool for locked intra medullary nailing of long bone fractures. It obviate the huge cost of acquiring and maintaining C arm required for closed locked intra medullary nailing of fractures of the shaft of long bone. The results from the use of such distal aiming device  compared favourably with those obtained from the use of C-arm from other centres and  eliminated the exposure to irradiation associated with the use of C-arms.  

Open Access Review Article

End-of-life Care in Nigeria: Preparing Nursing Students and Workforce to Take the Lead

Peretomode Evans, Udo Eunice

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-8
DOI: 10.9734/JAMPS/2017/34876

In this 21st century, several factors have informed the increasing need of end-of-life care globally. Notable amongst them are the global changes in both demographic and disease pattern; factors that have led to increasing number of chronic illnesses. Individuals suffering from chronic illnesses are faced with complex health challenges and thus, they ought to be supported and cared for as they progress towards the end-of-life. This care has always been a unique and important function of nurses irrespective of the work setting. Unfortunately, literatures in most parts of the world have shown that nurses are not adequately prepared to take on this role; demonstrating gaps in knowledge, attitude and skills in caring for the dying. The aim of this article is to increase awareness on the growing need for palliative and end-of-life care, review evidence to determine nurses’ preparedness in terms of knowledge, attitude and competence to provide quality care to patients who are near death and their family, and to discuss evidence based strategies that will enhance nurses’ knowledge, attitude and skills in providing quality and competent end-of-life care to patients approaching the end-of-life. The literature search related to the article was conducted from databases; google search, MEDLINE, Google scholars and Pubmed. Themes that emerge in literature suggest that knowledge, and competence of end-of-life care among nurses is lacking and the need to prepare nursing students and possess a workforce with requisite knowledge, attitude and skills to adequately care for the dying has become a priority.