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  Citation statistics : Table of Contents
   2016| January-March  | Volume 7 | Issue 1  
    Online since January 27, 2016

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Evolution of clinical pharmacy teaching practices in Pakistan
Atta Abbas Naqvi
January-March 2016, 7(1):26-27
  4 1,315 103
Diabetes mellitus in Pakistan: A major public health concern
Arshad Hussain, Iftikhar Ali
January-March 2016, 7(1):30-32
  4 4,527 95
A comparison between liposomal and nonliposomal formulations of doxorubicin in the treatment of cancer: An updated review
Yik Hoe Ngan, Manish Gupta
January-March 2016, 7(1):1-13
Cancer remains a major cause of hospitalization and death every year. From time to time, new formulations of anticancer drugs are available in the market and draw the concern of healthcare professionals in terms of the superiority, toxicology, and cost-effectiveness of the new formulations in comparison to the conventional formulation of the same drugs. Doxorubicin, which is a highly potent chemotherapeutic agent, comes with three formulations (pegylated liposomal, nonpegylated liposomal and nonliposomal conventional formulations). English-language literature in relation to the three formulations has been reviewed to inform the healthcare professionals regarding the differences between these formulations. In terms of efficacy, there is only one study supporting the superiority of liposomal doxorubicin, but there are more data which supports the non-inferiority of liposomal doxorubicin in comparison to conventional non-liposomal doxorubicin. It is emphasized that liposomal doxorubicin promotes better toxicology profile than nonliposomal conventional doxorubicin with an increased cost. The cost-effectiveness of liposomal doxorubicin is not well defined as there are very limited studies in this area. Apart from that, this review highlights the interpatient variability in regards to the clearance and volume of distribution following the administration of liposomal doxorubicin. In conclusion, further studies will be required to better define the superiority of liposomal formulation of doxorubicin regarding the efficacy and dose standardization of liposomal doxorubicin should be sought in the near future.
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Impact of pharmacists' intervention in improving adherence among patients with schizophrenia
Wan Nur Asyiken Wan Ab Rahman, Sarah Diyana Shafie, Long Chiau Ming
January-March 2016, 7(1):27-29
  - 1,755 97
Knowledge of warfarin therapy among patients attending Warfarin Clinic at a Public Hospital in Northern part of Malaysian Peninsular
Teoh Boon Ching, Syed Azhar Syed Sulaiman, Amal K Suleiman, Syed Wasif Gillani, Usman Abubakar
January-March 2016, 7(1):14-17
Background: Patient's knowledge of anticoagulation therapy is important to achieving and maintaining optimal therapy outcome as well as reducing adverse events. The aim of this study was to assess knowledge of warfarin therapy among patients attending Warfarin Clinic at a public hospital. Materials and Method: A cross-sectional survey of 128 patients was conducted at a Warfarin Clinic. Face to face interviews were conducted, using standard questionnaires to determine demographic characteristics and knowledge of warfarin therapy. Results: The mean age of participants was 50.5 years. Majority of patients were male (56.2%), Malays (46.89%) and married (78.1%). A large proportion of patients had only primary (33.6%) and secondary school education (43.0%). The result indicates almost all patients know the indication (95.8%) and dosage (92.2%) of warfarin. In addition, 89.1% of patients know what to do in case of a missed dose. However, more than half of participants do not know the consequence of missing a dose. Most patients know the purpose of INR monitoring and the consequence of INR value above or below the therapeutic range. There were only 42.2% of the patients who know the frequency of INR monitoring. Knowledge of drug interaction indicates more than 50% of patients possess knowledge of warfarin-alcohol, warfarin-vitamin, warfarin-OTC and warfarin-food interaction. There were 64.1% of patients who know when to seek immediate medical attention and 56.3% who are aware of side effect monitoring. Categorization of knowledge level shows 41.4% of patients have good level of knowledge about anticoagulation therapy. However, only 33.6% of patients have excellent knowledge while 1.6% of patients were found to have poor knowledge of warfarin therapy. Conclusion: It can be concluded majority of patients attending warfarin clinic have insufficient knowledge about warfarin therapy.
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Warfarin dose requirement and cytochrome P450 2C9 and Vitamin K epoxide reductase complex subunit 1-1639 genetic polymorphisms in Thai patients
Burassakorn Subsuphan, Chatchai Chinpaisal, Manat Pongchaidecha, Wibun Phanthabordeekorn, Surawut Watana
January-March 2016, 7(1):18-25
Aims: The purposes of this study were to investigate the influence of genetic polymorphisms of cytochrome P450 2C9 (CYP2C9)*3 and Vitamin K epoxide reductase complex subunit 1-1639 (VKORC1-1639) G >A and patient's characteristics on warfarin dose requirement and to establish an equation for predicting the warfarin maintenance dose in Thai patients. Settings and Design: This is an observational, retrospective study in outpatients. Ninety-one outpatients receiving warfarin at Phaholpolpayuhasena Hospital, Kanchanaburi, were recruited to this study. Subjects and Methods: Whole blood, dose, and demographic data were collected. Blood samples were analyzed for the genetic polymorphism by restriction fragment length polymorphism technique. Statistical Analysis Used: Differences in baseline characteristics among genotypes were evaluated by analysis of variance or Kruskal-Wallis and the Mann-Whitney U-test or Chi-square test for parametric and nonparametric variables, respectively. Association between genetic factors and warfarin dose was based on Eta test, whereas associations between warfarin dose and polymorphisms were evaluated using Pearson correlation test. Stepwise regression was used to identify factors contributing to warfarin dose requirement followed by linear regression model to develop a warfarin dosing algorithm. Results: CYP2C9*1*1 (wild type) genotype was found in 90 patients (98.90%), and CYP2C9*1*3 was found in only 1 patient (1.10%). No CYP2C9*3*3 genotype was observed. Polymorphisms of VKORC1-1639 GG was found in 9 patients (9.89%) while GA and AA genotype were found in 30 patients (32.97%) and in 52 patients (57.14%), respectively. Patients with VKORC1-1639 AA genotype required statistically and significantly lower, average weekly warfarin dose (19.97 ± 7.61 mg) than GG genotype (37.89 ± 12.20 mg) and GA genotype (29.48 ± 11.50 mg) with the P < 0.05. Conclusions: Using stepwise multiple linear regression, VKORC1-1639 AA, age, and weight could explain about 45.3% of the variation of warfarin maintenance dose. Multivariate analysis of the equation indicated a significant negative correlation between warfarin dose and VKORC1-1639 AA and age, but a significant positive correlation between warfarin dose and weight. This suggested that VKORC1 genotyping may be more important in warfarin dose adjustment and should be a priority for genotype measurement.
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