Volume 14, Issue 1, Winter and Spring 2014, Page 1-104

Effects of hormonal contraceptives on serum glucose, lipid profile and some liver function test

Isam Hamo Mahmood; Israa Mohammid Jaber

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 1-6
DOI: 10.33899/iphr.2019.161187

Objective: To investigate the effects of  hormonal contraceptives on serum glucose, lipid profile and some liver function tests.
Patients and Methods: One hundred and three women participated in this study. They were taken hormonal contraceptives including oral contraceptive pills  or injection for a period not less than 6 months up to 12 years . Another group consisting of one hundred non contraceptive users taken from the same population participated in the study as a control group. Blood samples were taken from the individual and sera were used for the determination of serum glucose, lipid profile and some liver function tests which include alkaline phosphatase (ALP), aspartate amino transaminase (AST) and alanine amino transaminase (ALT).
Results: A highly significant values of serum glucose concentrations, total cholesterol, triglycerides and LDL- cholesterol were obtained in contraceptive users as compared with contraceptive non users. Whereas a non significant values of ALP, AST, ALT and HDL cholesterol were obtained.
Conclusion: The use of hormonal contraceptives was associated with undesirable effects on serum glucose and lipid profile. Care should be taken when using hormonal contraceptives in women having diabetes mellitus or cardiovascular diseases.
Key Words: Hormonal contraceptives, ALP, AST, ALT, lipid profile.

Oral yeasts infection in children

Niem N. Jammil; Manahil M. Yehia

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 7-15
DOI: 10.33899/iphr.2019.161188

Objective:The study was designed to identify the yeasts which cause oral thrush in children, in addition to other sources including the teat of bottle, nipple of breast, pacifier, and vaginal swabs from mothers of newborn to detect the source of infection.
Patients and Methods: One hundred and twenty clinically diagnosed child with oral yeast infection were enrolled during this study. The clinical specimens were collected from Dec. 2012 – May 2013, and included (120) oral swabs from infected children and (60) swabs from healthy children . In addition to (46) swabs from teat of bottle feeding babies, (37) swabs from nipple of breast feeding mothers, (20) swabs from pacifier , and (17) swabs from mother's vagina of newborn. The identification process employed direct examination , culture in different media , germ tube , chlamydospore  formation and API - 20 C system tests .
Results:Candida  albicans  is the main isolate from both patients and control group (90.1% ; 78.3% respectively) , and also from the other sources . Moreover , other yeasts isolated from the patients only including  Cryptococcus  laurentii (3.9%) and  Saccharomyces cerevisiae (1%) .
Conclusions:Candida albicans and other yeasts were isolated from the oral lesions and other sources indicating that the infection transmitted for and back to the infected children.

Effect of conventional and sustained release sodium valproate on serum leptin and some liver function tests in epileptic patients

Sajid Kh Ameen; Faris A Ahmed

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 16-22
DOI: 10.33899/iphr.2019.161190

Objectives: To compare the effect between conventional and sustained released sodium valproate monotherapy on serum leptin, body mass index (BMI) and some liver function tests including serum alkaline phosphatase (ALP), alanine amino transferase (ALT), aspartate amino transferase (AST), albumin, total bilirubin (TB) and direct bilirubin (DB) in epileptic patients.
Patients and methods: The study is a case control study. It included 40 epileptic patients on conventional sodium valproate at doses 400-800 mg per day, and 42 patients on sustained released sodium valproate at doses 500-1000 mg per day. Forty healthy subjects sex and age matched served as controls were also included in the study. Blood samples were taken from the patients and controls and analyzed for serum ALT, ALP, AST, albumin, total bilirubin and direct bilirubin. Serum leptin was also analyzed by using ElISA technique.
Results: Serum leptin, ALT, ALP, AST and TB in epileptic patients treated by conventional sodium valproate were significantly (p < 0.05) higher than that in patients treated with sustained release sodium valproate. However, serum albumin was significantly (p < 0.05) lower than that in patients treated by sustained released sodium valproate. No significant change was noticed between the two patients groups for BMI and serum DB
Conclusion: Sustained release sodium valproate may have less hepatotoxic effect and cause less weight gain than conventional sodium valproate. The reduced frequency of doses and the possibility of dosing flexibility may all improve compliance of the patients.

Effects of atorvastatin on some inflammatory markers in patients with multiple sclerosis treated by interferon beta-1b

Farah Waleed Mahmood; Shamil Hashim Othman

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 23-31
DOI: 10.33899/iphr.2019.161191

Objective: To investigate the effect of Atorvastatin vs. placebo on some inflammatory markers in patients with multiple sclerosis treated by interferone beta-1b.To achieve the aim of this study, a randomized control comparative trial was adopted.
Patients and Methods: A total of 100 patients with multiple sclerosis were recruited and investigated for some inflammatory markers which included, interleukin-2, tumor necrosis factor-α, C-reactive protein, and erythrocyte sedimentation rate. The patients were divided into 2 groups, namely the atorvastatin group which consisted of 50 patients and the placebo group which consisted of 50 patients. The patient groups were followed- up for 12 weeks during which the above parameters were measured before starting therapies and at the end of the follow-up period using commercially available kits. The patient groups were compared with the control group consisted of 50 apparently healthy subjects.
Results: The IL-2,TNF-α,CRP and ESR at baseline in both patient groups were found significantly elevated as compared with the control group ( p< 0.001) . The use of atorvastatinhas resulted in significant decrease on the above parameters with non-significant effects in the placebogroup. Atorvastatinappeared to be superior in compared with the placebo group.
Conclusion: The use of atorvastatinfor 12 weeks in patients withmultiple sclerosis treated by interferone-beta has beneficial effect on some inflammatory markers studied in this research( IL-2,TNF-α,CRP and ESR).

Comparison of the effect of losartan versus candasartan on uric acid levels in hypertensive patients

Zeina A Munim Al-Thanoon

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 32-38
DOI: 10.33899/iphr.2019.161192

Background: It have been suggested by some studies that uric acid plays a causal role in the development of cardiovascular disease where as other studies concluded that uric acid merely reflects other concomitant risk factors, such as hypertension, insulin resistance, obesity, or lipid abnormality . Sartan drugs or angiotensin II receptor blockers do appear to lower uric acid levels (SUA). The clinical importance of this finding to patients with hypertension, or gout, or both is not yet known. The  present study was aimed to compare the effects of the antihypertensive drugs losartan and candasartan on blood pressure and uric acid level in hypertensive patients.
Materials and Methods: A total of 80 newly diagnosed hypertensive patients were divided into two groups, with 40 patients in each group. Group 1 was given losartan (50 mg/day) and group 2 was given candasartan (8mg/day). A control group of 50 apparently healthy individuals was included. Blood pressure and uric acid were measured for controls and patients before and after drug administration. 
Results:A significant  increase in blood pressure and uric acid were found in hypertensive patients before starting treatment (P<0.001), as compared with controls. After 2 months of treatment, the systolic and diastolic BP were significantly reduced in the both losartan and candasartan groups (P<0.001). Both drugs were similarly effective in reducing the blood pressure in patients with hypertension with no statistical significant difference between the two treatments.  Serum uric acid levels were only significantly reduced after 2 months of treatment with losartan (P < 0.001) but not with candasartan.
Conclusions: Our findings suggest that both losartan and candasartan therapy were similarly effective in reducing blood pressure in patients with hypertension. Losartan, but not candasartan, was associated with a significant reduction in serum uric acid levels. Our findings suggest that the losartan is the drug of choice in patients with hypertension and hyperuricemia and gout.

Histological changes of the rat liver after administration of imatinib mesylate:an experimental study

Luma Ibrahim Khalel Al-Allaf; Hafidh Al-Ashoo

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 39-50
DOI: 10.33899/iphr.2019.161193

Objectives: This study aims to determine the histological changes of the liver of rats after administration of  a low dose  or a clinically relevant high dose of Imatinib mesylate for one month in comparison to control ones.
Study setting and design: This experimental study was performed over a period of four months starting from the 10th march 2013 to the 10th July 2013 and was conducted on male Albino rats purchased from Animal Houses of both Mosul Medical College, and Veterinary College, University of Mosul, Mosul, Northern Iraq.
Methods: The first experiment includes40- 45 days aged rats who administered orally daily dose of 75mg/Kg of imatinib mesylate (Glivec®; Novartis) purchased from IBN-SENA Teaching Hospital , Mosul and bought from some private pharmacies for 30 days with age matched control who administered distilled water. The second experiment includes 40- 45 days aged rats who administered daily dose of 200mg/Kg orally)with age matched control who administered distilled water . Liver of rats from each experimental group were obtained. The tissues were embedded in paraffin and stained with hematoxylin-eosin and periodic acid schiff stain.
Results: The histological examination of the liver tissues of groups receiving imatinib at doses of 75 mg/kg or 200mg/kg on daily for 30 days duration showed different degrees of various histological changes of damage when compared with the control group . Male rats administered with 75 mg/kg of imatinib resulted moderate degree of several histological changes. The most striking feature is disruption in radial arrangement around central vein, sinusoidal dilatation, and hepatocytes with eosinophilic cytoplasm. Perivenular inflammatory cells, accumulation of inflammatory cells. Loss of cellular outline , and loss of euchromatin of the hepatocytes .Light microscopic examination of sections obtained from liver tissues of groups receiving imatinib at dose of 200mg/kg  revealed similar changes, however , these changes were more pronounced in comparison to those in low dose group.
Conclusion: Imatinib causes hepatotoxicity even in low dose group (75mg/kg, however, it has a dose dependant  effect but to some extent. Appropriate protective measures must be applied with anticancer treatment for improving liver function.

Effect of metformin on thyroid function tests in type 2 diabetic patients

Mohammed N. Abed

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 51-57
DOI: 10.33899/iphr.2019.161194

Background: Diabetes mellitus (DM) and thyroid disorder appears to be closely related.It has long been recognised that thyroid hormones have marked effects on glucose homeostasis, and although autoimmune thyroid disease is more prevalent in type 1 diabetes as a result of their common origin, in patients with type 2 diabetes the prevalence of hypothyroidism and hyperthyroidism is similar to that of the general population. The present study was conducted to assess the interplay between metformin treatment and thyroid function in type 2 diabetic patients.
Methods: A total of 73 diabetic patients were enrolled in this study, they were divided into two groups, the first group included 37 type 2 diabetic patients on metformin therapy, whereas the second group involved 36 type 1 diabetic patients on insulin therapy. Another group involved 35 apparently healthy volunteers were also included in the study as a control group. Blood samples were taken from the patients and controls, then  the   serum   was analyzed for measurement of fasting serum  glucose (FSG), total T3,   free T3 (FT3),  total T4, freeT4 FT4) and TSH using ELFA (Enzyme Linked Fluorescent Assay) technique (minividas).
Results: the results showed that there were no significant differences between T3, FT3, FT4 and TSH of the metformin group when compared to the same parameters in the control group. On the other hand FT3 and FT4 of insulin group were significantly lower than that of the control and metformin groups. Also total T4 inmetformin and insulin groups was significantly lower than that of control group, whereas the TSH of insulin group was significantly higher than that of control and metformin groups.
Conclusion:Chronic use of metformin in type 2 diabetic patients has no effects on thyroid function tests, and there was no significant correlation between glycemic control and thyroid hormones or TSH. However, TSH, T4, FT3 and FT4 in insulin group were significantly differe from control group and this may indicate the presence of subclinical hypothyroidism.

Evaluation of direct immunofluorescent method in the detection of Pneumocystis jiroveci among patients with lower respiratory tract infections

Manahil M. Yehia; Asmaa Z. Sheetawy; Zainalabideen A. Abdulla

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 58-62
DOI: 10.33899/iphr.2019.161195

Objective: Evaluate the use of direct immunofluorescent method in the detection of Pneumocystis jiroveci from induced sputum of patients with LRT infections.  
Patients and methods: Thirty patients with LRT infections were included (24 patients were immunocompromised and 6 immunocompetent). The present study conducted for 6 months from January-June, 2011. Smears were prepared from their induced sputa and stained with direct fluorescent antibody stain, then examined under fluorescent microscope.
Results: Sputum of 5(16.7%) patients revealed positive results for the presence of P. jiroveci and all of them were immunocompromised (two acute myloid leukemia, one acute lymphoid leukemia, one non-Hodgkin's lymphoma, and one asthma under long coarse of corticosteroid therapy).
Conclusion: Direct fluorescent antibody technique is more sensitive than the conventional methods for the detection of P. jiroveci in LRT infections.
Keywords: Pneumocystis pneumoniae, Pneumocystis jiroveci, immunocompromised patients.

The Effect of Misuse of Topical Corticosteroids on Skin

Deena K. Al-Samman; Israa M. Al-Banna; Wejdaan N. Al-Shakarchy; Mohammed M. Attar-bashi

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 63-75
DOI: 10.33899/iphr.2019.161196

Objectives: To assess the frequency of misuse of TC on skin , commonly used steroids and the most common dermatological problems resulting from it, as well as, to analyze the motives for such practices with the aim to raise awareness about this problem in Mosul city.
Methods: The study included 155 patients aged 0.8-49 years with dermatological disorders who attended Outpat­ient Department of Dermatology in Al-Salam Teaching Hospital in Mosul City . Inclusion criteria: those who had used TC without medical advice; continued use after short prescription regardless of the duration ;TC used incorrectly or used them for certain skin problems for which steroids are not indicated; Wrong indication (acne); undiagnosed dermatosis as well as a history of TC use continuously(for more than1 month) or intermittently (for more than 3 months) due to any purpose, and presented with ≥ 1 of the side-effects of these drugs as the chief complaint were criteria used to define unjustifiable/inappropriate use.
Patients with natural rosacea; those denying any history of using TC or who not consenting to answering the questionnaire; pregnant women; patients who were using prescribed TC regardless of the duration or side effects such as asthma, rheumatoid arthritis; patients with comorbidities that resembled/could cause changes similar to TC side-effects (polycystic ovaries / Cushing's syndrome/thyroid disorders)were excluded from the study. A questionnaire was designated and skin was examined to study patients.
Results: Of the 155 subjects misused TC most were females 98(63.23%)  and 57(36.77%) were males; of low social class 45(29%). The majority 123(85.2%) thought that corticosteroid use was safe and 56(36.1%) did not feel guilty for using such medications.
Eighty fife(55 %)patients reported that physician and pharmacists advised them for the first time to use TC. Ninety eight (63.3%) patients obtained the drug from the pharmacies, 30(19.3%)from nurse staff and 27(17.4%) from cosmetic shop/Beautician. lightening of the skin (30.6%)  was the main indication for use TC. Potent and very potent preparations were the main TC used by patients.Almost all had some features of TC side effects.
Conclusion: Inappropriate use of TC is a big problem in our country. Easy availability of very potent products without a prescription makes misuse very common which has a huge impact on derm­atological practice. It is responsible for a significant proportion of visits to dermatolo­gy clinics. It is a multiphase problem that needs the cooperation of different sectors in the community to overcome it. Education of the general public through special media programs and the introduction of a continuing medical education programs for medical and paramedical personnel as well as controlling the easy intake from pharmacies are probably the most important steps that could be taken to reduce this problem.

The role of serum cystatin C as an early predictor for the diagnosis of chronic kidney disease in Mosul City

Mohammed Khalid J. Al-Nori; Akram J. Ahmed

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 76-78
DOI: 10.33899/iphr.2019.161197

Background: Diagnostic marker to detect chronic kidney disease (CKD) at early stages is important as early intervention can slow the loss of kidney functions. Serum cystatin C (sCysC) is said to be a superior marker for CKD compared to serum creatinine (sCr) and other known markers in the near past period to detect the mild GFR reduction between 60 and 90 ml/min/1.73m2.
Objective: To detect fordetecting the role of cystatin C as an early predictor for the assessment of chronic kidney disease patients.
Methods:Blood and urine samples from 185 patients suffering from various stages of CKD or subjects under the risk of CKD were taken from Ibn-Sina teaching hospital during the period from 15th of March 2012 to 10th of sept 2013. Serum Urea (sUr), serum uric acid (sUA), serum creatinine (sCr), serum cystatin C (sCysC), 24 hour excreted urine protein and 24 hour excreted urine creatinine where analyzed then compared to corrected creatinine clearance for each patient.
Results:Theresults showed that serum CysC started to change from abnormal border line level at stage 2 to clearly abnormal level at stage three of CKD comparing to other assessments which used sCr, sUr, sUA. The results also indicated that the urinary 24h excreted protein was starting to be observed at stage 3 of CKD.
Conclusions:  The present study indicated that sCysC have the potential benefit for early detection of CKD especially in those with high risk before appearance of the symptoms and before occurrence of the complications.

High Performance Liquid Chromatographic Method for Determination of Tadalafil in Tablets and Wastewater

Nief Rahman Ahmed

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 87-94
DOI: 10.33899/iphr.2019.161198

Objective: A reverse phase high performance liquid chromatographic method (RP-HPLC) has been developed for the determination of  tadalafil in the pharmaceutical formulations  and environmental wastewater samples.
Method: Different analytical columns with various  stationary phases were tested. Good separation was achieved using supelcoC18 column (25cm x 4.6 mm. 5 µm) . The mobile phase (methanol: water: Triethylamine) , pH adjusted to 4.0 with dilute phosphoric acid was pumped at a flow rate of 1.3 ml/min in the ratio of 60:38:2   and the peaks  were detected at 220 nm.
Results: Linearity was obtained in the concentration range of 0.0 4-0.28 mg/ml .The RSD was found to be less than 1% indicating the method is precise and the recovery was100±1.25% indicating the method is accurate
 Conclusion: The proposed HPLC method may be used for determining tadalafil in pure drug samples , pharmaceutical dosage forms and environmental wastewater samples.

Comparative Effects of Telmisartan versus Valsartan on serum Leptin level, in hypertensive type 2 diabetes mellitus patients

Najlaa Saadi Ismael; Fathel Abaas Al-hamamy

Iraqi Journal of Pharmacy, 2014, Volume 14, Issue 1, Pages 95-104
DOI: 10.33899/iphr.2019.161199

Objective: The aim of this study was to compare the effects of telmisartan and valsartan onblood pressure and serum leptin in hypertensive type 2 diabetesMellitus patients.
Study design:A randomized control comparative clinical trial with open label design.
Study period: From 1st  February, 2012 to 30th March, 2013.
Patients and method: Eighty eight type 2 diabetic hypertensive  patients were randomly assigned to received either telmisartan (n = 46)  or valsartan (n = 42) with body mass index (BMI) 31.52±4.73 kg/m², 30.39±3.95 kg/m² respectivly. Forty one diabetic normotensive patients (n=41), age, sex, BMI, duration of diabetic  disease, duration of diabetic treatment matched to the diabetic hypertensive  patients groups were kept as control group. blood pressure (BP), leptin levels were measured at baseline and after 2 months of treatment.
Results: The study showed a significant higher systolic blood pressure (SBP), diastolic blood pressure (DBP) and serum leptin in the diabetic hypertensive patients before starting therapy as compared with the diabetic normotensive patients. Both telmisartan and valsartan significantly reduced serum leptin and BP. More reduction in DBP seen with valsartan  than with telmisartan.
Conclusion: Monotherapy with telmisartan and valsartan produce a beneficial reduction effects on BP and reduce leptin level. The improvement of leptin sensitivity may play a role directly or indirectly in the induction of hypertension control.