Prevalence of Side Effects, Drug Interaction among Patients Taking Statin in Turaif, Saudi Arabia

Background:Statins perceived to have favorable safety profile. Although many people on statin therapy do well but no drug is without potential for side effects. Awareness about risks as well as benefits of drugs is needed particularly drugs which are used on wide scale like statins because even uncommon side effects can have significant health impact. Objectives of the Study: To determine side effects occurrence among Saudi patients taking statins and to evaluate drug-drug interactions in Saudi patients taking statins.Methodology:Self administered cross sectional study conducted during a period of four months from October 2018 to January 2019 in Turaif general hospital, Saudi Arabia on random sample of 500 Saudi patients out of which 330 participants were included in the study which were taking different types of statins medication using self-administered questionnaire in Arabic language specially designed for the research purpose after obtaining verbal consent and the data analyzed by SPSS program.Results:A total of 330 patients; 128 (39%) females and 202 (61%) males—participated in the study. The majority 165 (50%) were in the age-group of 50 –59 years. Simvastatin was the most commonly used statin among study participants 136 (41%) followed by rosuvastatin114 (35%). Among the participants, there were some patients who take drugs which have drug interactions with statins; there were 64 (19%) take Amlodipine with simvastatin, 13 (4%) and 6 (2%) take esomeprazole and ompeprazole respectively with statins. Only 9 (3%) reported that they were advised by pharmacist to avoid grape fruit. Majority of participants 309 (94%) reported neck pain, difficulty in walking, frequently fatigue after starting on statin. Also majority of participants 320 (97%) suffer from muscle pain after starting statins medications. Conclusion:The percentage of statin related side effects in this study population is high especially myopathy. Also some patients in this study taking medications that have drug interaction with statins, Counseling to patient regarding statin therapy appear to be insufficient. So, this study indicate that there's a need for more efforts from the physicians and pharmacist to avoid prescribing or dispensing medication that have drug-drug interaction with statins and provide counseling to patients regarding their statin therapy

Public Attitude and Perception about Analgesic and their Side Effects

Introduction: Analgesics are substances which work in various ways to relieve different types of pain experienced in the body. Non-prescription over-the-counter (OTC) drugs are widely used by patients to control pain and fever. Study Objective: To evaluate of knowledge, attitudes and practices about analgesic and their side effects.Methods: A cross-sectional study conducted during a period of three months from September to December 2017 in Rafhaand Riyadh -Saudi Arabia on a random sample of 237 Saudi people, the data was collected by using a self-administered questionnaire in the Arabic language. Statistical analysis was done by using MS EXCEL using descriptive statistics and chi-square test. Results: A total of 237 participants out of 260 consented to be interviewed and completed the questionnaire with a response rate (91%). Their ages ranged between 18 years and 54 years with a mean (28) and standard deviation (7.9). Majority of participants were females (92%) and about two thirds (66%) were highly educated. A quarter of study participants (25%) do not read leaflet of analgesic before use. About one-fifth of respondents (20%) reported that they cannot stop taking analgesic even if the pain is mild. 12% and 36% of respondents always and sometimes, respectively, use more than one type of analgesic for pain relief. 10% of respondents reported the occurrence of side effects from analgesic. The respondents use analgesic mainly for headache (43%) andtoothache (25%). The chronic disease for which participants take analgesic were mainly arthritis (39%) and migraine (30%).About three-quarters of respondents (74%) were aware that the use of analgesic is accompanied by side effects. The respondents believed that the reasons for analgesic misuse are that analgesic easily obtained without a medical prescription (40%) and there is no educational or awareness program regarding analgesic use (33%). Majority of participants believed that there is no sufficient awareness about analgesic. The source of information about analgesic for participants is physician (24%). Panadol analgesic is the most commonly used analgesic (48%) reported by participants.Results showed that there is a significant statistical difference between male and female regard analgesic use (P=0.048) and between different level of educations and analgesic use (P=0.334). Also, there is a highly significant statistical difference between male and female regard reading the leaflet before taking analgesic (P=0.0001) and between the educational level of participants regarding reading the leaflet before analgesic use (P=0.0008).Conclusion: The over-the-counter (OTC) analgesic drugs are commonly used and many patients are unaware of their side effects.The findings of this study showed that people's knowledge, attitudes and practices regarding analgesic use is poor. Also, it is important to improve people's knowledge, attitudes and practices regarding analgesic use to reduce the misconceptions and misguided expectations contributing to inappropriate analgesic use. Therefore, health professional practice should play a major role in people's awareness of the appropriate use of OTC analgesic drugs

Microwave and conventional synthesis of Co [II], Cu [II] and Ni [II] metal complexes of some acid hydrazones with their spectral characterization and biological evaluation

The transition metal complexes of Co[II], Ni[II], and Cu[II] derived from N'-[[5-[2,5-dichlorophenyl]furan-2- yl]methylene]-2-hydroxybenzohydrazide [L24] and N'-[[5-[2, 5-dichlorophenyl]furan-2-yl]methylene]benzohydrazide [L21] have been synthesized by conventional as well as microwave method being shorter time consuming, solvent less and gives improved yields as compared to the traditional conventional technique. These compounds were characterized by melting point, TLC, FTIR, 1 H-NMR, elemental analysis, potentiometric titration, ICP-OES and EIMS. From this analytical data it is confirmed that complexes are in octahedral structure with coordination number 6 which revealed 1:2 [metal:ligand]. FTIR data shows that these synthesized hydrazone ligands have ONO donor sites and coordinate with transition metal ions in a tridentate monobasic manner. All these synthesized compounds were tested for evaluation of antibacterial activity by agar disc diffusion assay and total antioxidant activity by Phosphomolybdenum method

Haemorrhoidectomy with internal sphincterotomy: a useful method to relieve post operative pain

OBJECTIVE: This study was designed to compare short term outcome of post operative pain in patients operated for haemorrhoidectomy alone and haemorrhoidectomy with internal sphincterotomy

METHODOLOGY: This comparative observational study conducted at Liaquat University Hospital Jamshoro during August 2012 to July 2014. One hundred and sixteen patients of 3rd or 4[th] degree hemorrhoids were enrolled in the study. Patients were divided into two comparable groups. Group A underwent open haemorrhoidectomy along with lateral sphincterotomy whereas group B was operated for open haemorrhoidectomy alone. Postoperative pain was analyzed by using visual analogue score at 24 hours, 48 hours and on 10th post operative day

RESULTS: Total 116 patients were included in the study. Fifty eight patients in each group

The mean age of the patients was 42+/- 10.2. Male were 77 [66.4%] and 39 [33.6%] were female. Male to female ration was 2:1. During follow-up periods, patient in group A experienced less postoperative pain as compared to group B [p value is

CONCLUSION: Lateral internal sphincterotomy combined with haemorrhoidectomy significantly reduces postoperative pain without increasing morbidity

Effects of short-term exposure to [Imt, 50 Hz] electromagnetic fields on calcium concentration in different brain regions of mice: the role of calcium channel blocker

To evaluate the effect of short-term exposure to 50 Hz [1 mT] extremely low frequency electromagnetic fields [ELF EMFs] on the Ca[2+] concentration in 4 different regions of the mice brain [cortex, cerebellum, hippocampus and brainstem]. University of Bahrain, Arabian Gulf University. Prospective Randomized Controlled Study. Adult BALB/c male mice were exposed to 50 Hz [1 mT] ELF-EMFs for 2 hours/day for five consecutive days and were treated orally with the calcium channel blocker Amlodipine. Calcium was extracted from the mice brain tissues and the concentration of Ca[2+] was determined using atomic absorption spectroscopy. The effect of ELF EMFs exposure on the Ca[2+] concentrations varied in different regions of the brain, with a significant increase [P<0.05] only in the hippocampus and the brainstem. This increase occurred during short-term exposure to ELF EMFs and the Ca[2+] concentrations started to decrease during the interval of no exposure. The rise in Ca[2+] concentration due to ELF EMFs exposure did not occur in mice treated with the calcium channel blocker Amlodipine. The increase in Ca[2+] concentrations could have involved activation of the voltage-gated calcium channels [VGCCs] by ELF EMFs

Histological patterns of endometrial lesions in endometrial curettage specimens of abnormal uterine bleeding patients

Background: Endometrial curettage is one of the commonest invasive gynecological procedure in reproductive as well as post reproductive age in abnormal uterine bleeding

Objective: To determine the histological types of endometrial lesions in curettage specimens, of women having abnormal uterine bleeding

Methodology: This descriptive study was conducted in Bannu Medical College from 1[st] March 2011 to 31[st] May 2014. A total of 170 endometrial curettings were included in the study. The inclusion criteria was sufficient endometrial specimen from women of any age with abnormal uterine bleeding, where as the exclusion criteria was insufficient curetting specimen. A minimum of one sections and a maximum of three sections were taken from the endometrial specimen. Sections 5 micron thick were prepared and stained with H and E and reported by histopathologist. The data was entered and analyzed in SPSS version 17

Results: A total of 170 endometrial specimens were included in this study with age range from 21 to 73 years. The most common age group encountered was 31-40 years, in which 67[39%] cases of endometrial specimen were noted. The common histological lesion were secretory phase endometrium 54 [31.7%] followed by proliferative phase 47 [27.6%], retained product of conception 16 [9.41%], endometritis 13 [7.64%] and endometrial polyp 12 [7.05%]

Conclusion: This study showed that that endometrial curettage is a significant diagnostic tool in identification of the lesion leading to abnormal uterine bleeding in any age patients

Evaluation of various causes and treatment of obstructive jaundice at Liaquat university hospital

The purpose of this study is to evaluate various causes of obstructive jaundice and its available treatment modalities in this area. Descriptive study. This study was conducted at Liaquat University Hospital Hyderabad/Jamshoro from January 2010 to december 2010. All the patients above 15 years of both sexes were included in this study having obstructive jaundice diagnosed on the basis of clinical grounds and supported by LFT and ultrasonography. A uniform system of history taking, physical examination, investigation and treatment was adopted for all the patients and information was recorded on the pre-designed proforma. Comprises 80 cases of obstructive jaundice, average age was 50 years with the female to male ratio1.5:1. The most common cause was carcinoma of head of pancreas in 27 [33.75%] followed by bile duct stone disease in 24 [33%] cases of carcinoma of gallbladder were in females. Jaundice with weight loss, itching [46%] and mass [28%] were the presenting features in malignant obstruction while pain [83.33%] and fever [25%] was mostly seen in patient with choledocholithiasis. Gallbladder was palable in malignant obstruction only. Anemia was the common associated problem [60%] especially in malignant cases [83%] only biopsy was preferred in 30 [37.50%] of cases, while choledochoduodenustomy in 14 [17.5%]. Postoperative complications were only in 28 [35%] of patients with wound sepsis in 17 [11.25%]. The mortality rate was [11.25%]. Maximal survival for carcinoma of pancreas was 9 months. The average post operative stay was 12 days. Cholecystectomy with supraduodental choledochotomy and T-tube insertion is effective treatment for bile duct stones whereas internal drainage of billary system is good for advanced malignant cases

Clinical expression of homozygous sickle cell gene in Yemeni children

In this study the demographic and clinical profile of 105 Yemeni children under 16 years old with sickle cell anemia [SCA] were studied. They were 53 males [50.4%] and 52 females [49.5%], aged between 0.5 and 15 years [mean 7.4ys]. The most serious crisis as vaso-oclusive, hemolytic, sequestration and aplastic crisis were seen in [83.8%], [52.3%], [6.6%] and [5.7%] respectively. The hand-foot syndrome was found in [21%] of all patients and in [51%] of children less than 3 years old. The most serious complication was the respiratory tract infections which was the most frequent in these patients, being encountered in [65.7%]. The rate of hospitalization was of [76%]. Our findings show that SCA has a severe clinical course in Yemenis, resembling that in black Africans and in black Americans

evaluation of Milligan-Morgan and Ferguson procedures for haemorrhoidectomy at Liaquat university hospital Jamshoro, Hyderabad, Pakistan

To compare the outcome of Milligan-Morgan [MMH] and ferguson [fH] techniques for haemorrhoidectomy with regard to postoperative pain, control of bleeding, early mobilization of patients and wound healing. In this prospective, randomized clinical study conducted between January 2005 to December 2008, 213 patients with late 2[nd] degree; third or fourth degree hemorrhoids were assigned to two groups. One hundred ten patients in group A were operated by an open method and 103 patients in group B were operated by closed method. Age ranged from 22-70 years with mean age of 45.5 years. peak incidence was between 41-50 years. Out of 213 patients, 170 [79.81%] were male and 43 [20.18%] were females. The mean +/- SD operating time was significantly more in group B [31.3 +/- 4.8 min] than group A [25.2 +/- 5.6]. The duration of hospitalization and duration off from work was more in group A than the group B. Wound healing was quicker in group B than the group A. Post operative pain scores were significantly low in the Group A than Group B during first 24 hours and at first bowel movements. Reactionary hemorrhage occurred in 4 [3.63%] patients of group A, no patient in group B developed this complication. Retention of urine was seen in 13 [11.81%] patients in group A and 4 [3.88%] in group B. No patient in group A developed anal stenosis, while 3 [2.91%] patients in group B developed anal stenosis. Wound infection was one [0.9%] in group A and two [1.9%] in group B. Two [3.63%] patients in group A came with recurrent hemorrhoids and in group B, only one [0.97%] patient reported recurrence. The closed technique is more beneficial with respect to postoperative pain, control of bleeding, early mobilization of patients and wound healing

Distal urethral stent: a patient friendly approach after repair of hypospadias

In this case report we present a case of surgical repair of hypospadias followed by stenting of only distal part of urethra. The purpose of this report is to discuss the effectiveness of stenting of only distal urethra leading to better post operative outcome and better patient compliance without any complication

Acute respiratory distress syndrome with miliary tuberculosis

A 71-year-old man was admitted to the hospital complaining of productive cough and weight loss. Physical examination showed fine bilateral basal crackles. Laboratory findings showed elevated liver enzymes. Tuberculin skin test and sputum smear for acid-fast bacilli were negative. On the fifth day of admission, he deteriorated and developed severe respiratory distress. A chest radiograph demonstrated worsening pulmonary infiltrates. He was electively intubated and was put on a mechanical ventilator. The chest CT scan revealed diffuse bilateral pulmonary nodules and airspace disease. Based upon the clinical suspicion of acute respiratory distress syndrome associated with miliary tuberculosis [TB], empiric treatment with antituberculosis and systemic steroids was started. He was extubated after 6 days. The diagnosis of miliary TB was confirmed by a thoracoscopic lung biopsy. He was discharged with a near normal chest radiograph and was followed up as an outpatient

Appendecectomy during pregnancy. a comparison of laparoscopic with open appendicectomy in respect of safety and morbidity to mother and fetus

Acute appendicitis is the most frequent non-obstetric emergency that require surgery for the period of pregnancy. The aim of the study was to assess Laparoscopic versus Open method of appendicectomy in pregnant patients in respect of benefits and hazards to patients and fetus. Comparative Study. This study was conducted at Alrass General Hospital Saudi Arabia from 1[st] March 2008 to 1[st] June 2010. Pregnant women having acute appendicitis admitted in Alrass General Hospital Saudi Arabia and underwent open or laparoscopic appendicectomy were studied. A total of 118 pregnant women were operated for acute appendicitis. 66[55.9%, n = 118] patients underwent open and 52[44.1%, n = 118] patients underwent Laparoscopic appendicectomy. Mean age +/- SD [range] of patients 23.45 +/- 4.5 years [18-38] in OA [open appendicectomy] group and 22.00 +/- 2.94 years [17-37] in LA [Laparoscopic appendicectomy] group. Mean gestational age was 16.51 +/- 4.17 weeks [11-26] in OA and 18.28 +/- 4.61 weeks [10-27] in LA group. There were no fetal loss in any group. Pre-term delivery occurred in 6[9.1%] patients in OA and in 4[3.7%] patients of LA group. In laparoscopic surgery there is no increased risk to mother and fetus as compare to open surgery

Outcome of the rubber band ligation with Milligan Morgan haemorrhoidectomy

Haemorrhoids is a common anorectal disease seen in our society. Conservative management is usually adopted for 1[st] and 2[nd] degree haemorrhoids. Patients who do not respond to above management are the candidates for other modalities of treatment which includes sclerotherapy, rubber band ligation, cryosurgery and stapler gun or open haemorrhoidectomy. The purpose of study was to compare the outcome of the Rubber band ligation with Milligan Morgan haemorrhoidectomy in patients with 2[nd] and 3[rd] degree haemorrhoids. Hundred diagnosed admitted patients of uncomplicated 2[nd] and 3[rd] degree piles were treated either with rubber band ligation [RBL] or open method of Milligan Morgan [OH] for the period from January 2007 to December 2007 were included in the study. Both procedures were evaluated regarding effectiveness, safety, complications after procedures, hospital stay and return to work on a written Performa. Patients with 1[st] and 4[th] degree haemorrhoids, below the age of 12 years, bleeding diathesis, associated local anorectal conditions requiring surgery, complicated haemorrhoids, recurrent and secondary haemorrhoids were excluded from the study. Follow up of all these patients was done in OPD to assess any complication and recurrence. Data was analysed through SPSS-16.0. One hundred indoor patients with 2[nd] and 3[rd] degree haemorrhoids were treated either with rubber band ligation or open technique. Most [>90%] of the patients were males. Majority of the patients were in 30-33 years age group. Fresh bleeding [90%] and constipation [45%] were the commonest symptoms followed by prolapsed, discharge and irritation. Second degree was more common than 3[rd] degree haemorrhoids. Intensive pain was the commonest complain after both the procedures, however faecal incontinence was not reported in either group. Hospital stay was longer in open technique [70%] compare to few hours to one day in rubber band ligation group. Return to work was earlier in patients treated with rubber band ligation. Rubber band ligation is safe and effective method compare to open technique in 2[nd] and 3[rd] degree symptomatic haemorrhoids

Management of giant inguinal hernia

Objectives: to determine the frequency and evaluate the clinical presentation and management policies of giant inguinal hernia

Design: descriptive study

Place and duration of study: this study was conducted in the department of surgery at Liaquat University of Medical and health Sciences Jamshoro / Hyderabad and Rajputana Hospital Hyderabad from October 2000 to September 2002 [two years]

Material and methods: male patients of all ages with giant inguinal hernia diagnosed clinically were included in the study. A uniform system of history taking, physical examination, investigations and treatment was adopted for all patients and information was recorded on predesigned proforma

Results: all 30 patients were male with age ranging from 50 to 70 years. Average age being 54.33 +/- 5.62. Most of the patients 60% were farmers by occupation and having right sided giant inguinal hernia. Ninty percent of patients presented as an uncomplicated case with complaints of giant inguinoscrotal swelling causing difficulty in walking, sitting and difficulty in voiding. Only 3 cases [10%] were admitted with features of intestinal obstruction. Out of 30 cases, 14 [46.66%] underwent basini repair while 8 [26.66%] underwent repair with mesh and orchidectomy. Right hemicolectomy including resection of half portion of ileum with orchidectomy and mesh repair was done in 8[26.66%] patients. Two patients of 70 years died due to cardiorespiratory failure while one patient died because of renal failure. Clinically maximum number of patients [46.66%] belonged to MHL grade-I while only one patient belonged to MHL grade-IV. Postoperative complications, hematoma in 5 patients[41.6% cases] and wound infection in 4 patients [33.33%] were the most common complications followed by chest infection developed in 3 [10%]. Twenty cases [66.66%] had hospital stay of 7 to 9 days while others were discharged late due to postoperative complications

Conclusion: the frequency of giant inguinal hernia is more among patients of old age, labour class and from rural areas. It is common in our population because of ignorance of hernia, living in remote areas and unawareness of complications of the disease

Volvulus of caecum

This case report describes volvulus of caecum in a young boy of 18 years, who presented with symptoms of acute abdomen. The condition was diagnosed at laparotomy and the patient was treated with right hemicolectomy

Cholecystectomy; is drainage necessary?

To compare the outcome of cholecystectomy with and without drainage. The study was carried out from Jun 2005 to Nov. 2006 at Unit III, Department of Surgery, Liaqat University of Medical and Health Sciences, Jamshoro. All the patients diagnosed as cholelithiasis were treated with open cholecystectomy. The patients were randomly divided in group A and B. Number 18 Nasogastric tube was inserted in subheptic space after cholecystectomy in Group A, and no drain tube was placed in group B patients. Postoperatively patients in both groups were given same antibiotics. Postoperative complications and hospital stay were monitored in both groups. Exclusion criteria were cardiopulmonary disease, cirrhosis liver and diabeties mellitus. Patients with acute cholecystitis and choledocholithiasis were also excluded from study. Z-test is used to test the difference between proportions of two groups are statistically insignificant. During the study period a total of 100 patients were operated for cholelithiasis, with 50 patients in each group. The mean age for group A and B were 46 and 45 years respectively. The female to male ratio in the group A and B were 45:5 and 43:7 respectively. Mortality rate in both groups was zero. Group A had two cases of infected collection in subhepatic space and five cases of wound infection. In group B one patient with bile collection, one infected collection and two cases had wound infection. Mean hospital stay was 3.7 in group A as compared to 2.26 in group B. Both groups are statistically insignificant with respect to complications. Routine drainage after cholecystectomy is unnecessary

Clinical presentation and diagnosis of colorectal cancer

Fifty-six patients with colorectal carcinoma were managed during the period January 1995 to July 1996 at Hayat Shaheed Teaching Hospital, Peshawar. The male to female ratio was 1.24:1 with a mean age of 45.64 years. A Large number of patients [28.57%] were in the younger age group i.e.

Immunoglobulins and serum proteins in toxoplasmosis

Immunoglobulin levels in 47 children [age 13-20 years] with toxoplasmosis were compared with 46 age and sex matched controls. No significant difference was observed in mean serum immunoglobulin [IgG, IgA, IgM] levels between patients and controls but mean IgM levels were significantly [P] higher in children with acute toxoplasma infection. Total proteins were higher in patients while mean albumin and globulin levels were similar between the two groups. Estimation of serum immunoglobulins in young children with toxoplasmosis has no significance and should not be considered as an immunodiagnostic tool

Candida onychomycosis: an evaluation of the candida species as primary keratinolytic yeasts in nail disease

This is a pilot study of 5 nail specimens to evaluate the role of Candida species in onychomycosis by taking pure isolates of different species of Candida, growing these yeasts with normal nail keratin and assessing the growth of fungus periodically macroscopically and the final evaluation was made under electron microscope. The results suggest that the Candida albicans primarily has an important role in keratolysis of nails