Myofascial Pain Syndrome: A Report of 11 Cases Treated by Myofascial Massage Therapy, Riyadh, Saudi Arabia | Chapter 2 | Trends in Pharmaceutical Research and Development Vol. 1

Background: Myofascial pain syndrome (MPS) is a common pain condition characterized by a key symptoms and signs, determined by multiple etiologies, comorbid with a variety of systemic diseases and regional pain syndromes (RPS) and managed by diverse integrative therapies including complementary and alternative modalities (CAM) with variable outcomes. Objective: This study aimed to concisely report 11 cases of myofascial pain syndrome managed by myofascial trigger point therapy.  Methods: The relevant information about 11 cases was collected prospectively using a semistructured proforma. All patients were diagnosed mainly by detailed history and gold standard palpation method that helps identify taut muscles, tender myofascial trigger points, local twitch response and autonomic manifestations.  Results: Most of the patients with variable age and profession presented in emergency room with acute pain, limited motion, weakness, referred pain of specific pattern and associated autonomic signs and symptoms. Myofascial trigger point therapy alone with a timeline of about 30-60 minutes of 1-3 sessions brought about good results in all 11 patients (100%) who remained stable at two to three months follow-up.   Conclusion: Myofascial pain syndrome linked with latent or active myofascial trigger points developed due to repeated strains and injuries needs to be diagnosed by history and palpation method, systemic evaluation and laboratory investigations. Though several interventions are used in myofascial pain syndrome, myofascial trigger point massage therapy alone is found to be reasonably effective with excellent results. This clinical case series is calling for double-blind randomized controlled trials among patients with myofascial pain syndrome not only in Saudi Arabia but also in other Middle East countries in future.

Author(s) Details

Naseem Akhtar Qureshi 
National Center for Mental Health Promotion, Ministry of Health, Riyadh, Saudi Arabia.

Hamoud Abdullah Alsubaie
National Center for Complementary and Alternative Medicine (NCCAM), Ministry of Health, Riyadh, Saudi Arabia.

Dr. Mohammed Khulaif Alharbi
Department of Anesthesia, Faculty of Anesthesiology, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Gazzaffi Ibrahim Mahjoub Ali
National Center for Complementary and Alternative Medicine (NCCAM), Ministry of Health, Riyadh, Saudi Arabia.

Dr. Saud Mohammed Alsanad
College of Medicine, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Kingdom of Saudi  

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Novel Separation and Quantitative Determination of Levofloxacin, Prulifloxacin, Gatifloxacin, Sparfloxacin, Moxifloxacin and Balofloxacin Fluoroquinolone Antibacterials in Pharmaceutical Dosage Forms by RP-HPLC Method | Chapter 1 | Trends in Pharmaceutical Research and Development Vol. 1

For the first time, Simple, selective, sensitive RP-HPLC method developed for the separation and quantitative estimation of Levofloxacin (LEVO), Prulifloxacin (PRFX), Gatifloxacin (GATI), Sparfloxacin (SPAR), Moxifloxacin (MOXI) and Balofloxacin (BALO) relating to fluoroquinolone antibacterials in pharmaceutical dosage forms. The important advantage of the developed method was that the six separate drugs could be estimated on a single chromatographic system without modifications in detection wavelength and mobile phase by RP-HPLC. The chromatographic separation of the selected drugs carried out on Welchrom C18 column consisting of 250 mm X4.6 mm, 5 µm particle size utilizing mixture of 10 mM phosphate buffer (pH 3.1): Acetonitrile in the ratio of 70:30,v/v as mobile phase at the flow rate of 1 mL/min with detection wavelength at 293 nm by using UV spectrophotometric detector with total run time of 10 minutes and 3.613, 4.230, 4.707, 5.497, 5.880 and 6.253 minutes of retention time, 12,261, 12,554, 13,157, 14,761, 14,912 and 15,916 of plate number, 1.106, 1.067, 1.040 and 1.073, 1.030 and 1.086 tailing factors were obtained for LEVO, PRFX, GATI, SPAR, MOXI and BALO respectively. All calibration curves for six drugs showed indicated linearity over a concentration range of 2-10 µg/mL. The results regarding to limit of detection (LOD) and limit of quantitation (LOQ) for LEVO, PRFX, GATI, SPAR, MOXI and BALO were found to be 0.116 µg/mL and 0.348 µg/mL; 0.152 µg/mL and 0.460 µg/mL; 0.084 µg/mL and 0.255 µg/mL; 0.186 µg/mL and 0.558 µg/mL, 0.162 and 0.493, 0.112 and 0.390 respectively. These results                clearly show the low values of LOD and LOQ. The said proposed method utilized for quantification             of the marketed formulation. The mean assay values for LEVO, PRFX, GATI, SPAR, MOXI and BALO arrived at 99.317±0.990%, 99.9±0.04%, 99.9±0.02%, 99.45±0.01%, 99.945±0.056% and 99.68±0.09% respectively

Author(s) Details

Prof. Panchumarthy Ravisankar
Department of Pharmaceutical Analysis, Vignan Pharmacy College, Vadlamudi, Guntur District – 522 213, Andhra Pradesh, India

Dr. Ch. V. Prasada Rao
Department of Pharmaceutics, Vignan Pharmacy College, Vadlamudi, Guntur District – 522 213, Andhra Pradesh, India.

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A Critical Study of Late Presenting Urachal Remnant Tumour: Rare Adenocarcinoma Originated from Developmental Defect |Chapter 10 | Trends in Pharmaceutical Research and Development Vol. 1

Occupying only 0.01% of all adult cancer patients, the rare entity urachal adenocarcinoma constitutes 22-35% of adenocarcinomas originating from urinary bladder. Though with the gradual descend of the bladder in the course of development urachus should turn into median umbilical ligament, exceptional persistence of it can give rise to urachal cyst or urachal adenocarcinoma in adulthood. With only 43% of survival rate for 5 years and mean survival between 12 and 24 months urachal carcinoma is a devastating disease. Diagnosis of it is based on the MD Anderson Cancer Centre (MDACC) criteria. Computed Tomography (CT) Scan and/or Magnetic Resonance Imaging (MRI) Scan of abdomen and pelvis are the major imaging modalities to proceed towards diagnosis and staging. Not only histopathological examination but also immune-histochemical expression of both CK7 and CK20 suffice to clinch the diagnosis. Though surgical intervention forms the mainstay of treatment, several regimens of chemotherapy have also been tried to fight against unresectable, residual, extensive urachal carcinomas. This case took place in a 52 years old male patient who was presented with a gradually enhancing infra-umbilical swelling with slow growing urinary symptoms. By dint of Ultrasonography (USG) and Contrast Enhanced CT (CECT) scan of whole abdomen the tumour was detected involving the bladder wall and the anterior abdominal wall. Cystoscopy was followed by upfront cytoreductive surgery. Histopathological examination revealed the diagnosis of an adenocarcinoma which was further confirmed to be an urachal remnant carcinoma with the help of immunohistochemistry. Postoperative CT scan showed residual disease involving bladder wall and was treated with an adjuvant platin based chemotherapy regimen.

Author (s) Details

Ipsita Dey
Department of Pathology, R. G. Kar Medical College and Hospital, Kolkata, India.

Tushar Kanti Das
Department of Pathology, R. G. Kar Medical College and Hospital, Kolkata, India.

Chhaya Roy
Department of Radiation Oncology, R. G. Kar Medical College and Hospital, Kolkata, India.

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Quantification of Propranolol in Rat Plasma by LCMS/MS Using Tramadol as an Internal Standard for Pharmacokinetic Studies in TAA-induced Liver Fibrotic Rats | Chapter 9 | Trends in Pharmaceutical Research and Development Vol. 1

A simple, rapid and selective liquid chromatography coupled with tandem mass spectrometry (LCMS/MS) is developed and validated for quantification of propranolol without the sample extraction step in rat plasma using tramadol as an internal standard (IS). The analytes are separated using an isocratic mobile phase which consist of methanol and 10 mm ammonium formate (70/30, v/v) on an isocratic UK-C18 (Imtakt Unison 2.0 × 50 mm, 3 μm) column and was analyzed by MS/MS in the multiple reaction monitoring (MRM) mode using the transitions of respective (M+H)+ ions, m/z 260.0→116.2 and m/z 264.2→58.2 for quantification of propranolol and IS, respectively. The standard calibration curves showed good linearity within the range of 2.0 to 800.0 ng/ml (r2 = 0.999, 1/x2 weight). The lower limit of quantification (LLOQ) was 2 ng/ml. The retention time of propranolol and IS were 1.12 and 0.939 min which means that it is the potential for the high-through put potential of the proposed method. In addition, no significant metabolic compounds were found to interfere with the analysis. Acceptable precision and accuracy were obtained for the concentrations over the standard curve range. The validated method was successfully applied for the pharmacokinetic studies after 2 mg/kg of propranolol HCl in the thioacetamide (TAA)-induced fibrotic rats

Author(s) Details

Ju-Seop Kang
Department of Pharmacology, Clinical Pharmacology Lab, College of Medicine, Hanyang University, Seoul 133-791, South Korea.

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Research on Evaluation of the Effect of Crude Extract of Datura innoxia on the Cardiovascular Action of Detomidine in Rabbits | Chapter 8 | Trends in Pharmaceutical Research and Development Vol. 1

Datura innoxia indigenous shrub in South Asia region belongs to the family Solanaceae which contains medicinal important alkaloids (hyoscine, atropine, hycosamine, etc). Thirty adult rabbits of mixed breed, male and female were pretreated with 0.1 mg/500 mg of crude extract (1% of dimethyl sulfoxide (DMSO) solution) and injected 5 min later with 0.01 mg/500 mg of detomidine (group A, n=15) or Saline (group B, n=15). Mean arterial pressure, measurements and electrocardiography were performed for 65 min. After injecting crude extract of D. innoxia, the heart rate was increased by 45 and 46.34% in groups A and B, respectively. Heart rate remained increased after the injection of detomidine returning to base line values after 15 min. No increase in the mean arterial  pressure (MAP) was noted in group B rabbits. Crude extract shortened PR and QT interval in both groups but after detomidine, PR and QT interval were enlarged significantly at the end of the experiment. The second degree atrioventricular was blocked in two rabbits after 40 min only in group B. It was concluded that alkaloid present in D. innoxia prevented detomidine induced Bradycardia  and might be useful during combination against the Bradycardia induced by alpha-2 agonist in the rabbits.

Author(s) Details Dr. S. U. Rehman
Faculty of Sciences, University of Central Punjab, Lahore, Pakistan.

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Effectiveness and Properties of Hydrazide Drugs that Inhibit Growth of Mycobacterium tuberculosis | Chapter 12 | Modern Advances in Pharmaceutical Research Vol. 2

Aims: To examine the properties of hydrazide compounds shown to inhibit Mycobacterium tuberculosis. To identify properties that affect efficiency of bacterial inhibition.

Study Design: Utilizing data from previous studies of compounds that inhibit Mycobacterium tuberculosis, then statistical and pattern recognition methods are applied to identify interrelationships.

Place and Duration of Study: Department of Chemistry, Durham Science Center, University of Nebraska at Omaha, from January 2016 to July 2016.

Methodology: Interrelationships of pharmacological properties were identified by use of various pattern recognition techniques, such as hierarchical cluster analysis and path analysis. Molecular properties and descriptors for all compounds were determined, with additional characteristics such as structure scaffolding and functional group position was accomplished. Statistical analysis, including Pearson r correlation, Mann-Whitney test, one-way ANOVA, Kruskal-Wallis, and descriptive statistics were determined. Multiple regression analysis of molecular property values allows prediction of similar compounds. Determination of any numerical outliers was accomplished by applying Grubb’s test.                                                                                                    

Results: Compounds inhibiting the growth of Mycobacterium tuberculosis contained an aromatic ring or were non-aromatic structures (no ring). There was weak negative correlation of MIC to formula weight. The average formula weight, polar surface area, and Log P, is 183.55 grams/mole, 63.70 A2, and 0.768, respectively. Values of MIC ranged from 14.7 µg/mL to 100 µg/mL. Extent of bacterial inhibition was similar between aromatics to non-aromatics. No outliers were identified by Grubb’s test for all values of MIC taken together. Path analysis showed polar surface area to have most effect on MIC.

Conclusion: The measured level of growth inhibition MIC, showed strong positive relationship to polar surface area, number of hydroxyl and amine groups, oxygen and nitrogen atoms. Two aromatic compounds having a pyridine ring were found to be most similar to isoniazid. Aromatic and non-aromatic compounds showed similar levels of bacterial inhibition overall.

Author(s) Details

Dr. Ronald Bartzatt
Durham Science Center, University of Nebraska, 6001 Dodge Street, Omaha, Nebraska 68182, USA.

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Prodrugs Design | Chapter 11 | Modern Advances in Pharmaceutical Research Vol. 2

Prodrug design can be used in the following cases: improving active drug solubility and consequently bioavailability, increasing permeability and absorption and modifying the drug’s distribution profile. In the prodrug design, a computational approach consisting of calculations using Molecular Orbital (MO) and Molecular Mechanics (MM) methods and correlations between experimental and calculated values can be utilized.

Author(s) Details

Professor Rafik Karaman
Department of Bioorganic Chemistry, Faculty of Pharmacy, Al-Quds University, P.O. Box 20002, Jerusalem, Palestine and Department of Sciences, University of Basilicata, Viadell’Ateneo Lucano 10, 85100, Potenza, Italy.

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Role and Effectiveness of Simulation-based Training in Raising Family Medicine Residents’ Clinical Resuscitation and Critical Care Skills | Chapter 10 | Modern Advances in Pharmaceutical Research Vol. 2

Background: Family medicine (FM) physicians are bound to providing healthcare services at a variety of clinical and community settings. They should be equipped to competently handle health emergencies in a multitude of professional procedures. Medical education on patients often raises safety issues; simulation-based medical education (SBME) was a solution enabling education in a risk free environment.

Aim: To analyze the impact of a SBME on Family medicine residents’ performance in critical resuscitation procedures.

Methods: A systematic review of published articles between 1996 and 2016 was conducted. Systematized literature search through ranked search engines was done. All original research articles on SBME published between 1997 and 2012 were examined.

Results: The analysis included 6 relevant studies selected. The studies’ venues included either academic or healthcare settings in Netherlands, Switzerland; Greece, and Canada. The studies’ populations were mainly family medicine, and general practitioner, residents who participated in simulated resuscitation/life support educational activities. The number of participants in each SBME activity ranged between 28 and 72. The study of the Greek experiment included 434 residents. An interventional design was advocated, and a self-reported questionnaire to evaluate participants’ skills pursuant to SBME activities before and/or after the learning activities was unanimously utilized. The main SBME focus involved patient resuscitation and critical event care. Most studies came to significantly positive conclusions about SBME in raising residents’ resuscitation knowledge, skill, and behavior.

Conclusions: The role of interactive SBM teaching in preparing FM residents to rescuing and resuscitating the critically ill independently is now sufficiently evident. Despite such success potential, methods to achieve improved critical care competence advocating low cost simulated medical education solutions in low economic circumstances should be sought.

Author(s) Details

Dr. Majed Kh. Al Harthi
Department of Family and Community Medicine, Medical Education Fellowship, University of Toronto, Canada.

Raouf M. Afifi (MD, PhD, MSc, MPH, MHA, FACHCE)
Community Health Research Institute, International Management-Health Services, Indianapolis, Indiana, USA and National Research Excellence Institute, Cairo, Egypt.

Dr. Mohamed A. Tashkandi
Department of Preventive Medicine, Directorate of Health Affairs, Makkah, MoH, Kingdom of Saudi Arabia.

Dr. Ashraf E. Saad (MBBS, MPH, CIC)
Department of Preventive Medicine, Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia.

Yousef Afifi
Community Health Research Institute, International Management-Health Services, Indianapolis, Indiana, USA and National Research Excellence Institute, Cairo, Egypt.

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Spectrum of Thyroid Diseases in Makurdi, Benue State of Nigeria: A Review of 94 Consecutive Cases | Chapter 09 | Modern Advances in Pharmaceutical Research Vol. 2

This study aims to review the spectrum of thyroid diseases in Makurdi, Benue State of Nigeria through a histopathological survey. It is a retrospective study covering 1st January, 2005 to 31st December, 2016.

Ninety four (94) consecutive cases of thyroidectomy specimens collected from Holy Trinity Specialist Hospital, Makurdi, Nigeria a private hospital and Benue State University Teaching Hospital, Makurdi, Nigeria between January 1st, 2005 to December 31st, 2016 were examined histologically and analyzed with regards to age and sex.

There were 7 male specimens as against 87 female specimens giving a male: female ratio of 1:12.43. Nodular colloid goiter was the commonest histological lesion accounting for 72%, followed by thyroid carcinoma which accounted for 11.66%, adenoma 10.60%. Thyroiditis, 5.30% was the fourth commonest pathology and thyroglossal cyst/duct accounted for 1.06%. Follicular carcinoma was the commonest malignancy seen accounting for 7.51% of all specimens and most occurred in females. However, most of these thyroid malignancies occurred in younger age groups (20-49years) compared to other studies in Nigeria and Africa. There is need for a large scale study in Makurdi on the relatively younger age of our thyroid malignancies, higher incidence of follicular carcinoma when compared to other African studies and the relatively high incident of thyroiditis found in this study

Author(s) Details

B. A. Eke
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

B. A. Ojo
Department of Anatomic Pathology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

A. Adekwu
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

M. Efu
Department of Anaesthesia, College of Health Science, Benue State University, Makurdi, Benue State, Nigeria.

E. I. Ogwuche
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

P. Abayol
Department of Surgery, Federal Medical Center, Makurdi, Benue State, Nigeria.

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TNF-α Inhibitor Treatment for Crohn’s Disease: Comparative Review of Post Therapy Malignancy between Infliximab and Adalimumab | Chapter 08 | Modern Advances in Pharmaceutical Research Vol. 2

The association between chronic inflammatory disease and cancer has been well established through years of research. In corollary, progressive resistance to chimeric monoclonal antibodies has been reported in literature. The purpose of this investigation was to establish the overall trend of the chimeric monoclonal antibody (Infliximab) failure compared with human monoclonal antibody (Adalimumab). It was opined that this failure may result in subclinical yet cancer-inducing inflammation that could be measurable in patient populations undergoing the therapy by examining cancer prevalence. An overall trend of increased incidence of new malignancy in patient populations on Infliximab compared with Adalimumab was confirmed from the literature reviewed. There was also a significant trend of developing Gastrointestinal (GI) related cancer in patients on Infliximab, which corresponds with the majority of the progression process in Crohn’s disease. It was opined that future observations in clinical practice will lead to the phasing out of Infliximab as a front-line monoclonal antibody in the treatment of Crohn’s disease in favor of less immunogenic monoclonal antibodies. In conclusion an increased incidence of both general and GI malignancies has been widely reported in patient populations undergoing Infliximab therapy than with Adalimumab.

Author(s) Details

Danil Hammoudi, MD
Department of Pathology, Saint James School of Medicine, BWI, Anguilla.

Adekunle Sanyaolu, PhD
Department of Medical Microbiology and Immunology, Saint James School of Medicine, BWI, Anguilla

Nirav Nagarsheth, MD, MBA
Department of Pathology, Saint James School of Medicine, BWI, Anguilla.

Jason Kimbel, M.D., MHA
Department of Pathology, Saint James School of Medicine, BWI, Anguilla.

Amos Abioye, PhD
Department of Pharmacy, Leicester School of Pharmacy, De Montfort University, Leicester, LE1 9BH, United Kingdom.

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