kerbala journal of pharmaceutical sciences

Background: The availability of chronic diseases medications is an essential component of any welfare healthcare system. As a result of the inflated demand for these drugs, and the substantial cost they incur, several managerial approaches have been used to ensure the optimum use of the usually scarce financial healthcare resources. Cost-Minimization Analysis is an approach of pharmacoeconomics that deals with the use of generic medications wherever the legal and bioequivalence conditions are available. Objective: to determine whether the usually scarce financial resources are used in an optimum manner, through examining the level of application of Cost-Minimization Analysis (CMA) approach, as a mean of evaluating different bioequivalent alternatives, in order to incur maximum cost saving in the process of product procurement. Methods: This is an observational, cross-sectional study through reviewing the manufacturing sources, originator or generic, of the available anticancer medications in the surveyed oncology hospital, and how that affects the availability of these medications at the moment of conducting the study. Results: Out of 71 drugs in the Iraqi National Anticancer Drugs List, only 21 drugs (29.58%) were available. Twelve drugs out of the available twenty one medicines are originators (57.12%), seven medicines are generics (33.33%) and two drugs are available in both generic and originator form (9.53%). Out of the twelve products available from the original sources, only Rituximab is an available originator where no bioequivalent alternative generic is legally available (8.33%), while bioequivalent alternative generics are internationally available for the other eleven drugs (91.67%). Conclusions: there is a clear shortage of anticancer drugs in the surveyed oncology hospital. The Iraqi public healthcare sector is struggling to meet the actual needs of the medications listed in the national drug list, although the list does not contain unproven cost-effective anticancer medicines. The study demonstrated potential mismanagement of the scarce financial resources in the scope of non-application of Cost-Minimization Analysis; significant financial resources are devoted to originator- source medicines, the alternative bioequivalent generics of which are available.

Background : The worldwide popular method remains the oral combined contraception in prevention of pregnancy and consider in many countries the first choice of women that visit family planning clinics. Its action in multiple level by inhibition of ovulation, thickening of cervical mucus, interrupt penetration of sperm and disturb receptivity of endometrium lead to impairment of implantation. The weight gains mostly due water retention by the effect of estrogen and progesterone content of combined oral contraception. Patients and methods: A cross sectional study enrolled 300 women that attendants the family planning unit in primary health care. In period from Nov 2018 to Jun 2019. Women were eligible for this study age between 20-45 years and current use of combined oral contraception for prevention of pregnancy for at least three years ago. Data were collected by interview every participant enrolled in study with guidance of questionnaire. The sample further divided into groups according to body mass index (BMI) which is calculated according to formula BMI (weight (kg)/ height (m2)). Result :The result presented the mean age was 34.5 years, the mean of weight 65.8 and mean of body mass index was 24.1 kg/m2. Also 73% of sample were normal weight, and only 15.6% reported as gain in weight during uses of oral combined contraception. 12.3% of women that currently use of contraception with normal weight reported occurrence of pregnancy while in obese group 16% .The difference between two categories was insignificant. Conclusion : The weight gain during taking of contraception might be due to genetic or life style habit of women and not absolutely blame to combined oral contraception. In addition, there was no considerable effect of increase body weight in efficacy of combined oral contraception.

The period of transition between childhood to adult hood is called adolescent. The WHO defined the age of this period between (15-19 ) y. Female when become pregnant during this period called teenage or adolescent pregnancy. Adolescent birth rate is one of health indicators for family and community health, in addition to other indicators such as maternal mortality and antenatal care coverage, these indicators monitor of health of population.
Adolescent pregnancy is public phenomenon worldwide. More prevalent in sub-Saharan African countries and low in south Korea. Ninety percent of children that born to women less than 20 years are lived in developing countries.
Patients and methods
A case control study was included 141 mothers visiting Al Askan primary health care center in Kerbala city for postnatal care and for baby’s vaccination followed the delivery, in period from 1st February 2018 to 30th September 2018. The women ages were enrolled in study range from (15- 35 ) y. Participants divided into groups cases represented mother experience pregnancy below age of 20 years and control group included mother experience pregnancy over age of 20 years.
Result : Sixty-one women were represented the number of cases in study with mean age 18.4±1.3 and eighty women were represented control group with age 29.1±4.8. Anemia was more frequent complication presented in adolescent group in 86.8% while in adult pregnant women 51.2% this difference was highly significant p-value close to 0.001.
Conclusion : The study concludes the pregnancy during adolescent period has significantly higher rate of adverse outcome mostly on mother life that lead to more medical complication.

Background: Brain natriuretic peptide was first isolated in 1988 from porcine brain, then a similar substance (hormone) was discovered to be secreted by the heart ventricles cardio myocytes in response to stretch. A lot of debate is running for decades regarding its functions as an indicator of the type of pathology or prognostic outcome in strokr patients.
Patients and methods: Twenty four men and twenty four women with admitted at Al Husssieni Teaching hospital within 12 hours of cerebrovascular accidents were investigated to evaluate NT-pro-BNP and troponin levels estimation as indicator for determining pathology type and prognosis in stroke patients.
Results : The maen age mean age of the patients was 50.77 ±12.98 year. Two thirds of the patients had cerebral ischemia, 29% had intracranial hemorrhage and only 6% had sub-arachnoid hemorrhage. There was no significant difference in the mean Pro-BNP level between these three types of stroke and the mean was 29.62±17.10 ng/dl, 143.25±38.29 ng/dl and 179.65±32.27 ng/dl for sub-arachnoid hemorrhage, intra-cranial hemorrhage and cerebral ischemia, respectively. Similarly no significant gender difference was detected (p=.167), nor there was a difference between those who deceased (20.8%) and those who discharged a live (p=.726). The highest fatality rate differ significantly among different types of stroke, and was highest among those with sub-arachnoid hemorrhage (100%), modest anong patients with intra-cranial hemorrhage (50%), while the least was among those with ischemia (no death). The cardiac complications after stroke were explored, but these did not affect NTproBNP level significantly. Conclusions: brain natriuretic peptide (BNP) level was found not to be significantly different across the thtree main types of stroke. Its level was not affected by gender and it provides no progmostic importance for the fate or oucome after stroke.

Objective
To evaluate the effectiveness of a risk malignancy index (RMI) in both premenopausal and postmenopausal women with ovarian tumor.
Study design
Prospective observational study between October 2017 and October 2018.
Setting
Department of obstetrics and gynecology, Baghdad teaching hospital.
Patients and methods
Fifty-two women with ovarian mass enrolled in the study Preoperative serum CA125 level, ultrasound findings and menopausal status were recorded to calculate the risk malignancy index (RMI) accounting for each patient. Laparotomy done for each patient and histopathological result were recorded.
Results
From the Fifty-two women, 71.2% were premenopausal and 28.8% were postmenopausal, twenty-two women (42.3%) had malignant ovarian tumors and 65% of malignant cases were postmenopausal.
CA125 concentration was more significant among postmenopausal women than premenopausal (median 152IU/ml versus 32 IU/ml) respectively.
Risk malignancy index (RMI) score yielded better diagnostic performance for ovarian masses differentiation than individual parameter. The optimal RMI score to predict malignancy was at a cut-off value of 209 with a sensitivity of 72.7 % and a specificity of 100%. The ROC (receiver operating characteristic) curve for the RMI score was 0.97, which greater than the areas for U/S (0.94) and CA125 (0.84).
Conclusion
Risk malignancy index (RMI) is a simple diagnostic tool provides a quantitative assessment of risk of malignancy by incorporating serum CA125 levels, U/S findings and menopausal status (in both pre menopause and post menopause) performed individually in women with ovarian masses.
The main purpose of this study was the evaluation of the risk of malignancy index defined in a selected population with ovarian tumor.
It can be used to discriminate between benign and malignant ovarian tumors.
It is useful in referring patients with advanced tumors to a more complex health care unite, although it does not seem to show prognostic value.
This index is a simple score system which can be applied directly to clinical practice and might be of value in the preoperative assessment of the ovarian mass with only a few numbers of false negative cases.

Background The gathering of urine for 24hrs for total protein was nominal and long test procedure and consider as ideal way .It was not free of alert ,to alternate this 24 hrs collection procedure, the physician work in new way of one voided spot urine protein to creatinine ratio correlate to 24hr urine protein excretion. Patient and method Sixty- six patients taken from outpatient clinic in nephrology unit of Imam AL Hussein Medical city .Thirty-seven of patients were male and 29 of patient were females ,patients with systemic lupus erthromatosis ,diabetes mellitus ,urinary track infection and pregnancy were exclude. Patients dividing into 5 groups according to glomerular filtration rate , urine and serum Creatinine was calculated. The result of 24hr proteinuria and Up/C ratio calculated to patients and according to glomerular filtration rate the result obtain to each groups. Result The correlation between urine protein to creatinine ratio and 24hr urinary protein excretion at the different level of glomerular filtration rate were calculated and find significant correlation (1.94 to 2.04) in all five groups with P value <0.05 significant .Conclusion From this study found that single voiding protein to creatinine ratio was an alternative to 24hr to asses protein urea at all stage of glomerular filtration rate .

Background and objective: Pulmonary hypertension together with right ventricular dysfunction are considered as risk factors that increase mortality and morbidity in patients with renal impairment, fluid over load and high systolic blood pressure. The current study tries to investigate any association between hemodialysis, right ventricular dysfunction and pulmonary hypertension.
Patients and method.
This is a cross-sectional study performed to predict the association of end-stage renal disease and dialysis with right ventricular dysfunction and pulmonary hypertension. Thirty patients (age range 35-68 years) in hemodialysis unit in Imam- Al-Hussein Medical City in Karbala, Iraq were assessed for pulmonary hypertension and right ventricular dysfunction. Whereas, twenty control persons (age range 34-65 years) who had no renal failure and no dialysis were assessed for the same purpose. Heart failure, obstructive air way disease and cardiac disease were excluded from the study. Echocardiography study was performed after taking informed consent from all participants. Blood pressure and cardiac (and pulmonary) indices were measured and finding were statistically analyzed to detect any association. All the above findings were compared in the two study groups.
Result: The average systolic diastolic blood pressure was significantly higher in hemodialysis than in control group. Regarding echocardiography, the following indices were found in the dialysis group: LVH, increase long RT ventricular dimension, increase RT ventricle fraction area change, increase tricuspid plane systolic excursion, decrease in systolic velocity at tricuspid valve, increased RT ventricular wall thickness and increase in systolic pulmonary artery pressure. In addition, the dialysis group showed increase mid zone RT Ventricular dimension , though the difference of the latter was non-significant.
Conclusion: Data of the current study revealed high incidence of pulmonary hypertension and right ventricular dysfunction among hemodialysis patients with chronic renal failure.

49 urine samples taken from female having (UTI) and taking oral contraception pill for long time,.samples were collected and divided into: (23) sample from women taking contraception more than one year and having inflammation., (15) urine sample from women taking contraception less than one year and having inflammation and (11 )sample from women taking contraception for one month.
These patient divided into age groups:
- (20-30) years (this group include 17 (100%) patient and result show that 9 (53 %) of patient show no infection and only 8 (47 %) of patients show infection.
- (30-40) years (this group include 17 (100%) patient and result show that 8 (47 %) show no infection and 9 (53 %) show infection.
- (40-50) years (this group include 15 (100%) patient and result show that 7 (47 %) show no infection and 8 (53 %) show infection. The results of this study showed a significant infection occur among the women with age of more than 30years and infection in women with age less than 30 years occur to lesser extent.so that this result given us an indication of that prolong use of oral contraceptive pill may contribute to the increase risk of UTI and infection was appear to be occur in women with age of >30 years. various hormones can affected by Birth control pills and disrupt hormonal regulations. the estrogen level may reduce dramatically by some birth control pills, then cause vaginal abrasion which leading to dryness increase, damaging tissue and irritation.. researchers suggested that the birth control should don't taking by women with yeast and UTI chronic infection .