Issue 2004-4

2004; Vol 4(1): 1-25
1.Evaluation of pharmaceutical care program in pregnant women with iron deficiency anemia.
Natenaree Sirisopaa* and Manat Pongchaidechab
a Postgraduate Student in Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmacy, b Department of Pharmaceutics (Clinical Pharmacy), 
Faculty of Pharmacy, Silpakorn University, 6 Rajamankha Nai Rd., Muang,Nakhon Pathom 73000, Thailand.
Correspondence: Dr Natenaree Sirisopa, e-mail:
Abstract. Iron deficiency anemia in pregnancy is a major public health problem in Thailand. It is an important cause of serious adverse effects on 
mothers and infants. The aim of this quasi experimental study was to evaluate the effect of pharmaceutical care program in pregnant women with 
iron deficiency anemia at the antenatal clinic of Kaengkhoi Hospital, Saraburi, Thailand. Subjects were recruited and enrolled by specific criteria, 
and given informed consents based on the hospital ethic committee agreement. The program was given to the experimental group (n=27) which 
was then compared with the control group (n=27) by looking at 1.mothers’ knowledge of iron deficiency anemia in pregnant women, 2.compliance 
of pregnant women regarding iron supplementation and 3. levels of hematocrit (Hct). Data analysis was performed by SPSS V11.5. Results showed  
that 3 months after implementing the program, the experimental group had the average scores of knowledge significantly higher than those of the 
control group (7.48±2.40 vs. 4.63±2.35, p=0.000). The compliance of pregnant women regarding iron supplementation in the experimental group 
was also significantly higher than the control group (2.34±1.37 vs. 3.33±1.4, p=0.004). During the      3 months period, there were significant increases 
in Hct levels in the experimental group (31.79±1.46, 32.31±2.27, 33.04±2.73%, p=0.028), whereas there were no significant increases in the control 
group (31.43±1.99, 31.52±2.33, 32.08±2.68%, p=0.178).Although Hct levels between the experimental group and the control group were not significantly 
different (33.04±2.73% vs. 32.08±2.68%, p=0.188), only the experimental group showed greater Hct levels based on the WHO criterion (Hct≥33%). 
In conclusion, this study has demonstrated that the implemented pharmaceutical care program could be used as a guideline to increase the knowledge 
and compliance, and thus the Hct levels in pregnant women with iron deficiency anemia.
Keywords: Iron deficiency anemia; Pregnant women;Phamaceutical care; Hematocrit
How to cite: Sirisopa N and Pongchaidecha M. Evaluation of pharmaceutical care program in pregnant women with iron deficiency anemia. Int J Clin Nutrition 2004; 4: 1-5.

Jan Fedacko (1), Petra Fedackova(2), RB Singh(3),TK Basu. 1,2PJ Safaric University, Kosice, Slovakia; Halberg Hospital and Research Institute, Moradabad, 
India; 4Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Canada.
Correspondence: Dr Jan FedackoMD, PhD, PJ Safaric University, Kosice, Slovakia,  Email:
Abstract. The seeds of fenugreek  are rich sources of fiber and antioxidants which may inhibit atherothrombosis due to its anti-inflammatory, antioxidant, 
hypolipidemic and nitric oxide activating effects. In the present trial, we examine the effects of fenugreek seeds  on biomarkers of cardiovascular diseases 
(CVDs). In a randomized, double blind, placebo controlled trial in a hospital, patients were recruited after informed consent and clearance from the ethic 
committee.All subjects (n=61) with mild to moderate hyperlipidemia were assigned to American Heart Association step 1 diet for a period of 12 week and 
then randomized to two different test agents in identical sachets for another 12 weeks. The test agents were fenugreek seeds powder (60.0g/day) and 
cellulose placebo (3.g/day).Of 61 subjects with serum cholesterol between 5.17 and 7.76nmol/1, 59 successfully completed 12 weeks of NCEP step I 
diet and then augmented the diet with one of the fibre or fenugreek supplement for additional 12 weeks. Incremental differences from placebo for 
low density lipoprotein (LDL) cholesterol were: -15.1% for fenugreek; for total cholesterol the differences were -13.4% for fenugreek. The incremental 
differences in triglycerides (significant) for fenugreek were -9.5% with a 4.4% increase in HDL cholesterol. LDL/HDL cholesterol ratio showed significant 
decline from the baseline levels in the fenugreek group without such changes in the control group. Fasting and postprandial blood glucose as well as 
lipid peroxides and diene conjugates (indicators of oxidative stress) and TNF-alpha showed significant decline in fenugreek  group whereas these changes 
were non-significant in the placebo group. The incremental differences in lipid peroxides and diene conjugates were significant for fenugreek. 
The incremental differences in serum nitrite (indicator of nitric oxide) for fenugreek were significant causing an increase in nitrite levels. 
Compliances to treatment varied between 92% and 99% and only mild gastrointestinal side effects were observed. Intervention  with fenugreek seeds 
revealed significant hypoglycemic, hypocholesterolemic, antioxidant, anti-inflammatory and nitric oxide activating effects, on NCEP step 1 diet effects. 
Keywords. Flavonoids, HDL-Cholesterol, antioxidant, oxidative stress, cytokines.
How to cite: Fedacko J, Fedackova P, Singh RB, Basu TK. Effects of  fenugreek seeds  on inflammation  and nitric oxide in patients with hyperlipidemia. 
Int J Clin Nutrition 2004; 4: 6-10.
Teodora Handjiev Darlenska (1), Krasimira Hristova (2), Svetslav Handjiev(3), MA Niaz ((4); 1Department of Pharmacology, Sofia University, Sofia, Bulgaria,
3National Heart Hospital, Sofia, Bulgaria; 4BASORD, Sofia, Bulgaria; 4Halberg Hospital and Research Institute,
Correspondence: Dr Teodora Handjieve Darlenska,MD,PhD, Department of Pharmacology, Sofia University, Sofia, Bulgaria, Email.
Abstract. Vitamin and mineral deficiency may be important in the pathogenesis of  cardiovascular diseases (CVD) and other chronic diseases such as type 
2 diabetes and cancer. Epidemiological studies indicate that vitamin A, E  and C and beta-carotine as well as  folic acid and selenium, zinc and copper 
were inversely associated with risk of morbidity and mortality due to CVDs and cancer. Randomized, controlled intervention trials showed  beneficial 
effects in CVDs and cancers in some initial studies but no evidence of benefit in the prevention  in the later trials. However, adverse effects were observed 
in some of the important studies indicating that further trials are not necessary. Hence, there is no evidence to support the use of vitamins in the prevention 
of CVDs and cancer. Further studies are necessary to find out the role of vitamins and minerals in children, malnutrition and chronically ill people in the elderly 
population. Since vitamin C consumption during antenatal period has been protective against damage to fetus, it seems that administering vitamins to pregnant 
women may be a new area of research.
Kewwords. Minerals, heart disease, oxidative stress, stroke, cancer.
How to cite: Teodora Handjiev Darlenska (1), Krasimira Hristova (2), Svetslav Handjiev(3), MA Niaz ((4); Effects of vitamins and mineral supplements on risk of 
vitamin dificiency: state of the evidence. Int J Clin Nutrition 2004;4: 16-20.

RG Singh, RB Singh(2), J Nagchaudhuri(3), Fabien De Meester. Institute of Medical Sciences, BHU, Varanasi, India; The Tsim Tsoum. Institute, Krakow, Poland
Correspondence: Prof Dr RG Singh, MD,DM, Department of Medicine, Institute of Medical Sciences, BHU, Varanasi, India; Email:  <>
According to Mahabharata(5000 BCE), the ancient scripture of India, Maharshi Chyawan was one of the eight son of St. Bhrigu and Puloma. He was physically 
weak due to his premature birth but he was enjoying the status of being the only divine son of St Puloma. Maharashi Chyawan married King Sharyati’s daughter 
Sukanya at an old age. Sometime after the marriage, the twins Ashvini Kumaras came to the hermitage of saint Chyawan and offered him a medicine after the 
use of which the saint regained his youth. That medicine was named as ‘Chyawanprash’ after the name of Chyawan; thus it is a divine preparation. This tonic 
is available in semisolid form and is a rich in flavonoids, vitamins and monerals as well as fiber. The main ingredients are: amla (stargoose berry)  rich in vitamin 
C and pectin, tannins which are potential antioxidants,  retard the oxidation of vitamin C. Indian ginseng or winter cherry, long pepper, saffron, tinospora cordifolia, 
pistanchio tree or zebra wood, asparagus racemosus,and flex seed, honey and clarified butter. Chyavanprash tonic may be beneficial in immune function, vigor, 
power, memory function, and physical fitness. Basic science research is urgently required to find out its biochemical and clinical effects to establish its role in 
the prevention of diseases and health promotion.
Keywords. Antioxidant, immunity, oxidative stress, memory.
How to cite: Singh RG, Singh RB, Singh RK, J Nagchaudhuri J,De Meester F. Chyawanprash; the oldest tonic of the world.Int J Clin Nutrition 2004; 4: 16-20.

Jan Fedacko1, Daniel Pella1, Peter Horvath1, Petra Fedackova1, Petra Durcikova3 and Ram B Singh4 ;Faculty of Medicine, Safaric University, Kosice, Slovakia.
Faculty of Medicine, Safaric University, Kosice, Slovakia; Halberg Hospital and Research Institute, Moradabad, India 
Correspondence: Jan Fedacko, MD,PhD, Medical Faculty of Safarik University and Pasteur Univeristy Hospital,
Kosice, Slovakia; Email: janfedacko@hotmail. com
Abstract: Coenzyme Q (CoQ10) deficiency has been observed in patients with cardiovascular, neurological and other diseases. The 
objective is to evaluate possible benefits of ubiquinone supplementation in cardiovascular diseases(CVDs) and degenerative diseases of the brain. 
CoQ10 has strong influence on lipid metabolism, oxidation of blood lipids, vascular inflammation and on the cell membranes of cardiac and arterial 
cells and neurons. These pathogenetic mechanisms seem to be important in patients with neurological and cardiac disease as well as in brain-heart 
connection.  Its supplementation has several beneficial effects including the stabilisation of atherosclerotic plaque and decreasing the size of myoacardial 
infarction and the protection of neurons. Antioxidant properties of CoQ10 are responsible for the prevention of many drug side effects. Several studies 
have suggested the beneficial effect of CoQ10 in neuro-cardiovascular diseases, that will require further confirmation. Adverse effects such as nausea 
and vomiting may be reduced by using highly bio-available brands, that reduce the oral dosage of COQ. CoQ10 is still in the investigational stages and 
the list of possible indications related to brain and heart diseases and their linkage, appears to be quite extensive. There is still the need for a number of 
large, double blind multicenter, randomized, controlled clinical trials, in order to confirm the possible beneficial effects of CoQ10 supplementation in 
different neurocardiological conditions. 
Keywords: Heart diseases, brain degeneration,  antioxidant, oxidative stress.
How to cite: Fedacko J, Pella D, Horvath P, Fedackova P, Durcikova P and Singh RB. Coenzyme q10 in cardiovascular and brain diseases