Objective: This work aimed to explore the possibility of using Fourier-transform infrared (FTIR) spectroscopy and chemometrics to develop multivariate models to authenticate the "halal-ity" of pharmaceutical excipients with controversial halal status (e.g., magnesium stearate).
Materials and Methods: The FTIR spectral fingerprints of the substance were used to build principal component analysis (PCA) models. The effects of different spectral pretreatment processes such as auto-scaling, baseline correction, standard normal variate (SNV), first, and second derivatives were evaluated. The optimization of the model performance was established to ensure the sensitivity, specificity, and accuracy of the predicted models.
Results: Significant peaks corresponding to the properties of the compound were identified. For both bovine and plant-derived magnesium stearate, the peaks associated can be seen within the regions 2900cm-1 (C-H), 2800cm-1 (CH3), 1700cm-1 (C=O), and 1000-1300cm-1 (C-O). There was not much difference observed in the FTIR raw spectra of the samples from both sources. The quality and accuracy of the classification models by PCA and soft independent modeling classification analogy (SIMCA) have shown to improve using spectra optimized by first derivative followed by SNV smoothing.
Conclusion: This rapid and cost-effective technique has the potential to be expanded as an authentication strategy for halal pharmaceuticals.
Objective: This study addressed the therapeutic effect of 3-(2,5-dimethoxyphenyl)-1-(5-methyl furan-2-yl) prop-2-en-1-one (DMPF-1); synthetic chalcone derivative, on antinociceptive activity in vivo.
Materials and Methods: The antinociceptive profile was evaluated using acetic-acid-induced abdominal writhing, hot plate, and formalin-induced paw licking test. Capsaicin, phorbol 12-myristate 12 acetate (PMA), and glutamate-induced paw licking test were carried out to evaluate their potential effects toward different targets.
Results: It was shown that the doses of 0.1, 0.5, 1, and 5 mg/kg of DMPF-1 given via intraperitoneal injection showed significant reduction in writhing responses and increased the latency time in hot-plate test where reduced time spent on licking the injected paw in formalin and dose contingency inhibition was observed. The similar results were observed in capsaicin, PMA, and glutamate-induced paw licking test. In addition, the challenge with nonselective opioid receptor antagonist (naloxone) aimed to evaluate the involvement of the opioidergic system, which showed no reversion in analgesic profile in formalin and hot-plate test.
Conclusion: Collectively, this study showed that DMPF-1 markedly inhibits both peripheral and central nociception through the mechanism involving an interaction with vanilloid and glutamatergic system regardless of the activation of the opioidergic system.
Objectives: This study aimed to evaluate the patterns of intraperitoneal (IP) antibiotic utilization for the treatment of peritonitis in CAPD patients.
Materials and Methods: This is a retrospective study conducted at a tertiary hospital setting in Malaysia. Medical records of CAPD patients who were diagnosed with peritonitis and registered with National Kidney Registry from 2013 to 2018 were reviewed. Types of antibiotics used and its dose and duration were recorded and reported using the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.
Results: A total of 105 peritonitis episodes were recorded from 72 patients. The most common first-line empirical antibiotic combinations used were ceftazidime/cefazolin (40%, n = 42), followed by cefepime/cefazolin (30.5%, n = 32) and ceftazidime/cloxacillin (25.7%, n = 27). The definitive therapy for culture-proven CAPD-related peritonitis (CAPD-P) showed that vancomycin was the most frequently prescribed antibiotic (31.7%, n = 26/82), followed by amikacin (14.6%, n = 12/82), meropenem (11%, n = 9/82) and ampicillin (11%, n = 9/82). Ciprofloxacin was among the least prescribed definitive antibiotics for CAPD-P (2.4%, n = 2/82) but the DDD/100 patient-days estimates showed that it had the highest therapeutic intensity.
Conclusion: There are various IP antibiotics used for CAPD-P and the most common empirical therapy was the combination of ceftazidime and cefazolin while vancomycin is predominantly used for definitive therapy. Future studies to evaluate the clinical outcomes of the antibiotic use should be conducted to have a better insight on the efficacy of the peritonitis treatment.
Materials and Methods: The articles published in different journals were retrieved by searching many research databases such as Cochrane library, Europe PMC, PubMed, and Web of Science; we searched these databases for all published articles till November 2018.
Results and Discussion: The searching results using Cochrane library showed an increase in the number of randomized clinical trials that related to the keyword of "antimicrobial stewardship" specially in the last 5 years. Using Europe PMC, we found 6178 results. From these results, there are 3874 free full texts. In addition, there are 2132 original articles in PubMed and by searching Web of Science database till November 8 there are 3085 results. These results show that the number of trusted published articles was increased continuously; this shows the increasing interest of the researchers in ASPs. These researches will help health-care providers to use antibiotics appropriately and to overcome the barriers of implementing ASPs.
Conclusion: The results of this study show that the researchers had high levels of interest in participating in research activities related to the appropriate use on antibiotics and the implementation of antimicrobial stewardship programs.
MATERIALS AND METHODS: This chapter summarizes the medical history for 7 years from January 2011 to December 2018 of patients who have been treated for oral carcinoma in the Hospital USM, Oral and Maxillofacial Surgery (OMFS) Unit. Each patient's complete medical record was checked, and data gathered were based on age, gender, site lesion, clinical diagnosis, and mortality. Version 26.0 of the SPSS software was used to evaluate the correlation and distribution of patient survival.
RESULTS: This was a retrospective cross-sectional review of the medical evidence of 117 patients infected for oral carcinoma at OMFS (Hospital USM). Sixty-seven (57.26%) of the patients were male and fifty (42.74%) were female. Patient age ranged from 25 to 93 years. Malay has the highest prevalence (85.5%) in oral carcinoma, followed by a second ethnic group, Chinese (7.7%). The result indicates that the majority of oral carcinoma patients were over 60 years old.Cases of oral squamous cell carcinoma have proved to be the most prevalent malignant tumour in the mouth cavity. The largest number of cases collected is 91% of the data collected. Mucoepidermoid carcinoma (10%) is the second most common small salivary gland tumor.
CONCLUSION: OSCC is the most prevalent kind of oral cancer. According to the data review, the most popular site for oral cancer is the tongue.
Materials and Methods: Crude methanolic fraction of E. suberosa (Roxb) bark and its respective fractions were screened for the presence of different phytochemicals with different reagents. On the basis of increasing order of polarity, different organic solvents were used to obtain different fractions. Enzymatic studies were performed on crude methanolic extract of the plant. All the assays were performed under standard in vitro conditions.
Results: The phytochemical analysis shows the presence of alkaloids, phenols, triterpenoids, phytosterols, and flavonoids. Phenolic compounds and flavonoids are the major constituents of the plant. In anticholinesterase assay, the percent inhibition of standard drug (eserine) was 91.27 ± 1.17 and the half maximal inhibitory concentration (IC50) was 0.04 ± 0.0001. For α-glucosidase inhibition, the IC50 value for Dichloromethane fraction was 8.45 ± 0.13, for Methanol fraction it was 64.24 ± 0.15, and for aqueous fraction it was 42.62 ± 0.17 as compared with standard IC50 that is 37.42 (acarbose). Furthermore, results show that all fractions have potential against anti-urease enzyme, but DCM fraction of crude aqueous extract has significant IC50 value (45.26 ± 0.13) than other fractions.
Conclusion: Keeping in view all the results, it is evident that the plant can be used in future for formulating effective drugs against many ailments. Secondary metabolites and their derivatives possess different biological activities, for example, .g. flavonoids in cancer, asthma, and Alzheimer. Furthermore, the extracts of this plant can be used in their crude form, which is an addition to the complementary and alternative treatment strategies.
Materials and Methods: The bark was extracted using different solvents, for example, dichloromethane, ethyl acetate, methanol, and aqueous for obtaining the organic fractions. These organic fractions were then evaluated for their cytotoxic and antimicrobial activity compared with the standard. Cefixime was used as the standard for antibacterial assay, whereas clotrimazole was used as the standard for antifungal activities. Bacterial strains used were Staphylococcus aureus and methicillin-resistant S. aureus (MRSA), whereas for antifungal activities Candida albicans, Candida parapsilosis, and Candida krusei strains were used.
Results: The organic fractions obtained were evaluated for their cytotoxic and antimicrobial activities. In cytotoxic assay (Brine shrimp lethality assay), dichloromethane fraction was the most potent with LD50 of 47.63, whereas aqueous, methanol, and ethyl acetate fractions showed LD50 of 121.74, 422.2, and 201.96, respectively. Similarly, for antibacterial assay, dichloromethane fraction showed 32.2mm zone of inhibition against MRSA in comparison with standard cefixime (zone of inhibition, 30.5mm). A minimal zone of inhibition with crude saponins (13.1 and 12.2mm) was observed against C. albicans in comparison to standard (cefixime) with a zone of inhibition of 28.5mm. No prominent results were observed against C. parapsilosis and C. krusei strains.
Conclusion: The study was based on the plant from Indo-Pak origin, and it has shown some prominent cytotoxic and antibacterial activities. Although the results of this study have provided a basic idea about the efficacy of plant extract, still more explanatory and high-scale studies can be beneficial for elaborating the cytotoxic and antimicrobial activities of this plant.
Objective: The objective of this study was to investigate the prevalence and pattern of medications associated with geriatric syndromes (MAGSs) among the discharged elderly patients (≥65 years old).
Materials and Methods: This is a cross-sectional study that was conducted at a Malaysian teaching hospital from October to December 2018. The discharge medications of geriatric patients were reviewed to identify MAGSs using Beers criteria, Lexicomp drug information handbook, and the United States Food and Drug Administration (USFDA) drug inserts. Chi-square test was used to compare MAGS prescribed between categories. Spearman's rank-order correlation was used to test the correlation between the presence of MAGS and the number of discharge medications. A binomial logistic regression was applied to determine the predictors of prescribing MAGSs.
Results: A total of 400 patients (mean ± standard deviation [SD] age, 72.0 ± 5.0 years) were included, and 45.3% of them were females. The most common diseases were hypertension followed by diabetes mellitus. The mean ± SD number of discharge medications per patient was 4.2 ± 2.5. The MAGSs were prescribed in 51.7% of the patients, and 54 patients were discharged with more than one MAGSs. The most commonly prescribed MAGSs were opioid analgesics, vasodilators, and β-blockers, which are associated with falls, depression, and delirium. Polypharmacy was found in 138 patients, and it was significantly associated with the presence of MAGSs (P < 0.001). No significant differences were found in prescribing MAGSs based on the patients' gender, race, and age.
Conclusion: The prescribing of MAGSs occurred in half of the discharged elderly patients. Physicians should be aware of the medications that are associated with special side effects in the elderly patients, and should switch to safer alternatives when possible.
MATERIALS AND METHODS: A cross-sectional descriptive study was undertaken with a cohort of 75 patients attending the University Diabetic Center at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. The EuroQoL-five-dimensional (EQ-5D) scale was used to assess HRQoL. EQ-5D was scored using values derived from the UK general population survey. The brief diabetic knowledge test in questionnaire format developed by the University of Michigan Diabetes Research and Training Center and the attitude toward self-care questionnaire based on the diabetic care profile were used.
RESULTS: Fifty-eight (77.35%) respondents were male with a mean 12.6 ± 8.4 years of a history of diabetes. Thirty-four (45.3%) were in the age group of 45-55 years with a mean age of 54 ± 9.2 years. A moderate level of HRQoL (0.71 ± 0.22) was recorded in the study cohort. The mean EQ-5D score was lower in females compared to male patients (0.58 ± 0.23 vs. 0.74 ± 0.20). The mean score of Michigan Diabetic Knowledge Test was 8.96 ± 2.1 and the median score was 9.00. Of 75 diabetic patients, 14.7% had poor knowledge; 72% had moderate knowledge, and only 13.3% had good knowledge. The average attitude score of all respondents was 6.38 ± 2.11. There was a significant positive association between attitude and EQ-5D score.
CONCLUSION: HRQoL and knowledge scores were moderate in type 2 diabetic patients in Riyadh, Saudi Arabia. Patient attitude toward the disease was positive, and this was positively associated with HRQoL; most respondents believed they are responsible for their care. It is likely that a high quality of diabetes self-management education program will provide benefits and affect significantly on type 2 diabetes patients in Saudi Arabia.
Materials and Methods: A cross-sectional design using a validated questionnaire was conducted nationwide among randomly selected Malaysian CPs. The questionnaire consisted of consisted of 32 questions with three sections. The Cronbach's alpha measure for the scale on awareness was 0.494 and 0.724 for the interaction between CPs and GPs. Descriptive statistics were reported. The Chi-square test, Mann-Whitney test, Kruskal-Wallis test, and post hoc analyses were applied at the alpha level of 0.05.
Results: Of the 127 CPs who filled out the responses, 57.5% (n = 73) mentioned that they rarely or never interacted with GPs. Many CPs (n = 106, 83.5%) were aware of their role in providing patient education, and 109 (85.8%) indicated that they could suggest nonprescription medicines to patients, whereas 88 respondents (69.3%) were aware that they could suggest alternative medicines. A total of 117 respondents (92.1%) indicated their willingness to perform selected screening tests and identify and prevent prescription errors. A considerable number of CPs (n = 76, 59.8%) were aware of their ability to design and regulate prescribed regimens, and 89 (70.1%) showed their willingness to monitor these regimens. The total average score of the CPs' awareness toward their roles in providing healthcare for the 16 activities/items and the value of the interaction mean score was 12.00 (±2.92), with a median score of 12.00 (interquartile range: 9.5-14.5).
Conclusions: Malaysian CPs are fully aware of their role in providing healthcare and pharmaceutical care. Though the majority of them were willing to provide extended services, they are often unable to perform these roles due to the lack of interprofessional collaboration, lack of time, and absence of remuneration for their extended services. Training programs, practice guidelines, and professional service fee may encourage CPs to perform more extended services.
Materials and Methods: Dried root of P. glabra was extracted under reflux with methyl alcohol, fractionated through the vacuum liquid chromatography technique, and evaporated and then purified the compounds using column chromatography and preparative thin-layer chromatography. THP-1 cells were treated with amentoflavone, 5,7,4'-hydroxyflavonoid, and stigmasterol with various concentrations (0-30 µg/mL) and then incubated with MTS reagent for 2h. Treatment was done for 24, 48, and 72h. Then, effects of these compounds were also tested on PGE2, TNF-α, and IL-6 expression in human THP-1-derived macrophage cells for 24h.
Results: Three new compounds such as amentoflavone, 5,7,4'-hydroxyflavonoid, and stigmasterol were isolated. After 24h of incubation, a significant decrease in cell viability was reported with IC50 values of amentoflavone, 5,7,4'- hydroxyflavonoid, and stigmasterol (21 µg/mL ≡ 38 M), (18 µg/mL ≡ 66 M) and (20 µg/mL ≡ 48.5 M), respectively. Whereas for 48 and 72h treatment showed a less decreased cell viability compared with 24h treatment. These compounds also showed a significant reduction in the production of TNF-α, IL-6, and PGE2 in a dose-dependent manner.
Conclusions: The isolated new compounds showed significant cytotoxicity and anti-inflammatory effects.
Data Sources and Methods: A retrospective study based on telephone calls reported on poisoning caused by pharmaceutical products undertaken by the National Poisoning Centre (NPC) in Penang (Malaysia) was used as the basis of this study covering the period between 2010 and 2015. The study included the mode and type of poisoning, exposure routes as well as the incidence locations.
Results: A total of 10,998 cases were examined, finding that females represented 5,899 cases (53.6%) being intoxicated more frequently compared to the number of males, 3,839 (34.9%). The age group of poisoning cases ranged between 20 and 29 years representing 2,579 (23.4%) of reported cases. The common mode of poisoning was attributed to suicide 5,203 (47.3%) from among the 10,998 cases and the highest poisoning agents reported were from the psychiatric group of pharmaceutical products of 2,287 (21%).
Conclusion and Implications: These findings indicate a rising trend of suicidal poisoning attempts between 2013 and 2015, which emphasizes the need for more stringent and effective enforcement protocols to limit the rising incidence of poisoning. As such, analyzing the trends in poisoning in a particular zone periodically could help health policy-makers to develop management policies and prevention strategies.