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   Table of Contents - Current issue
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January-March 2020
Volume 12 | Issue 1
Page Nos. 1-82

Online since Wednesday, January 29, 2020

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REVIEW ARTICLES  

Preparation of medicinal plants: Basic extraction and fractionation procedures for experimental purposes Highly accessed article p. 1
Abdullahi R Abubakar, Mainul Haque
DOI:10.4103/jpbs.JPBS_175_19  
Preparation of medicinal plants for experimental purposes is an initial step and key in achieving quality research outcome. It involves extraction and determination of quality and quantity of bioactive constituents before proceeding with the intended biological testing. The primary objective of this study was to evaluate various methods used in the preparation and screening of medicinal plants in our daily research. Although the extracts, bioactive fractions, or compounds obtained from medicinal plants are used for different purposes, the techniques involved in producing them are generally the same irrespective of the intended biological testing. The major stages included in acquiring quality bioactive molecule are the selection of an appropriate solvent, extraction methods, phytochemical screening procedures, fractionation methods, and identification techniques. The nitty-gritty of these methods and the exact road map followed solely depends on the research design. Solvents commonly used in extraction of medicinal plants are polar solvent (e.g., water, alcohols), intermediate polar (e.g., acetone, dichloromethane), and nonpolar (e.g., n-hexane, ether, chloroform). In general, extraction procedures include maceration, digestion, decoction, infusion, percolation, Soxhlet extraction, superficial extraction, ultrasound-assisted, and microwave-assisted extractions. Fractionation and purification of phytochemical substances are achieved through application of various chromatographic techniques such as paper chromatography, thin-layer chromatography, gas chromatography, and high-performance liquid chromatography. Finally, compounds obtained are characterized using diverse identification techniques such as mass spectroscopy, infrared spectroscopy, ultraviolet spectroscopy, and nuclear magnetic resonance spectroscopy. Subsequently, different methods described above can be grouped and discussed according to the intended biological testing to guide young researchers and make them more focused.
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Inclining trend of the researchers interest in antimicrobial stewardship: A systematic review p. 11
Nehad J Ahmad, Abdullah U Althemery, Abdul Haseeb, Reham F Yusuf, Azmi Ahmed Hassali, Amer H Khan
DOI:10.4103/jpbs.JPBS_186_19  
Introduction: The implementation of antibiotic stewardship programs (ASPs) can improve the treatment of infections and can decrease the adverse events that result from antibiotics use. In the last decades, there is an increasing interest of the researchers in the implementation of ASPs. 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.
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ORIGINAL ARTICLES Top

Attention-deficit hyperactivity disorder: Knowledge and perception of dental care providers at Ajman p. 16
Moyad Shahwan, Abdulhaq Suliman, Ammar Jairoun, Sahib Alkhoujah, Hebatullah Mohammed, Halima Abdullah
DOI:10.4103/jpbs.JPBS_119_19  
Aim: This study aimed to improve our understanding regarding attention-deficit hyperactivity disorder (ADHD) awareness among dental care providers of Ajman University (AU), and also to identify factors that are highly associated with an increased awareness toward ADHD. Materials and Methods: This is a cross-sectional survey study designed and carried out among convenience sample of dental care providers. The survey was carried out by using a self-administrated questionnaire. The questionnaire was composed into demographic, socioeconomic, and ADHD information. Results: The study shows low level of awareness toward ADHD. Moreover, participants who provided treatment for a patient with ADHD were found to show higher degree of awareness toward ADHD. Discussion: The existing results will be used in developing a well-planned program and clear polices to increase the level of awareness regarding ADHD.
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Adherence of geriatric patients and their beliefs toward their medicines in the United Arab Emirates p. 22
Nihal A Ibrahim, Zehra Edis, Klaitham S Al-Owais
DOI:10.4103/jpbs.JPBS_93_19  
Introduction: Drug adherence is a major factor in determining health outcomes of geriatric patients and is a growing concern for health-care systems as the geriatric population shows a steep rise due to improved health-care services in the UAE. Aim: We aimed to evaluate the adherence and beliefs of geriatric patients in the UAE toward their medicines and to explore the factors affecting them. Methods: A cross-sectional study was performed including 163 geriatric patients. Surveys, direct observations, and interviews were used for primary data collection. Demographic data were computed using descriptive statistics method. The Statistical Package for the Social Sciences (SPSS) program, Version 19.0, SPSS Inc., Chicago, IL, USA, was used to analyze and code the raw data, whereas chi-squared test was used to analyze the responses. Secondary data were also collected. Results: The results indicated that patient factors and medication factors are the main risk factors for medication nonadherence among geriatric patients in the UAE. The study found that drug regimen (91.4%, N = 149), forgetfulness (87.1%, N = 142), time constraints (67.5%, N = 110), and cost (55.2%, N = 90) were the main key factors affecting medication adherence. Also, poor communication (12.9%), the lack of trust (16.6%), confidence (20.2%), and patient involvement (43.6%) were shown to influence adherence behaviors to medication. The main habits, attitudes, and beliefs that were found to affect patient’s adherence were follow-ups (73%), inadequate knowledge of medicine (60.1%), the lack of perceived benefits (18.4%), and limited knowledge on health conditions (19.6%). The study showed 161 patients among the total 163 participants forget taking their medications and others cease from taking their medications. To conclude, nonadherence to medications is a substantial problem among the elderly in the UAE. Conclusion: The study findings confirm the need for further research to examine the perspectives of at-risk population with a focus on knowledge, beliefs, and attitudes on medication nonadherence.
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Water pipe smoking affects young females and males differently with some effects on immune system cells, but none for C-reactive protein, thyroid hormones, and vitamin D p. 31
Sawsan H Mahassni, Khloud A Alajlany
DOI:10.4103/jpbs.JPBS_271_18  
Introduction: Water pipe smoking (WPS) is a major health threat leading to higher mortality, morbidity, and incidence of many diseases, such as inflammatory, respiratory and cardiovascular diseases; and cancers. This study aimed to determine the differences in the effects of WPS on the immune system, inflammatory markers, lipids, vitamin D, and thyroid hormones in female and male WP smokers, and compared to nonsmokers of both sexes. No other studies showed the differences between female and male WP smokers for the parameters investigated here, with the exception of the lipid profile. Methodology: The study was carried on 76 randomly chosen subjects (17 female and 17 male WP smokers, 21 female and 21 male nonsmokers) living in Saudi Arabia with an age range of 20–35 years. Blood samples were collected to determine the differential complete blood counts; lipid profiles; and C-reactive protein, triiodothyronine, thyroxine, and vitamin D concentrations. Results: Results showed no significant differences between female smokers and nonsmokers for all parameters. Male smokers had a significantly lower mean monocytes count and a significantly higher mean red blood cell count and hemoglobin concentration compared to male nonsmokers. Comparing females and males among smokers and nonsmokers separately, the only significant difference in the parameters that was not found in both comparisons was a significantly lower mean basophil count in female nonsmokers compared to male nonsmokers. Conclusion: It may be concluded that the effects of WPS were limited to males with immune cells and hematology minimally affected, and that females and males were affected differently by WPS.
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Gas chromatography–mass spectrometry characterization of bioactive compounds from Ziziphus nummularia (Burm. F.) stem bark with promising in vitro antiplasmodial activity p. 42
Babita Aggarwal, Pankaj Sharma, Hardarshan S Lamba
DOI:10.4103/jpbs.JPBS_41_18  
Objective: This study was carried out to evaluate the in vitro antiplasmodial activity of alcoholic and hydroalcoholic extract of Ziziphus nummularia stem bark as well as the determination of core structure fractionated from its crude extract. Materials and Methods: The antiplasmodial activity of stem bark extracts was investigated by in vitro schizont maturation inhibition assay against Plasmodium falciparum (both chloroquine sensitive and resistant). The crude extract was analyzed by gas chromatography–mass spectrophotometry (GC–MS). Result: Both alcoholic and hydroalcoholic extracts showed their potential toward in vitro antiplasmodial activity against P. falciparum strains MRC-02 (CQ sensitive) and RKL-09 (CQ resistant). Alcoholic extract showed more promising antiplasmodial activity with Inhibitory concentration (IC50) of 0.130 and 1.191 for MRC-02 and RKL-09 strains, respectively, as compared to hydroalcoholic extract with IC50 of 1.856 and 2.981 for MRC-02 and RKL-09 strains, respectively. No morphological changes in erythrocytes were observed when investigated for chemical injury to the erythrocytes. Chemical characterization of alcoholic extract was performed by GC–MS analysis to identify the bioactive compounds that are responsible for antiplasmodial activity. Alkyl esters, phenolics, and flavonoids were found as major compounds and also showed resemblance to existing antimalarial drugs. Conclusion: The findings suggested that the investigated extracts will provide a foundation for combating the resistant strains of P. falciparum. Also, the compounds isolated from Z. nummularia crude extract are viable newer chemical antimalarial candidates requiring further investigation.
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Assessment of association between antihypertensive drug use and occurrence of new-onset diabetes in south Indian patients p. 48
Sneha M Sabu, Shubha Seshadri, Girish Thunga, Pooja G Poojari, Leelavathi D Acharya
DOI:10.4103/jpbs.JPBS_168_19  
Objective: The objective of this study was to determine the association between antihypertensive drug use and new-onset diabetes (NOD) in patients with hypertension (HTN). Materials and Methods: A retrospective observational study was conducted in a tertiary care hospital located in south India. Patients diagnosed with HTN and HTN with diabetes between January 2012 and December 2016, were identified and studied. Medical records of these patients from Medical Record Department were evaluated by medical record review method, and relevant data were recorded in a case record form. Statistical evaluation by chi-square method and odds ratio (OR) was carried out to appraise the incidence of NOD in patients taking antihypertensive medications. Results: A total of 1250 patients with HTN were screened, and based on inclusion and exclusion criteria, 952 patients were enrolled in the study; among which, 537 were patients with HTN and 415 were patients with diabetic HTN. The majority of the patients with HTN and patients with diabetic HTN were from the age-group of above 60 years. The most commonly prescribed drugs observed in our study population were amlodipine in 94 (22.7%) patients. OR was calculated and it was observed that the combination therapy has a fivefold risk for the development of NOD in patients with HTN, followed by Angiotensin II receptor blockers (2.06) (confidence interval [CI]: 1.56–2.73), diuretics (1.33) (CI: 0.95–1.85), non-Dihydropyridine calcium channel blockers (DHP CCBs) (1.3) (CI: 0.51–3.30), vasodilators (1.13) (CI: 0.40–3.15), and Angiotensin converting enzyme inhibitors (1.06) (0.68–1.64). Conclusion: Patients on non-DHP CCBs, diuretics, and combination antihypertensives showed more chances of developing NOD.
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Knowledge, Attitude, and Practice of General Population toward Complementary and Alternative Medicines in Relation to Health and Quality of Life in Sungai Petani, Malaysia p. 57
Syed G Mohiuddin, Sohail Aziz, Muhammad Z Iqbal, Atta A Naqvi, Rizwan Ahmed, Mansour A Mahmoud, Syed A Ghori
DOI:10.4103/jpbs.JPBS_182_19  
Purpose: The demand of complementary and alternative medicine (CAM) has increased drastically over the past few decades. The perceptions about CAMs among general population are positive. However, the literature highlights that effectiveness and acceptance of alternative therapies among the general population is still a subject of debate. Materials and Methods: This is a cross-sectional study and the response along with demographic details was collected through a validated questionnaire; the results were analyzed by using a validated data collection tool. The results were concluded based on good, moderate, and poor responses, which were evaluated through data analysis by using the Statistical Package for the Social Sciences software version 20.0., SPSS Inc., Chicago, III, USA. A value of P < 0.05 was considered statistically significant. Results: In total, 182 (44.4%) of male and 228 (55.6%) of female respondents were selected for this study. Studies showed that a greater knowledge level was observed among female respondents (15.55 ± 2.7, P < 0.001). The selected Chinese population had relatively good knowledge (i.e., 15.63, P = 0.006). People practicing Buddhism had also good knowledge. Rural population had lesser family income and showed a good practice pattern and understanding (P = 0.006). The positive attitude was identified among women ( P < 0.001) with a mean score of 15.55 ± 2.7. Postgraduate participants were found to have diverse results with SD ± 6.23, and 77.1% had a good attitude. A statistically significant association was observed between religion and attitude of respondents (P < 0.001). Conclusion: Although a better practice was noticed in Malaysian population, more awareness is required and knowledge should be disseminated among the population to improve the overall health and quality of life in Malaysia.
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Community pharmacist’s role in providing oral health-care services: Findings from Malaysia p. 64
Ali Blebil, Juman Dujaili, Ramadan Elkalmi, Huei ling Kelly Tan, Ming S Tai, Tahir Mehmood Khan
DOI:10.4103/jpbs.JPBS_152_19  
Introduction: Pharmacists have been well recognized as an active and have a more integrated role in the preventive services within the National Health Services. This study assessed the community pharmacists’ attitudes, beliefs, and practices toward oral health in the Malaysian setting. Materials and Methods: A cross-sectional survey-based study was used to conduct this project. An anonymous self-administered questionnaire was developed and distributed among community pharmacists within Kuala Lumpur and Selangor states areas, Malaysia. The data collection was carried out from the beginning of November to the end of December 2018. Results: Of the 255 pharmacists, 206 agreed to participate in the study, yielding a response rate of 80.8%. Overall, approximately half of the pharmacists provided two to five oral health consultations per week and two to five over the counter (OTC) oral health products recommendations per week. The main services provided by community pharmacists in were the provision of OTC treatments (93.7%), referral of consumers to dental or medical practitioners when appropriate (82.5%), and identify signs and symptoms of oral health problems in patients (77.2%). In addition, more than 80% of the pharmacists viewed positively and supported integrating oral health promotion and preventive measures into their practices. The most commonly reported barriers to extending the roles of pharmacists in oral health care include lack of knowledge or training in this field, lack of training resources, and lack of oral health educational promotion materials. Conclusion: The study shows that community pharmacists had been providing a certain level of oral health services and play an important role in oral health. The findings highlighted the need of an interprofessional partnership between the pharmacy professional bodies with Malaysian dental associations to develop, and evaluate evidence-based resources, guidelines, the scope of oral health in pharmacy curricula and services to deliver improved oral health care within Malaysian communities.
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A study to identify the most common reasons to wean among breastfeeding mothers in UAE p. 72
Moayad J Al-Shahwan, Sabrina Ait Gacem, Nageeb A G M Hassan, Fetta Djessas, Ammar A Jairoun, Sabaa S Al-Hemyari
DOI:10.4103/jpbs.JPBS_230_19  
Background: Despite the great benefits of breastfeeding for the mother and the child, many mothers face a lot of challenges and issues during lactation, which might lead to early weaning. Aim: The aim of this study was to assess the factors that can lead to early weaning and to identify the most common reasons to early weaning among breastfeeding mothers. Materials and Methods: This was a cross-sectional, questionnaire-based survey study. Eight hundred and fifty questionnaires were distributed to lactating mothers, but only 820 were returned making the response rate of 96.5%. Breastfeeding mothers in Ajman and Sharjah, United Arab Emirates (UAE) participated in the study. Statistical Analysis: The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20. IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Descriptive statistics were used to summarize the data concerning the demographic characteristics. Categorical variables (such as nationality and educational level) were described by using frequency, percentages, bar chart, and pie chart. Results: The results revealed that 29% of respondents stopped breastfeeding for some reason. The main reasons stated by the participants were low milk supply (25.8%) and pain, congestion, and abscess (19.22%) followed by new pregnancy (17.5%), which were the most identified reasons for early discontinuation of breastfeeding. Conclusion: Our study indicated that the misconception of weaning because of a new pregnancy has declined in the UAE compared to a study conducted 3 years ago. A positive improvement was also observed in terms of weaning due to personal desire compared to previous years among mothers as they became more aware of the benefits of breastfeeding.
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Chemical composition and bioactivity of Vitex cofassus Reinw. extracts on the larval and pupal stages of Aedes aegypti p. 77
Lukman Muslimin, Asril Burhan, Khairuddin Khairuddin, Cicilia Kriswanty, Aswal Arsyandi, Megawati Megawati
DOI:10.4103/jpbs.JPBS_148_19  
Aims and Objectives: This study sought to investigate the chemical composition, larvicidal, and cytotoxic potentials of the fruit extract of Vitex cofassus Reinw. Materials and Methods: The chemical composition was analyzed using the gas chromatography–mass spectrometry technique. Separately, mortality data were evaluated by probit analysis to determine the lethal concentration (LC)50 and LC90 values on brine shrimp and Aedes aegypti larvae. Moreover, the effects on different stages of Ae. aegypti were also examined. Results: Fourteen majority components representing carboxylic acid were identified. The extract was very toxic to both brine shrimp and Ae. aegypti larvae with LC50 values of 0.308 and 0.514 µg/mL, whereas the LC90 values were 4.317 and 1.921 µg/mL, respectively. The effect of the fruit extract of V. cofassus on different stages of Ae. aegypti indicated that high concentrations (2.00–4.00 µg/mL) promoted complete mortality. A concentration of 0.125 to 1.00 µg/mL inhibited larval metamorphosis. Conclusion: To the best of our knowledge, this is the first study to evaluate the chemical composition and larvicidal effects of the fruit extract of V. cofassus. The results indicate that the extract may be a promising source of larvicidal compounds that could be useful for pharmaceutical applications.
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ERRATUM Top

Erratum: Community Pharmacist’s Knowledge, Attitude, and Practices towards Vitamin Supplements in Al-Khobar Region, Saudi Arabia: A Descriptive Cross-Sectional Study p. 82

DOI:10.4103/0975-7406.277206  
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