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   2019| April-June  | Volume 11 | Issue 2  
    Online since April 26, 2019

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Applying Beers Criteria for elderly patients to assess rational drug use at a university hospital in Northern Cyprus
Sarah Khamis, Abdikarim Mohamed Abdi, Ali Uzan, Bilgen Basgut
April-June 2019, 11(2):133-141
Background: Several regulations for potentially inappropriate medications (PIMs) have been published specifically for elderly patients to rationalize drug use in such vulnerable communities. Objectives: To determine the proportion and characteristics of PIMs in patients receiving one or more drugs according to Beers Criteria 2015. Materials and Methods: A cross-sectional prospective analysis of 451 inpatients admitted between September 25 and October 25, 2016, was conducted in Near East University Hospital, Northern Cyprus. Data were extracted from the patient medical records using special forms. Results: A total of 119 elderly patients were identified (26.4%) and evaluated, of which 107 were eligible and 12 were excluded. Of the 1039 prescribed medicines, 16.9% were PIMs during hospitalization, whereas 12% were at discharge. The most prevalent PIM group during hospitalization was identified as the “medications to be avoided in older adults” (48.8%), whereas it also formed 52% of medications prescribed at discharge. PIMs of the class “drugs used with caution” formed 19.4% of prescribed medicine during hospitalization and 18.4% on discharge. The prevalence of polypharmacy was 79.4%, mainly identified as unpreventable polypharmacy of elders. Conclusion: A significantly higher prevalence of PIMs was observed in hospitalized patients than those discharged, with high prevalence of polypharmacy. These results necessitate a nationwide assessment, and responsible bodies who adopt strategies should act to reduce or overcome the aforementioned high prevalence in Northern Cyprus.
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Prevalence of depression among health sciences students: Findings from a public university in Malaysia
Abdul Rahman M Fata Nahas, Ramadan M Elkalmi, Abdulkareem M Al-Shami, Tarek M Elsayed
April-June 2019, 11(2):170-175
Background: High rates of psychological problems including depression among university students have been reported in various studies around the world. The objectives of this study were to explore the prevalence of depressive disorder, as well as the associated sociodemographic factors (gender, origin, school, and year of study) among health sciences students. Materials and Methods: This cross-sectional study was conducted among 425 students from 5 different schools of health sciences at International Islamic University Malaysia, using the Patient Health Questionaire-9 (PHQ-9). Results: With a response rate of 85.9% (n = 365), the results showed a depressive disorder prevalence of 36.4%. The mean PHQ-9 score of the respondents was 8.10 (SD = 4.9), indicating mild depression severity. A statistically significant association was revealed between gender and severity of depression (P = 0.03), as well as between students’ origin and severity of depression (P = 0.02). Conclusion: The findings indicated high prevalence of depression among undergraduate health sciences students. While providing significant information to students’ affairs department, the study findings suggest the necessity to address depressive disorder in health sciences university students in Malaysia. Future research is needed to confirm these results in larger samples.
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A completely polyherbal conditioning and antioxidant shampoo: A phytochemical study and pharmaceutical evaluation
Riham O Bakr, Reham I Amer, Marwa A A Fayed, Tamer I M Ragab
April-June 2019, 11(2):105-115
Aim: A recent approach in shampoo research has been to find a natural alternative for synthetic detergents that have deteriorative effects on hair follicles. This study aimed at the formulation of a completely herbal shampoo containing a natural foaming agent, in addition to having conditioning, antioxidant, and antimicrobial effects. Material and Methods: The leaves of Salix babylonica L., Ziziphus spina-christi L. (Willd), and Glycyrrhiza glabra rhizomes were extracted with 70% methanol then quantified for their phenolic and flavonoid contents using colorimetric assays that were qualitatively identified by Ultra-performance liquid chromatography (UPLC) with tandem mass spectrometry (MS-MS). The mineral content was also estimated. The radical scavenging activity was estimated using 1,1-diphenyl-2-Picrylhydrazyl (DPPH) and the half maximal inhibitory concentration (IC50) was determined. Additionally, the antimicrobial activity was tested using agar diffusion assay and compared to vancomycin and ketoconazole. Four formulations, consisting of the different plant extracts and a combination of the extracts, were prepared and evaluated for several physicochemical properties. The best formula was evaluated for its conditioning effects using scanning electron microscope and blind touch tests by asking volunteers for grading the formulations. Results and Discussion: UPLC-MS-MS analysis of S. babylonica and Z. spina-christi allowed tentative identification of 12 phytoconstituents in each. Z. spina-christi showed the highest phenolic content and a high copper, zinc, and manganese content beside the best antioxidant activity, whereas G. glabra had a high potency against Bacillus cereus and Candida albicans. The polyherbal shampoo formulation (F4) was selected as an optimized formulation because of a high foam stability after 4 min, low wetting time (2 s), surface tension reduction, and comparable results for percent solid content. F4 showed good conditioning effect and consumer contentment. Conclusion: The formulated polyherbal shampoo is chemical free, extra-nourishing shampoo with excellent conditioning, cleansing, and antimicrobial effects.
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Diphtheria: The patch still remains—A case report from the state of Uttarakhand
Aroop Mohanty, Mohit Bhatia, Pratima Gupta, Saurabh Varshney, Manu Malhotra, Balram J Omar
April-June 2019, 11(2):190-193
Diphtheria is a potentially fatal acute infectious disease caused by toxigenic strains of Corynebacterium diphtheriae. It is rare in most developed countries due to routine childhood vaccination. Although Universal Immunization Programme is fully functional in India, several hospital-based surveillance studies over the recent years indicate that cases of this infection do occur among school-going children and adolescents. Poor immunization coverage, failure to take booster doses, and absence of data regarding coverage of booster doses of Diphtheria, Pertussis, and Tetanus vaccine are some of the factors responsible for persistence or possible reemergence of this infection in our country. There are no published reports of diphtheria from the state of Uttarakhand, India, in the recent years. We hereby report a confirmed case of diphtheria from this region.
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Wound-healing effect of honey gel and film
Febriyenti Febriyenti, Henny Lucida, Almahdy Almahdy, Istianah Alfikriyah, Muhammad Hanif
April-June 2019, 11(2):176-180
Background: Honey has been formulated into gel and film dosage forms for burn wound as previously reported. Aims: In this study, we evaluated the ability of honey gel and film to promote the healing of burns and incision wounds on the skin of Sprague-Dawley female white rats. Materials and Methods: Twenty-four female rats were divided into four groups, which were treatment groups (for honey gel or film), negative control, and positive control (treated with marketed product “B”), respectively. Burn and incision wound were created by the method previously reported with slight modification. Parameters such as the percentage of wound closure and the tensile strength of the incision wound were determined. Results: The experimental results showed that honey film has a greater effectiveness to accelerate the healing for burns and incision wound in comparison to the negative control. Conclusions: Two-way analysis of variance indicates the type of treatment group, and time has a significant effect on the burn wound (P < 0.05). Honey film shows the significant difference (P < 0.05) with other group on the incision wound.
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Vitamin D and elevated serum uric acid as novel predictors and prognostic markers for type 2 diabetes mellitus
Abdulbari Bener, Abdulla O A A Al-Hamaq, Mustafa Öztürk, Ihab Tewfik
April-June 2019, 11(2):127-132
Aim: To ascertain the active role of uric acid and vitamin D as potential biomarkers for impaired glucose metabolism among people living with type 2 diabetes mellitus (T2DM) in Turkish community. Subjects and Methods: This study was based on 680 patients with T2DM and 680 healthy subjects aged between 25 and 70 years, who visited the diabetes and endocrinology department of Istanbul Mega Medipol University Teaching Hospital, Istanbul, Turkey, during January 2016 to April 2018. The investigated biochemical indices included lipid profiles (low-density lipoprotein [LDL], high-density lipoprotein, total cholesterol, and triglyceride [TG]), uric acid, blood pressure (BP), serum creatinine, glycosylated hemoglobin (HbA1c), thyroid-stimulating hormone (TSH), postprandial glucose, and any related comorbidities. Results: This study reported significant differences between family history duration of patients with T2DM of ≤5 and >5 years when compared to that of control subjects with respect to body mass index (BMI), smoking habit, sheesha smoking, income, family history of metabolic syndrome, hypertension, coronary heart disease, and nephropathy. Similarly, significant differences were found between patients with T2DM (with family history T2DM duration of less than 5 years and more than 5 years in contrast to healthy subjects’ level of LDL, TG, fasting blood glucose, HbA1c, systolic BP (SBP), bilirubin, albumin, magnesium, potassium, calcium, number of sleeping hours, and TSH. We uncovered the correlation between serum uric acid level with the clinical biochemical indices related to T2DM: serum calcium (r = 0.336), magnesium (r = 0.272), potassium (r = 0.205), HbA1c (r = 0.638), fasting blood glucose (P = 0.486), bilirubin (r = 0.251), albumin (r = 0.285), LDL (r = 0.322), TG (r = 0.434), diastolic BP (DBP) (r = 0.392), SBP (r = 0.344), BMI (r = 0.482), waist circumference (WC) (r = 0.366), age (r = 0.217), number of sleeping hours (r = 0.275), and TSH (r = 0.445). Multivariate stepwise logistic regression showed that variables, such as serum vitamin D, uric acid, TSH, HbA1c, DBP, WC, BMI, and SBP, were considered at higher risk as significant (P < 0.001) predictors for T2DM. Conclusion: The results suggest strong positive correlation between serum uric acid level with BP (SBP and DBP), age, BMI, and WC among patients with T2DM. This study ascertains that an increase in uric acid level may be due to elevated level of HbA1c, metabolic syndrome, diabetes, obesity, and/or hypertension.
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Antidiabetic activity of ajwain oil in different in vitro models
Nilamaideen Noorul Aneesa, Roy Anitha, Sheeja Varghese
April-June 2019, 11(2):142-147
Context: Ajwain oil is an essential oil with thymol as its major constituent which is known for many pharmacological activities.Aims: To evaluate the anti-hyperglycaemic potential of ajwain oil using different in vitro models.Methods and Material: In vitro α-amylase and α-glucosidase inhibitory effect of ajwain oil was carried out by the method of Bernfeld and Shibano et al. 1997 with minor modifications respectively. Cytotoxicity of the ajwain oil was assessed using MTT assay. Glucose uptake potential was assessed in differentiated L6 myotubes using fluorescent tagged 6-NBDG.Results: Ajwain oil showed very good α – amylase inhibitory activity. A maximum inhibition of 88.55 ±0.43 % was achieved at a concentration of 4µL/ml by ajwain oil which was comparable to that of standard acarbose, 90.96 ± 1.81%. The IC50 of the extract was found to be 0.47µL/ml and for acarbose 0.69µL/ml. The maximum in vitro α – glucosidase inhibitory activity was found to be 89 ± 0.72 % and 91.67 ± 1.09% at 4µL/ml for ajwain oil and acarbose. The IC50 of the extract and acarbose were found to be 0.37µL/ml and 0.41µL/ml respectively. Ajwain oil has enhanced glucose uptake in L6 myotubes in a dose dependent manner.Conclusion: The anti-hyperglycaemic activity of the ajwain oil strongly support its ability to decrease sugar level hence it may be further validated for its use as an antidiabetic agent.
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Comparative evaluation of wound healing potential of manuka and acacia honey in diabetic and nondiabetic rats
Rupam Gill, Basavaraj Poojar, Laxminarayana K Bairy, Kumar S E Praveen
April-June 2019, 11(2):116-126
Background: Manuka honey has attracted the attention of the scientific community for its antimicrobial and antioxidant properties. The active compounds of manuka honey to which its myeloperoxidase activity inhibition is owed are methyl syringate (MSYR) and leptosin (a novel glycoside of MSYR). The non-peroxide antibacterial activity is attributed to glyoxal, 3-deoxyglucosulose, and methylglyoxal. These properties make it an inexpensive and effective topical treatment in wound management. This study has focused on the evaluation of the effect of manuka honey and acacia honey on wound healing in nondiabetic and streptozotocin-induced diabetic rats. Materials and Methods: This study was conducted on a total of 42 rats (six rats in each group) and respective drug/substance was topically applied once daily on the excision wound for 21 days. Induction of diabetes was carried out in rats in groups IV, V, VI, and VII only. Measurement of wound contraction was carried out on days 3, 6, 9, 12, 15, 18, and 21 after operation. Time taken for the complete epithelization was recorded along with a histopathological examination of the healed wound bed. Results: Topical application of manuka honey achieved ≥80% wound contraction on day 9 after operation in both the nondiabetic and diabetic group. Complete epithelization was achieved 2 days earlier than the normal epithelization time in the manuka group. Histopathological examination showed well-formed keratinized squamous epithelium with normal collagen tissue surrounding hair follicles. Conclusion: This study provides good outcome with respect to wound healing (especially in diabetic condition) when manuka honey was compared to acacia honey and standard treatment.
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Awareness of physicians and clinical pharmacists about ACC/AHA guidelines for dyslipidemia management: A cross sectional study
Mohammad Fathullah Zaitoun, Mais Hasan Iflaifel, Loloah Abdullah Almulhim, Mohammed Ali Al-Ghamdi, Yasir Ahmed Ibrahim
April-June 2019, 11(2):181-186
Introduction: Cardiovascular diseases (CVDs) are one of the leading causes of morbidity and mortality worldwide. Although genetics could contribute to the incidence of CVD, they are mostly acquired conditions. Management of precipitating factors such as hyperlipidemia can prevent CVD. Therefore, clinical guidelines have been used as a tool to improve patient outcomes and minimize practice variation. Objective: The objective of this study was to assess health-care providers’ (physicians and clinical pharmacists) awareness about the latest edition of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines of dyslipidemia management. Materials and Methods: To meet the study objective, a self-administered questionnaire was designed based on the recommendations of the latest edition of the ACC/AHA guidelines for dyslipidemia management. After validation, the questionnaire was distributed to physicians and clinical pharmacists in Al-Ahsa province of Saudi Arabia. Results: Validation of the questionnaire was carried on 10 participants (Cronbach’s alpha = 0.816). Seventy-seven participants completed the questionnaire (acceptance rate = 51.33%). The majority of participants knew about the release of the ACC/AHA 2013 guidelines for dyslipidemia (77% of the physicians and 48% of the clinical pharmacist). Inadequate knowledge of the major changes in the dyslipidemia management was observed in both study groups with no significant difference between them (the median score for physicians and pharmacists was 4 out of 10 with a range of 1–9, Z = −0.15, P = 0.88).Conclusion: Inadequate level of knowledge about practice-changing recommendations of the recent ACC/AHA guidelines for dyslipidemia management was observed among the study participants. This level of knowledge could result in clinical malpractice and worsen management outcomes. Thus, efforts should be in place to raise awareness about the evidence-based management of dyslipidemia and monitor compliance to guidelines and their implementation outcomes.
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Relationship between antimicrobial prescribing and antimicrobial resistance among UTI patients at Buraidah Central Hospital, Saudi Arabia
Sulaiman I A Alsohaim, Abdulkader A Bawadikji, Ramadan Elkalmi, Mohammed Imad Al-deen M Mahmud, Mohamed Azmi Hassali
April-June 2019, 11(2):162-169
Introduction: Most of the decisions regarding diagnosis and treatment are based on laboratory test results. Urinary tract infections (UTIs) are among the most common infections in humans. The changing antimicrobial sensitivity in UTI requires appropriate antibiotics. Antimicrobial resistance is an emerging problem in the Kingdom of Saudi Arabia where the complete reversal of antimicrobial resistance is difficult due to irrational use of antibiotics. Objectives: This study aimed to determine the most common bacterial agents causing UTI in different seasons among patients who were admitted to Buraidah Central Hospital (BCH), Saudi Arabia. The study also evaluated the link between prescribing and resistance toward antimicrobials. Materials and Methods: A 6-month retrospective study was conducted among adult patients who were admitted to the inpatient department at BCH. A total of 379 files were collected from microbiological laboratory for inpatients. Results: Most UTI-causing bacteria prevailed in the same season. Of 15 bacterial strains, 12 were significantly correlated with 20 (of a total of 40) antibiotics that were used. Most bacteria were gram-negative. Gram-negative bacilli including Escherichia coli, Klebsiella spp., and Pseudomonadaceae and gram-positive Enterococcus faecalis were most frequently causing UTIs. Conclusion: Overall prevalence of antibiotic resistance was negative in bacterial isolates. However, the relationship between antimicrobial prescribing and antimicrobial resistance was significantly negative among UTI patients in BCH, Saudi Arabia.
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Use of phosphate binders in end-stage renal disease: An experience from a secondary care hospital in United Arab Emirates
Syed Arman Rabbani, Sathvik B Sridhar, Padma G M Rao, Martin T Kurian, Basset E Essawy
April-June 2019, 11(2):148-154
Objective: Hyperphosphatemia in end-stage renal disease (ESRD) is associated with many serious patient-level consequences including cardiovascular events and mortality. The purpose of this study was to investigate the use of phosphate binders in ESRD patients on maintenance hemodialysis. Materials and Methods: The study was a prospective observational cohort study including adult ESRD patients undergoing hemodialysis at a secondary hospital in United Arab Emirates. Patient characteristics were compared as per type of phosphate binder used. Bivariate and multivariate multinomial logistic regression analyses were carried out to determine variables that were independently associated with use of different phosphate binders. Results: Phosphate binders used at our study site were sevelamer, calcium carbonate, and a combination of sevelamer and calcium carbonate. Bivariate multinomial logistic regression analysis revealed that serum phosphorous (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.04–1.09, P = 0.047; OR: 0.10, 95% CI: 0.03–0.89, P = 0.042), calcium (OR: 0.11, 95% CI: 0.02–0.86, P = 0.041; OR: 0.22, 95% CI: 0.01–0.96, P = 0.012), and calcium–phosphorous product (OR: 0.20, 95% CI: 0.06–0.64, P = 0.008; OR: 0.16, 95% CI: 0.05–0.54, P = 0.003) levels were significantly lower in patients on sevelamer per se as well as in patients on combination therapy, respectively when compared to calcium carbonate per se. Multivariate multinomial logistic regression analysis revealed that in sevelamer and combination groups, cardiovascular diseases (OR: 0.12, 95% CI: 0.02–0.65, P = 0.022; OR: 0.10, 95% CI: 0.01–0.88, P = 0.038) were significantly lesser compared to calcium carbonate group after being adjusted for other variables in the model. Conclusion: We observed that hyperphosphatemia and related events in our study population were better controlled by sevelamer per se and combination therapy than calcium carbonate per se. Further large scale, multicenter studies are required to confirm and establish these findings.
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Case-based learning: Our experience in clinical pharmacology teaching
Ameya A Hasamnis, Aditya Arya, Sapna S Patil
April-June 2019, 11(2):187-189
Majority of junior doctors struggle to apply the knowledge of pharmacology to prescribing drugs. A paradigm shift in teaching of clinical pharmacology is the need of the hour in medical curriculum. One of the ways to enhance the teaching of clinical pharmacology is to develop and conduct case-based learning for MBBS students instead of didactic lecturing. Case-based learning session can bridge the gap between theory and practice. Case-based learning provides hands-on training in a classroom setting. We tried to develop and conduct case-based learning for year two medical students and evaluated their response via the Dundee Ready Education Environment Measure questionnaire. Majority of our students enjoyed learning clinical pharmacology through case-based learning. Case-based learning also provided students the opportunity to embrace the principles of problem solving, critical thinking, and lifelong learning. It helped students to amalgamate the concept of development of P drug list with rationale prescribing habits. Majority of our students also agreed that they understood the content of the subject taught in the session.
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Screening of potential phytocompounds from Euclea crispa (Thunb.) leaves targeting human epidermal growth factor receptor 2 (HER2) signaling pathway
Chella Perumal Palanisamy, Anofi Omotayo Tom Ashafa
April-June 2019, 11(2):155-161
Background: Overexpression of human epidermal growth factor receptor 2 (HER2) plays an important role in the development and progression in a variety of cancers and it is a novel therapeutic target for breast cancer and ovarian cancer. Euclea crispa (E. crispa) is a South African medicinal plant in the family Ebenaceae used in the management of different human diseases and disorders. Aims: The aim of this study was to evaluate the potential inhibitors against HER2 from hexane extract of E. crispa leaves. Materials and Methods: Chemical fingerprinting method was used to identify the presence of natural compounds from the extract whereas their inhibitory activities were analyzed by molecular docking analysis against HER2. Absorption, distribution, metabolism, and excretion (ADME) properties also predicted to establish the pharmacokinetics and pharmacodynamics profiles of the selected compounds. Results: The molecular docking analysis expressed that phenyl glucuronide, hydrocortisone acetate, and 6-(4,6-dioxo-1,4,5,6-tetrahydropyrimidin-2-yl-amino)hexanoic acid trifluoroacetate possess good inhibitory activities with good glide score of −6.63, −5.41, and −5.40 and glide energy of −35.03, −42.51, and −31.38 kcal/mol, respectively when compared with standard Food and Drug Administration–approved drug and other compounds. All the screened compounds were within the acceptable and permissible limits of ADME properties. Conclusion: Thus, from this study it can be concluded that, these screened natural compounds from E. crispa leaves may serve as potential inhibitors for HER2 and they might lead to development of new therapeutic agents against cancer and its associated complications.
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