044350   KOCHHAR A, BANDAY J, AHMAD Z, PANJIAR P, VAJIFDAR H (Anesthesia Dep, Vardhman Mahavir Medical Coll and Safdarjang Hospital, New Delhi, Email: kochharanjali0@gmail.com) : Cervical epidural analgesia combined with general anesthesia for head and neck cancer surgery: A randomized study. J Anaesthesiol Clin Pharmacol 2020, 36(2), 182-6.

The role of cervical epidural analgesia in head and neck cancer surgery is not fully explored. The aim of this study was to evaluate cervical epidural analgesia in terms of opioid and anesthetic requirements and stress response in patients undergoing head and neck cancer surgery. After institutional ethical committee approval and written informed consent, 30 patients undergoing elective head and neck cancer surgery were randomized into two groups: Group E (cervical epidural analgesia with general anesthesia), and group G (general anesthesia alone). In group E, an 18 gauge epidural catheter was placed at cervical (C) 6 – thoracic (T) 1 level. After test dose, a bolus of 10 ml of 0.2 % ropivacaine was given followed by continuous infusion. Technique of general anesthesia and post‑operative management was standardized in both the groups. Opioid and anesthetic drug requirement was observed. Blood glucose and serum cortisol levels were measured at baseline; post‑incision and after surgery. There was significant reduction in the requirement of morphine (P < 0.001), isoflurane (P = 0.004) and vecuronium (P = 0.001) in group E. Post‑operative, blood glucose and serum cortisol levels were significantly reduced (P = 0.0153 and 0.0074, respectively). Early post‑operative pain was reduced with the lesser requirement of post‑operative morphine. The use of combined cervical epidural analgesia with general anesthesia reduces opioid, anesthetic drug requirement and stress response as compared to general anesthesia alone in patients undergoing head and neck cancer surgery

3 illus, 2 tables, 20 ref

044349   RAMLAN A A W, PARDEDE D K B, MARSABAN A H M S, HIDAYAT J, PEDDYANDHARI F S (Anesthesiology and Intensive Care Dep, Indonesia Univ, Jakarta, Indonesia, Email: andi.ade@ui.ac.id) : Efficacy of 0.5 mg/kg of propofol at the end of anesthesia to reduce the incidence of emergence agitation in children undergoing general anesthesia with sevoflurane. J Anaesthesiol Clin Pharmacol 2020, 36(2), 177-81.

Emergence agitation (EA) is a common transient behavioral disturbance after inhalational anesthesia and may cause harm to the patient. This study evaluated the efficacy of 0.5 mg/kg of propofol administered at the end of anesthesia to reduce the incidence of EA in children undergoing general inhalational anesthesia. This double‑blind randomized clinical trial was done in children aged 1–5 years undergoing general anesthesia with sevoflurane. One hundred and eight subjects were included using consecutive sampling method and randomized into two equal groups. Propofol in the dose of 0.5 mg/kg was administered at the end of anesthesia to children in the propofol group, while those in the control group did not receive any intervention at the end of anesthesia. Incidence of EA, transfer time, postoperative hypotension, desaturation, and nausea‑vomiting were observed. Aono and Pediatric Anesthesia Emergence Delirium scale were used to assess EA. Incidence of EA was 25.9 % in the propofol group compared to 51.9 % in the control group (RR = 0.500; 95 % CI 0.298–0.840; P = 0.006). Mean transfer time in propofol group was longer (9.5 ± 3.9 min) than control group (7.8 ± 3.6 min) (mean difference 1.71 min; 95 % CI 0.28–3.14; P = 0.020). Hypotension was found in one patient (1.9 %) in propofol group, while in control group there was none. Nausea‑vomiting was found in five patients (9.3 %) in propofol group and eight patients (14.8 %) in control. There was no desaturation in both the groups. Administration of 0.5 mg/kg of propofol at the end of anesthesia effectively reduces the incidence of EA in children undergoing general inhalational anesthesia with sevoflurane.

1 table, 22 ref

044348   KUMAR A, DOGRA N, GUPTA A, AGGARWAL S ( Anaesthesiology Dep, SMS Medical Coll, Jaipur, Rajasthan, Email: anupamag213@gmail.com) : Ultrasound‑guided transversus abdominis plane block versus caudal block for postoperative analgesia in children undergoing inguinal hernia surgery: A comparative study. J Anaesthesiol Clin Pharmacol 2020, 36(2), 172-6.

Ultrasound‑guided (USG) transversus abdominis plane (TAP) block has emerged as a safe and effective regional anesthesia technique as it provides adequate postoperative pain relief for lower abdominal surgeries. Caudal block is a gold standard technique in pediatric surgeries. Our aim was to compare the duration of postoperative analgesia between TAP block and caudal block in children undergoing inguinal hernia surgeries. In a prospective, randomized, controlled study, 112 children of age 2‑8 years and ASA grade Ӏ and ӀӀ, undergoing elective inguinal hernia surgery were randomly allocated into two groups: Group T (n = 56) received USG‑guided TAP block with 0.5mL/kg of 0.2 % ropivacaine and Group C (n = 56) received caudal block with 1mL/kg of 0.2 % ropivacaine. The primary outcome variable was the duration of postoperative analgesia and the secondary outcome variables included variation in hemodynamic parameters and adverse effects, if any.  There was no significant difference in median of CHEOPS score till 5 postoperative hours, thereafter till 24 postoperative hours, significantly lower CHEOPS score were found in Group T. Mean duration of analgesia was 523.44 ± 61.30 min in Group T, whereas in Group C, it was 352.59 ± 32.54 min. No significant difference was observed in hemodynamic variations and adverse effects. TAP block and caudal block both are effective in providing postoperative analgesia in children undergoing inguinal herniotomy. USG‑guided TAP block was found to be superior as it provided longer duration of analgesia and reduced rescue analgesic dose without any significant adverse effects as compared with caudal block after inguinal herniotomy

2 illus, 3 tables, 16 ref

044347   CHAURASIA R, JAIN A, SENGAR N S, PANDEY S (Anesthesiology Dep, Maharani Laxmi Bai Medical Coll, Jhansi, Email: dr.shivali22@gmail.com) : Enhancing cooperation during pediatric ultrasound: Oral midazolam versus conventional techniques. J Anaesthesiol Clin Pharmacol 2020, 36(2), 166-71.

Ultrasound is a safe and non‑invasive method for detecting numerous pathologies. Pediatric patients are often uncooperative which leads to decreased quality and increased time of scan. We compared the conventional means alone and combination of oral midazolam for the above cited purpose.  This double blind prospective study (CTRI/2016/06/007030) was conducted after obtaining due approval from institutional ethical committee. One hundred Children aged 2‑6 years belonging to ASA class 1 or 2, posted for high resolution ultrasonography of abdomen were included in the study. They were randomised to receive midazolam 0.3 mg/ kg mixed in 20 mL of apple juice (Group I) or 20 mL of apple juice alone (Group II) 20 minutes prior to the procedure. The parameters assessed were level of cooperation, sonologist's satisfaction, total scan time, heart rate and SpO2 . Out of 100 patients, 44 patients of group I and 42 of group II were analysed. The cooperation score was significantly higher in Group I (35 %) than Group II (19 %). Likert scale revealed very satisfied and satisfied rating in 61.3 % (Group I) and 21.4 % (Group II). The time taken by sonologist and number of attempts were significantly less in Group I than Group II. There was no difference in discharge time between the groups. There was no reportable adverse event in either group. Oral midazolam is a safe and effective agent to aid routine abdominal ultrasonography in pediatric patients.

1 illus, 4 tables, 30 ref

046298   BUDIMAN A, SOFIAN F F, SANTI N M W S, AULIFA D L (Sains Malaysia Univ, Pulau Pinang- 118 00, Malaysia, Email: sohailafridi@student.usm.my) : In vitro cytotoxic and antimicrobial activities of Erythrina suberosa (Roxb) Bark. J Pharm Bioall Sci 2020, 12(2), 210-6.

The study was focused on evaluating cytotoxic and antimicrobial activities of Erythrina suberosa (Roxb.) bark through in vitro pharmacological screening.  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. 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 32.2 mm zone of inhibition against MRSA in comparison with standard cefixime (zone of inhibition, 30.5 mm). A minimal zone of inhibition with crude saponins (13.1 and 12.2 mm) was observed against C.  albicans in comparison to standard (cefixime) with a zone of inhibition of 28.5 mm. No prominent results were observed against C. parapsilosis and C. krusei strains. 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.

3 illus, 2 tables, 23 ref

044346   RAJAN S, BARUA K, TOSH P, KUMAR L (Anaesthesiology Dep, Amrita Institute of Medical Sciences, Kochi- 682 041, Kerala, Email: sunilrajan@aims.amrita.edu) : Is intraoperative supplementation of dextrose essential for infants undergoing facial cleft surgeries?. J Anaesthesiol Clin Pharmacol 2020, 36(2), 162-5.

Dextrose is commonly added to the intraoperative maintenance fluids of pediatric patients. The primary objective was to evaluate the effect of addition of 1 % dextrose to Ringer’s lactate (RL) on blood glucose levels in infants undergoing facial cleft surgeries. This prospective, randomized, single blinded study was conducted in forty infants undergoing either cheiloplasty or palatoplasty. Random blood sugar (RBS) was assessed using a glucometer after induction of anaesthesia, and at 1 and 2 hours later. Group R received RL and Group D received RL with 1 % dextrose as intraoperative maintenance fluid. Hypoglycemia was defined as RBS <70 mg/dL and hyperglycemia as RBS >150 mg/dL. Baseline RBS levels and those at 60 min and 120 min post‑induction were comparable in both groups. The increase in blood sugar levels from baseline to 60 min and to 120 min in each group was significant. Incidence of hyperglycemia was comparable in both groups. There were no episodes of hypoglycemia, intraoperatively. Use of Ringer lactate alone or with addition of 1 % dextrose resulted in comparable intraoperative blood sugar levels when used as maintenance fluid in infants undergoing facial cleft surgeries. 

4 tables, 20 ref

044345   GUPTA A, SEN I, BHARDWAJ N, YADDANAPUDI S, MATHEW P J, SAHNI N, BHATIA A (Anesthesia and Intensive Care Dep, Postgraduate Institute of Medical Education and Research, Chandigarh- 160 012, Email: indumohini@gmail.com) : Prospective audit of sedation/anesthesia practices for children undergoing computerized tomography in a tertiary care institute. J Anaesthesiol Clin Pharmacol 2020, 36(2), 156-61.

The aim of the study was to enumerate the sedative drugs used, assess the efficacy of sedative drugs, and determine the incidence of adverse events. A prospective audit of children sedated for computerized tomography (CT) by anesthesiology team was conducted for a period of 4 months. The data included patient demographic variables, fasting period, medications administered, adequacy of sedation, imaging characteristics, adverse events, and requirement for escalated care.  A total of 331 children were enrolled for sedation by the anesthesia team. The drugs used for sedation were propofol, ketamine, and midazolam. Twenty‑two percent children received one sedative drug, 60 % children were administered two drugs, and 5 % children required a combination of all three drugs for successful sedation. Sedation was effective for successful conduct of CT scan in 95.8 % patients without the requirement of a repeat scan. Twelve (5 %) children experienced adverse events during the study period. However, none of the adverse events necessitated prolonged postprocedural hospitalization or resulted in permanent neurologic injury or death. The current practice of sedation with propofol, ketamine, and midazolam, either single or in combination was efficacious in a high percentage of patients. The incidence of adverse events during the study period was low.

1 illus, 3 tables, 24 ref

046297   ALI N M, CHAN L C, AKHIR N S N M, IZANI A S A, LEONG C T, MUNESWARAO J, VERMA A K (Dermatology Dep, Hospital Pulau Pinang, Pulau Pinang, Malaysia, Email: norazlimamohdali@gmail.com) : Effectiveness of color and picture labeling in improving the knowledge on topical medications among patients with psoriasis: A randomized controlled trial. J Pharm Bioall Sci 2020, 12(2), 201-9.

The success of topical treatment in patients with psoriasis is still below par in Malaysia. The contributing factors include patients’ understanding and knowledge about prescribed topical medications. The aim of this study was to assess the effectiveness of color and picture labeling (C and P labeling) in improving the knowledge about topical medications among patients with psoriasis. An unblinded randomized controlled trial was undertaken at the dermatology clinic of a tertiary care hospital. Consent from the patients fulfilling inclusion criteria were obtained, and they were included in this study. They were randomized into two groups, namely Gp-1 (C and P labeling) and Gp-2 (conventional labeling). Both groups were assessed at week 0, 6, and 12 (visit 1, 2, and 3) using knowledge assessment list and psoriasis severity assessment score. For visit 2 (week 6), reinforcement of their understanding of topical treatment was performed. A total of 101 patients were recruited. Only 91 of them completed the study. The mean ages were 44.52 (±16.61) and 45.49 (±15.84) years, with 70.3 % males and approximately half Malay ethnics. The changes of knowledge and comparison of Topical Application Assessment Score between the groups showed an incremental raise of significance with every visit (P = 0.006 [week 1], 0.004 [week 6], and 0.002 [week 12]). Psoriasis Area and Severity Index 75 could not draw any conclusion as patients who achieved >75 % improvement were inadequate. C and P labeling was effective in improving the understanding and knowledge of patients with psoriasis. Both groups showed improvement in body surface area and Dermatology Life Quality Index for every visit; however, it was statistically insignificant.

3 illus, 7 tables, 22 ref

044344   GUPTA A, GAIROLA S , GUPTA N (Anesthesiology Dep, AIIMS, New Delhi, Email: drnishkarsh@rediffmail.com) : Safety of anesthetic exposure on the developing brain– Do we have the answer yet?. J Anaesthesiol Clin Pharmacol 2020, 36(2), 149-55.

During the past two decades, a vast number of studies done on rodents and nonhuman primates have implicated general anesthetic exposure of developing brains in producing neurotoxicity leading to various structural and functional neurological abnormalities with cognitive and behavioral deficits later in life. However, it is still unclear whether these findings translate to children and whether single exposure to anesthesia in childhood can have long‑term neuro‑developmental risks. Considering the fact that a large number of healthy young children are undergoing elective surgery under general anesthesia globally, any such potential neurocognitive risk of pediatric anesthesia is a serious public health issue and is therefore important to understand. This review aims to assess the current preclinical and clinical evidence related to anesthetic neurotoxicity

2 illus, 1 table, 58 ref

046296   AHMED Z, AZIZ S, HANIF M, MOHIUDDIN S G, KHAN S H A, AHMED R, GHADZI S M S, BITAR A N (Sains Malaysia Univ, Pulau Pinang, Malaysia, Email: sohailafridi@student.usm.my) : Phytochemical screening and enzymatic and antioxidant activities of Erythrina suberosa (Roxb) bark. J Pharm Bioall Sci 2020, 12(2), 192-200.

This study aimed to evaluate the phytochemicals screening of Erythrina suberosa (Roxb) bark and to analyze the enzymatic activities of its various organic fractions. 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. 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.  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.

4 illus, 3 tables, 29 ref

044343   HALEEM S, OZAIR A, SINGH A, HASAN M, ATHAR M (Anaesthesiology and Critical Care Dep, Aligarh Muslim Univ, Uttar Pradesh, Email: shahlahaleem@yahoo.co.in) : Postoperative urinary retention: A controlled trial of fixed‑dose spinal anesthesia using bupivacaine versus ropivacaine. J Anaesthesiol Clin Pharmacol 2020, 36(1), 94-9.

Following spinal anesthesia (SA), patient discharge is often delayed due to postoperative urinary retention (POUR), the incidence of which varies widely. The present study of bupivacaine versus ropivacaine in equianalgesic doses was taken to explore the correlation between time to void urine and time for complete functional recovery. In this double‑blinded study fifty adult patients were assigned to two groups (bupivacaine/ropivacaine) according to alternate case allocation for receiving SA for lower abdominal, perineal, and lower limb surgeries, lasting less than 2 h. Statistical analysis was conducted using an intention‑to‑treat approach, using Mann–Whitney test for nonparametric data. Primary outcome data could not be obtained for 14 out of the 50 patients due to perioperative bladder catheterization. No patients were lost to follow‑up. Both the bupivacaine and ropivacaine groups were comparable in terms of ability to void (8.0±2.3vs. 7.0±1.2 h; P>0.05), modified Bromage scale after 4 h of SA (1.8 ± 1.3 vs. 2.6 ± 0.9 grade; P > 0.05), time to complete ambulation (6.7 ± 1.4 vs. 6.1 ± 1.0 h; P > 0.05), and time to negative Romberg test (6.1 ± 1.4 vs. 5.6 ± 0.9 h; P > 0.05), respectively. Strong positive correlations (r = 0.7–0.9) were found between time to void urine and time for complete ambulation. Time to void urine and recovery of motor functions were found comparable statistically when bupivacaine and ropivacaine were used in the doses of 12.5 and 18.75 mg, respectively, for SA. However, group ropivacaine required lesser time to void and no patient developed POUR. Time to void urine was more than the time for ambulation. This may indicate a need for “selective spinal anesthesia” or adjuvant combination technique to accelerate the resolution of a block for ambulatory surgery

1 illus, 4 tables, 24 ref

046295   SALAHSHOOR M R, ABDOLMALEKI A, FARAMARZI A, JALILI C, SHIVA R (Anatomical Sciences Dep, Kermanshah Univ of Medical Sciences, Kermanshah, Iran, Email: roshankhah@yahoo.com) : Does tribulus terrestris improve toxic effect of malathion on male reproductive parameters?. J Pharm Bioall Sci 2020, 12(2), 183-91.

Tribulus terrestris has antioxidant and free-radical-scavenging properties. Malathion is the most common organophosphate, which is capable to produce free radicals and induce disturbance on some of male reproductive parameters. This study was designed to evaluate the effects of T. terrestris extract against damage induced by Malathion to the reproductive parameter of male rats. In this experimental study, 48 male Wistar rats were randomly assigned to eight groups: first group, sham group (normal saline); second group, Malathion (250 mg/kg) group; third to fifth groups, T. terrestris groups (2.5, 5, and 10 mg/kg body weight, respectively); and sixth to eight groups, Malathion + T. terrestris groups (2.5, 5, and 10 mg/kg). Tribulus terrestris extract (2.5, 5, and 10 mg/kg body weight, respectively) administrated orally, and daily for 8 weeks. The sperm parameters, testis malondialdehyde (MDA), serum total antioxidant capacity, serum testosterone level, and the height of germinal layer were evaluated and analyzed statistically. All the values of male reproductive parameters reduced significantly in the Malathion group as compared to the sham group (P < 0.01) except MDA level, which increased significantly. The T.  terrestris and T.  terrestris + Malathion treatments in all doses increased the whole parameters significantly as compared to the Malathion group (P < 0.01) except MDA level, which decreased significantly. No significant changes were observed in all T. terrestris groups as compared to the sham group (P > 0.05). Tribulus terrestris extract administration attenuates the toxic effects of Malathion on some of the male reproductive parameters.

1 illus, 1 table, 38 ref

044342   GUPTA S, FERNANDES R J, RAO J S , DHANPAL R (Anesthesiology Dep, St. John’s Medical Coll and Hospital, Bengaluru- 560 034, Karnataka, Email: surbhi_pg@yahoo.com) : Perioperative risk factors for pulmonary complications after non‑cardiac surgery. J Anaesthesiol Clin Pharmacol 2020, 36(1), 88-93.

Postoperative pulmonary complications (PPCs) lead to increased morbidity, mortality, length of hospital stay, and cost to the patient. This study was conducted to determine the risk factors and assess the incidence of PPC after non‑cardiac surgery. This prospective, observational study was conducted on 1,170 patients undergoing non‑cardiac surgery. Details of patient, surgical, and anesthetic factors were collected and patients were followed up for the entire duration of hospital stay for the occurrence of PPC. Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score and the length of hospital stay was noted for all the patients. Regression analysis was used to find the risk factors associated with development of respiratory complications. The incidence of PPC was found to be 59 in 1,170 patients (5 %) in our hospital. Multivariate analysis revealed that patients with intermediate and high risk ARISCAT scoring had higher odds of developing PPC. Higher age (>50 years), positive cough test, presence of nasogastric tube, and intraoperative pulmonary complications were identified as independent risk factors associated with the occurrence of PPC. We found 5 % incidence of PPC in our study. Recognition of the delineated risk factors and routine use of ARISCAT score for preoperative assessment may help identify patients at a higher risk of developing postoperative pulmonary complications.

4 tables, 29 ref

044341   SILPA A R, KOSHY K A , SUBRAMANIAN A, PRADEEP K K (Anesthesia Dep, Lourdes Hospital, Kochi, Kerala, Email: write2koshy@gmail.com) : Comparison of the efficacy of two doses of dexmedetomidine in attenuating the hemodynamic response to intubation in patients undergoing elective cardiac surgery: A randomized double‑blinded study. J Anaesthesiol Clin Pharmacol 2020, 36(1), 83-7.

Transient tachycardia and hypertension associated with laryngoscopy and intubation may be hazardous to patients presenting for cardiac surgery. The α 2 agonist dexmedetomidine may blunt this stress response, but the optimal dose which will accomplish this without causing hypotension and bradycardia is not well established. The primary objective of this study was to compare the efficacy of two doses of dexmedetomidine (0.5 and 1 µg/kg) as a 15 min infusion in attenuating the hemodynamic stress response to laryngoscopy and endotracheal intubation in elective cardiac surgery.  Seventy six patients scheduled for elective cardiac surgery received a single preoperative dose of dexmedetomidine of either 0.5 µg/kg (low dose) or 1 µg/kg (high dose) as a 15‑min infusion prior to induction. The hemodynamic response to laryngoscopy and endotracheal intubation (heart rate, systolic blood pressure, mean arterial pressure, and diastolic blood pressure) were recorded at different times. Independent sample t‑test, Chi‑square test of association, and repeated measures analysis of variance were used to analyze the collected data. The incidence of hypertension following intubation was significantly more in the low‑dose group. Administration of 1 µg/kg dexmedetomidine was not accompanied by hypotension or bradycardia. Dexmedetomidine in a dose of 1 µg/kg is more effective than 0.5 µg/kg for attenuation of hemodynamic stress response to intubation in cardiac surgery. A more graded increase in the dose of dexmedetomidine may lead to an optimum dose in attenuating the hemodynamic response to intubation.

1 illus, 3 tables, 19 ref

046294   ALAHMAD M M, MAJED I, SIKH N, ALAHMAD K (Al Ain Univ, Abu Dhabi, UAE, Email: mohammad.alahmad@aau.ac.ae) : The impact of community–pharmacist-led medication reconciliation process: Pharmacist–patient-centered medication reconciliation. J Pharm Bioall Sci 2020, 12(2), 177-82.

Patients and their healthcare providers’ are in need to access a correct and complete list of all patients’ active bills for safe and effective clinical care. Currently, Healthcare Information Systems are not providing a proper access to the patients’ medications lists. Thus, this study aimed to evaluate the impact of community pharmacist-led medication reconciliation process in community pharmacies in the UAE through applying a pharmacist–patient-centered medication reconciliation (PPCMR). This was an interventional study of medication reconciliation process in 25 pharmacies in the UAE during July 1, 2019 till September 1, 2019. The participant pharmacists were surveyed and interviewed to gather more information about the barriers and enablers of the process before and after the implementation of PPCMR. After the implementation of PPCMR, medication reconciliation service was available in 84 % of the pharmacies compared to 40 % before the PPCMR (Z = –2.84, P = 0.005). The main workforce barriers to implement this service were reduced to 27 % compared to 47 % before the PPCMR. The operational barriers for the service were decreased from 56 % to 28 %. The facilitators in delivering the service in community pharmacies were improved from 29 % to 63 %. The active collaboration between the pharmacists and physicians was enhanced from 28 % to 72 % (Z = –3.2, P = 0.001) in the participated pharmacies. There is a statistically significant difference toward the impact of the PPCMR on the whole medication reconciliation service χ2 (df  =  3)  =  200, P  <  0.001.  Community pharmacists are not always accessible or well placed to provide a medication reconciliation service. The implementation of PPCMR in each community pharmacy will raise the expectations regarding the appropriateness of medication management and use.

1 illus, 3 tables, 26 ref

044340   BHIRUD P H, CHELLAM S, MOTE M N, TOAL P V (Anaesthesia Dep, BARC Hospital, Mumbai- 400 094, Maharashtra, Email: priteebhirud@gmail.com) : Effects of intravenous dexmedetomidine on spinal anesthesia and sedation – A comparison of two different maintenance infusions. J Anaesthesiol Clin Pharmacol 2020, 36(1), 78-82.

Our aim was to study the effects of a low‑dose bolus (0.5 mcg/kg) of dexmedetomidine followed by two different infusion doses (0.25, 0.5 mcg/kg/h) on spinal anesthesia, sedation, hemodynamics and side effects. Eighty consenting patients were randomized into two groups A and B with 40 patients each. Patients in both groups were administered intravenous (IV) dexmedetomidine 0.5 mcg/kg over 10 min prior to SAB followed by IV dexmedetomidine 0.25 mcg/kg/h infusion (A) and 0.5 mcg/kg/h infusion (B) throughout the duration of surgery. Time for onset of sensory and motor block, duration of motor block and analgesia, time for two segment regression, intra operative hemodynamics and sedation were assessed. P value less than 0.05 was taken as significant. Onset of sensory block to T10 was 2.1 ± 0.3 min in group A and group B. Onset of motor block was 4.6 ± 0.9 min in group A and 4.3 ± 0.9 min in group B. Duration of motor block in group A was 235.6 ± 12.4 min compared to group B which was 245.3 ± 9.3 min. Time for 2 segment regression in group A was 139.7 ± 29.7 min compared to group B which was 152.3 ± 18.7 min. Total duration of analgesia was 259.3 ± 92.4 min in group A and 273.8 ± 52.3 min in group B. There was a significant reduction in heart rate and mean blood pressure compared to the baseline within both the groups. Sedation was comparable in both the groups. IV dexmedetomidine bolus of 0.5 mcg/kg prior to subarachnoid block followed by maintenance infusion of 0.5 mcg/kg/h significantly prolonged duration of motor block, time for two segment regression, along with stable hemodynamics and adequate sedation.

2 illus, 3 tables, 14 ref

044339   CHILKOTI G T, KARTHIK G, RAUTELA R (Anesthesiology and Critical Care Dep, Univ Coll of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, Email: geetanjalidr@yahoo.co.in) : Evaluation of postoperative analgesic efficacy and perioperative hemodynamic changes with low dose intravenous dexmedetomidine infusion in patients undergoing laparoscopic cholecystectomy – A randomised, double‑blinded, placebo‑controlled trial. J Anaesthesiol Clin Pharmacol 2020, 36(1), 72-7.

Dexmedetomidine is a α2‑agonist with sedative, sympatholytic and analgesic properties and hence, it can be a very useful adjuvant in anesthesia as stress response buster, sedative and analgesic. We aimed to evaluate the effects of low dose dexmedetomidine infusion (0.5 mcg/kg/h) on postoperative analgesic efficacy along with the perioperative hemodynamic changes in patients undergoing laparoscopic cholecystectomy. Eighty patients of American Society of Anesthesiologists (ASA) physical grades I and II undergoing laparoscopic cholecystectomy were randomly allocated into two groups of 40 patients each. Group I (Normal Saline group) patients received normal saline and group II (Dexmedetomidine group) patients received dexmedetomidine infusion at 0.5 mcg/kg/h respectively, starting 15 min before induction and continued till the end of surgery. Parameters noted were heart rate, mean arterial pressure, oxygen saturation, post‑operative pain was evaluated using VAS and analgesic requirement. Statistical tests such as ANOVA test for continuous variables, post‑hoc test for intergroup comparison, and Chi‑square test for discrete values were applied. Post‑operative efficacy was found to be limited in the dexmedetomidine group in terms of VAS score. The analgesic requirement in 24‑hour was observed to be reduced in dexmedetomidine group when compared to the NS group; however, not statistically significant. In group NS, significant hemodynamic stress response was seen following laryngoscopy, tracheal intubation, creation of pneumoperitoneum and extubation. On intergroup comparison, the hemodynamic response was significantly attenuated in the dexmedetomidine group when compared to the NS group. No significant side effects were noted. Dexmedetomidine IV in an infusion dose of 0.5 µg/kg/hr is effective in providing postoperative analgesia in terms of significant reduction in analgesic consumption in 24 hours and in addition to the effective obtundation of the pneumoperitoneum‑induced hemodynamic changes.

2 illus, 3 tables, 21 ref

044338   LOMATE P A, MANE M V (Anaesthesia Dep, Bharati Vidyapeeth Deemed Univ Medical Coll and Hospital,, Sangli- 416 416, Maharashtra, Email: manoharmane2002@yahoo.co.in) : Efficacy of multimodal analgesia with perineural buprenorphine or dexmedetomidine for surgeries performed under ultrasound‑guided infraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2020, 36(1), 66-71.

Perineural adjuvants when used as a part of multimodal analgesia (MMA) will maximize the quality and duration of analgesia of the nerve blocks. In the present study, we compared the duration of postoperative analgesia and other block characteristics of two groups of MMA comprising either perineural buprenorphine or dexmedetomidine in the upper limb surgeries performed under ultrasound‑guided (US‑guided) infraclavicular brachial plexus blocks. A total of 100 adult patients undergoing elective upper limb orthopedic surgery under US‑guided infraclavicular brachial plexus block were randomly divided into two groups. Group I received 150 µg buprenorphine and Group II received 50 µg dexmedetomidine, perineurally added to 30 ml of 0.375 % bupivacaine. Both groups also received tramadol 50 mg IV, dexamethasone 4 mg IV, and diclofenac 75 mg infusion as part of MMA. Both groups were compared for the duration of postoperative analgesia, block characteristics, and incidence of adverse effects. The duration of postoperative analgesia was significantly prolonged in Group II (937.6 ± 179.1 min vs 1280.4 ± 288.8 min). The onset of sensory and motor blocks was shorter in Group II (P < 0.05). The duration of sensory and motor blocks was significantly prolonged in Group II (P < 0.05). The number of rescue analgesics required in the first 24 hours was less in Group II (1.98 ± 0.62 vs 0.8 ± 0.64). Although heart rate and blood pressure levels were lower in Group II, all patients were hemodynamically stable. For surgeries under brachial plexus block, perineural dexmedetomidine when used as a part of MMA provided a prolonged duration of postoperative analgesia and improved block characteristics than perineural buprenorphine.

2 illus, 4 tables, 28 ref

046293   BUDIMAN A, SOFIAN F F, SANTI N M W S, AULIFA D L (Pharmaceutics and Pharmaceutical Technology Dep, Padjadjaran Univ, Jawa Barat, Indonesia, Email: arif.budiman@unpad.ac.id) : The formulation of lozenge using black mulberries (Morus nigra L.) leaf extract as an α‐glucosidase inhibitor. J Pharm Bioall Sci 2020, 12(2), 171-6.

Diabetes mellitus is a chronic metabolic disease, which possibly leads to kidney, brain, heart failure, and other organ complications, subsequently harming human health. These symptoms have been prevented using the leaf of black mulberry (BM), as a traditional medicine, because the phenolic compounds contained are able to decrease blood glucose concentration. Meanwhile, previous reports have shown that BM contains 1-deoxynojirimycin, with strong activity as an α‐glucosidase inhibitor. The aim of this study, therefore, was to formulate and evaluate BM leaf extract in lozenge dosage form as an α‐glucosidase inhibitor. The leaves of BM were extracted using the maceration method, where ethanol (70 %) served as a solvent, and the inhibitory activity of the sourced α‐glucosidase enzyme was determined through in vitro study. Subsequently, the extract was formulated into lozenge dosage form and evaluated for physical stability and also the effect of α‐glucosidase enzyme. The result showed an inhibitory activity of BM leaf extract against the enzyme α-glucosidase, with a half maximal inhibitory concentration (IC₅₀) value of 357.6 μg/mL, whereas the lozenge formulation containing 43 % of extract as well as 5 % polyvinylpyrrolidone showed the best physical stability as compared to other formulas. However, the lozenge inhibits α‐glucosidase enzyme with an IC₅₀ value of 549.7 μg/mL. It was established that the lozenge of BM leaf extract possesses activity as an α‐glucosidase inhibitor.

3 illus, 4 tables, 27 ref

044337   PUROHIT G, SETLUR R, DHAR M, BHASIN S (Anaesthesiology and Critical Care Dep, Army Hospital, New Delhi- 110 010, Email: mriduldhar@hotmail.com) : Assessment of head and neck position for optimal ultrasonographic visualisation of the internal jugular vein and its relation to the common carotid artery: A prospective observational study. J Anaesthesiol Clin Pharmacol 2020, 36(1), 62-5.

There is a wide variation in the anatomical relationship of the Internal Jugular Vein (IJV) to the Common Carotid Artery (CCA). This makes landmark based techniques of IJV cannulation and head rotation questionable and may lead to accidental arterial puncture. We conducted this study to determine the anatomical relation of the IJV to the CCA using (USG) in patients undergoing IJV cannulation for central venous access, and to analyse the effect of head rotation on this relationship. A prospective observational study was conducted on 100 patients requiring central venous access, in the operation theatre or the intensive care unit. Anatomical relationship of the IJV to CCA at the level of the cricoid cartilage was analysed by noting the segment position (1‑12) around the CCA using a high frequency linear USG probe on patients in neutral head position, on both sides and also with the head rotated to the contra lateral side by 15 ° and 45 °. Antero‑lateral segments 1 and 2 were the most common positions (50 % on the right and 73 % on the left side). Change in segment causing increase in overlap of IJV and CCA with 15 ° head rotation was seen in 44 % subjects on the right and 39 % on the left. Statistically, a higher number of subjects showed overlap with 45 ° rotation (99 % on right and 97 % on left, P < 0.05). There is a wide variation in anatomical location of the IJV in relation to the CCA as seen by USG. Excessive head rotation causes overlap of IJV over CCA which may cause inadvertent arterial puncture, even under USG guidance. Thus, it is preferable to cannulate the IJV in neutral or near neutral head and neck position.

3 illus, 3 tables, 10 ref

044336   ARYA V, GUPTA D, AGARWAL A, PAUL M, MISHRA P (Anaesthesiology Dep, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow- 226 014, Uttar Pradesh, Email: drdevendragpt@yahoo.com) : Comparative evaluation of success of ultrasound‑guided internal jugular vein cannulation using needle with guard: A randomized, controlled study. J Anaesthesiol Clin Pharmacol 2020, 36(1), 57-61.

We devised a guard which can be slid and fixed over the central venous puncture needle at a desired length (measured through ultrasound) preventing the needle from penetrating deeper into the skin beyond this guard. This randomized, single blinded, controlled study was designed to evaluate the success of ultrasound guided internal jugular vein (IJV) cannulation using measured guided needle with guard in terms of success and occurrence of complications. After ethical approval and written informed consent from the patients ultrasound‑guided right‑sided IJV cannulation was done with a conventional puncture needle (length of 6.4 cm) in the control group (n = 210) and with a conventional puncture needle with a guard fixed proximal to the bevel at a distance equal to the distance between the skin entry point and the midpoint of IJV measured with the help of USG in the study group (n = 210). The primary outcome studied was the number of attempts for successful cannulation. The secondary outcomes studied were complications and ease of cannulation. 419 patients were randomized into control (n = 209) and study groups (210). Successful IJV cannulation in the first attempt (primary endpoint) in the study group was significantly higher compared to the control group (98.6 vs. 85.7 %, P = 0.007). Posterior venous wall puncture was reduced in the study group, that is, 0.5 % (1/210) compared to control group, that is, 8.61 % (18/209) (P = 0.001). Common carotid artery puncture was 7.18 % (15/209) in control group and 0 % (0/210) in study group (P = 0.001). Operators rated better ease in study group (P < 0.001). The use of measured guided needle with guard significantly improved the accuracy, success and ease of USG guided IJV cannulation and decreased complications.

3 illus, 2 tables, 16 ref

046292   JAHAN D, HASAN M M A, HAQUE M (National Defence Univ of Malaysia, Kuala Lumpur, Malaysia, Email: runurono@gmail.com) : Diamond–blackfan anemia with mutation in RPS19: A case report and an overview of published pieces of literature. J Pharm Bioall Sci 2020, 12(2), 163-70.

Diamond–Blackfan anemia (DBA), one of a rare group of inherited bone marrow failure syndromes, is characterized by red cell failure, the presence of congenital anomalies, and cancer predisposition. It can be caused by mutations in the RPS19 gene (25 % of the cases). This case report describes a 10-month-old boy who presented with 2 months’ history of gradually increasing weakness and pallor. The patient was diagnosed as a case of DBA based on peripheral blood finding, bone marrow aspiration with trephine biopsy reports, and genetic mutation analysis of the RPS19 gene. His father refused hematopoietic stem cell transplantation for financial constraints. Patient received prednisolone therapy with oral folic acid and iron supplements.  Hemoglobin raised from 6.7 to 9.8 g/dL after 1 month of therapeutic intervention.

3 illus, 90 ref

044335   TAUZIN FIN P, BARRUCAND K, SESAY M, ROULLET S, GOSSE P, BERNHARD J-C, ROBERT G, SZTARK F (Anesthesia and Critical Care Dep, Hôpital Pellegrin, Bordeaux Cedex- 33076, France, Email: patrick.tauzin-fin@chu-bordeaux.fr) : Peri‑operative management of pheochromocytoma with intravenous urapidil to prevent hemodynamic instability: A 17‑year experience. J Anaesthesiol Clin Pharmacol 2020, 36(1), 49-54.

Surgery for pheochromocytoma (PCC) can cause excessive catecholamine release with severe hypertension. Alpha blockade is the mainstay of preoperative management. The aim of this study was to evaluate the efficacy and tolerance of intra‑venous (IV) urapidil, a competitive short acting α1 receptor antagonist, in the prevention of peri‑operative hemodynamic instability of patients with PCC. This retrospective observational study included 75 patients (79 PCC) for PCC removal surgery from 2001 to 2017 at the Bordeaux University Hospital. They received, 3 days before surgery, continuous intravenous infusion of urapidil with stepwise increase to the maximum tolerated dose. Urapidil was maintained during the procedure and stopped after clamping the adrenal vein. Plasma catecholamine concentrations were measured during surgery. Hypertensive peaks (SAP >160 mmHg) and tachycardia >100 beats/min were treated with boluses of nicardipine 2 mg and esmolol 0.5 mg/kg. We recorded 20/79 (25 %) cases with systolic arterial pressure (SAP) >180 mmHg. Only 11/79 (14 %) had hypotension with SAP <80 mmHg. Peaks of catecholamine secretions were observed preferentially during peritoneal insufflation and tumor dissection (P < 0.05). A correlation was found between tumor size (mm) and the highest norepinephrine levels [r = 0.288, P = 0.015], and between hypertensive peaks (mmHg) and the highest norepinephrine levels [r = 0.45, P = 0.017]. No mortality was reported. The median [range] postoperative hospital stay was 4 [2–9] days.  IV urapidil limits hypertensive and hypotensive peaks during PCC surgery, and corresponds to surgical imperatives allowing a short hospital stay, due to its “on–off” effect.

4 illus, 1 table, 25 ref

046291   BANSOD K A, BASHIR M S M, INGLE S S (Pharmacology Dep, Dr. Panjabrao Deshmukh Memorial Medical Coll, Maharashtra- 444 603, Email: shilpaingle888@gmail.com) : Adverse drug reaction profile in Amravati region of India: A pharmacovigilance study. J Pharm Bioall Sci 2020, 12(2), 155-62.

This pharmacovigilance study was conducted in Amravati region of central India to identify the nature and prevalence of adverse drug reactions, which will be helpful for better drug prescription practice and management of diseases. Adverse drug reaction reporting forms from April 2016 to March 2019, were collected from the pharmacovigilance center, which include details of demographics, investigations, concomitant drug history, and details of present complaints including reaction details, onset, recovery, drug information, hospitalization, management, and assessment. A total of 19 cases were reported. Approximately 47.4 % male and 52.6 % female experienced the reactions with age-group ranging from 15 to 75 years. The most common adverse drug reactions were caused by antimicrobial agents (47.6 %) followed by other group of drugs (37 %) and nonsteroidal anti-inflammatory drugs (15.9 %). Polypharmacy was the most common cause (31.6 %) with the most common route being intravenous (42.1 %). Skin reactions were the most common (84. 2 %). Antitubercular drugs were more commonly responsible for exfoliative lesions, whereas paracetamol and unknown drugs were responsible for multiple ulcerative lesions. Reactions to antitubercular drugs were considered as possible (15.8 %), whereas with other drugs (63.2 %), it was probable. It is a tip of the iceberg, which provides important demographic details in which adverse drug reactions were reported. Cutaneous reactions due to common drugs are responsible for hospitalization of the patients. There is an urgent need of training for health-care providers so that reporting can be improved and better picture can emerge.

6 tables, 51 ref

044334   LAL J, BANSAL T, DHAWAN G, TAXAK S, SMRITI M, SHARMA J, THAPER D (Anaesthesia Dep, Health Sciences Univ, Rohtak- 124 001, Haryana, Email: aggarwalteenu@rediffmail.com) : Comparison of conventional with Parker flex‑tip tracheal tube for intubation through air‑Q intubating laryngeal airway. J Anaesthesiol Clin Pharmacol 2020, 36(1), 43-8.

The problem of difficult and failed intubation led to increased development of equipment for airway management. A number of supraglottic airways have now been developed to facilitate the passage of tracheal tubes. Conventional PVC tracheal tubes are recommended for intubation through the air‑Q ILA. No study has compared different PVC tubes for blind intubation through air‑Q ILA. Thus, we undertook this prospective, randomised, single blind study to compare two PVC tracheal tubes with different designs viz. conventional PVC tracheal tube (TT) and Parker flex‑tip TT with regards to success rate, ease of intubation and total time required for successful intubation through air‑Q ILA. One hundred patients of either sex, aged 18–60 years, belonging to American Society of Anesthesiologists (ASA) physical status class I and II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included in the study. Blind intubation using conventional PVC TT and Parker flex‑tip tube was done in group A (n = 50) and group B (n = 50), respectively. The first attempt success rate in Parker flex‑tip TT was significantly more as compared to conventional PVC TT (P = 0.002). Success rate of intubation was significantly more in Parker flex‑tip TT as compared to conventional PVC TT (P = 0.004). The intubation was significantly easy in Parker flex‑tip tube as compared to conventional PVC TT (P = 0.002). Total time of intubation was less in Parker flex‑tip tube as compared to PVC TT (P = 0.043). Unique design of the Parker Flex‑tip TT resulted in increase in success rate, first attempt success rate and ease of intubation in group B in present study.

3 illus, 6 tables, 15 ref

044333   CHALERMKITPANIT P, RODANANT O, THAVEEPUNSAN W, ASSAVANOP S (Anesthesiology Dep, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand, Email: pornpan.c@chula.ac.th) : Determination of dose and efficacy of atracurium for rapid sequence induction of anesthesia: A randomised prospective study. J Anaesthesiol Clin Pharmacol 2020, 36(1), 37-42.

Succinylcholine and high dose rocuronium are neuromuscular blocking agents commonly used for rapid sequence induction of anesthesia. Their usage is limited or contraindicated in some circumstances. The aim of this study is to determine the dosage and efficacy of atracurium without priming for rapid sequence induction of anesthesia. One hundred fifteen surgical patients under general anesthesia were randomised into three groups. All patients were given 2‑3 mg/kg propofol and 1 µg/kg fentanyl intravenously for the induction of anesthesia followed by different doses of atracurium (0.6 mg/kg, 0.75 mg/kg or 1 mg/kg) without a priming dose. Tracheal intubation was performed within one minute after the administration of the study drugs. The intubating conditions, vocal cord movement and diaphragm movement were graded as the primary endpoints. Statistical analysis was done using one‑way analysis of variance (ANOVA) and Post Hoc tests. Atracurium doses of 1 mg/kg, 0.75 mg/kg, and 0.6 mg/kg provided 51.4 %, 43.6 % and 26.3 % success rates of intubation without coughing or bucking, respectively (P = 0.03). The intubating conditions were graded as excellent or good in 86.5 % of the 1 mg/kg atracurium group patients and in 84.6 % of the 0.75 mg/kg group patients (P < 0.05). An atracurium dose of 1 mg/kg facilitated significant differences in vocal cord and diaphragm paralysis compared with the dose of 0.6 mg/ kg (P = 0.03).  The administration of a relatively high dose of atracurium without priming can be used as an alternative neuromuscular blocking agent for rapid sequence induction of anesthesia in some circumstances.

3 illus, 3 tables, 22 ref

044332   JAYALEKSHMI S, PAUL C, THOMAS M K (Anaesthesia Dep, Jubilee Mission Medical Coll and Research Institute, Thrissur- 680 005, Kerala, Email: drcherish@gmail.com) : Efficacy of Baska mask and Laryngeal mask airway supreme during positive pressure ventilation – A comparative study. J Anaesthesiol Clin Pharmacol 2020, 36(1), 31-6.

Supraglottic airway devices have several roles including maintenance of a clear upper airway during general anesthesia. We primarily compared the efficacy of Baska mask (BM) and laryngeal mask airway supreme (LMAS) for the rate of first time successful placement and the seal pressure. The secondary outcome measures included laryngopharyngeal morbidity and the correct positioning of the gastric port. A sample size of 30 was calculated in each study group. A total of 70 study participants were included in the statistical analysis of which 36 patients were in the BM group and 34 patients were in the LMAS group. The BM was successfully inserted in 28 patients (77.8 %), whereas LMAS was successfully inserted in 33 patients (97.1 %) in the first attempt (P = 0.028). The mean oropharyngeal seal pressure in the BM group was higher (33.28 ± 6.80 cm H₂O) than compared to the LMAS group (27.47 ± 2.34 cm H₂O) with a P value <0.001. There was no significant difference between the two groups in the incidence of postoperative laryngopharyngeal morbidity both in the immediate postoperative period (P = 0.479) and that seen 24 hours post operatively (P = 0.660). The nasogastric tube could easily be inserted in the entire study population. From the present study, it is concluded that the BM creates a higher oropharyngeal seal pressure than the LMAS. However, the BM is more difficult to insert. The incidence of postoperative laryngopharyngeal morbidity is similar in both groups.

2 illus, 4 tables, 24 ref

046290   SINGH H P, SINGH T G, SINGH R (Chitkara Univ, Punjab, Email: gurjeetthakur@gmail.com) : Sinapic acid attenuates cisplatin-induced nephrotoxicity through peroxisome proliferator-activated receptor gamma agonism in rats. J Pharm Bioall Sci 2020, 12(2), 146-54.

The aim of this study was to investigate the involvement of peroxisome proliferator-activated receptor gamma (PPAR-γ) in renal protection offered by sinapic acid in cisplatin-induced nephrotoxicity in male rats. Nephrotoxicity was induced by single dose of cisplatin (5 mg/kg, intraperitoneal [i.p.]) in rats. Cisplatin-induced nephrotoxicity was assessed by measuring serum creatinine, creatinine clearance, urea, uric acid, potassium, magnesium levels, fractional excretion of sodium, and microproteinuria in rats. Superoxide anion generation, thiobarbituric acid reactive substances, myeloperoxidase activity, and reduced glutathione levels were measured to assess oxidative stress in renal tissues. Hematoxylin and eosin stain showed renal histological changes. The significant changes in serum and urinary parameters, elevated oxidative stress, and renal histological changes established the induction of nephrotoxicity. Sinapic acid treatment (20 and 40 mg/kg, orally [p.o.]) provides dose-dependent and significant (P  <  0.05) nephroprotection against cisplatin-mediated nephrotoxicity in rats. Nephroprotective effect of sinapic acid was abolished by PPAR-γ inhibitor, bisphenol A  diglycidyl ether (30 mg/kg, i.p.) in rats. It is concluded that PPAR-γ agonism serves as one of the mechanisms in sinapic acid-mediated renoprotection.

4 illus, 2 tables, 68 ref

044331   SINHA A, JAYARAMAN L, PUNHANI D (Anesthesia Dep, Max Super Speciality Hospital, New Delhi- 110 017, Email: apsin@hotmail.com) : Predictors of difficult airway in the obese are closely related to safe apnea time!. 2 illus, 3 tables, 17 ref 2020, 36(1), 25-30.

We aimed to redefine the preoperative factors that may challenge the airway and safe apnea time (SAT) in the obese. We analyzed 834 patients with body mass index (BMI) >35 kg/m² for their difficult airway score (DASc). DASc is a consolidation of measures of difficult airway like mask ventilation, difficult intubation, change of device, and number of personnel required. DASc varied from “0” no difficulty to “12” serious difficulty and DASc ≥6 was considered difficult. Preoperative parameters – neck circumference (NC), BMI, STOPBANG score, Mallampati score, obstructive sleep apnea grade, and waist circumference– were assessed. Receiver operating characteristic curve was used to identify risk factors for obese patients at DASc ≥6. The Youden index (for the best threshold, with highest sensitivity and specificity) was BMI 45 kg/m² and NC 44.5 cm. Their absence had an 81 % negative predictive value to include a difficult airway, while their presence had a positive predictive value of 55 %. This further has sensitivity of 66 % and specificity of 73 %. The mean SAT (256 ± 6 s) was inversely related to DASc (P < 0.001). This study demonstrates that BMI and NC have a strong association with difficult airway in obese patients and are inversely related to SAT. Amongst these NC is the single most important predictor of difficult airway in obese and should be used as a screening tool.

1 illus, 6 tables, 39 ref

046289   SHANAIDA M, JASICKA-MISIAK I, MAKOWICZ E, STANEK N, SHANAIDA V, WIECZOREK P P (Pharmacognosy and Medical Botany Dep, I. Horbachevsky Ternopil National Medical Univ, Ternopil- 460 01, Ukraine, Email: shanayda@tdmu.edu.ua) : Development of high-performance thin layer chromatography method for identification of phenolic compounds and quantification of rosmarinic acid content in some species of the Lamiaceae family. J Pharm Bioall Sci 2020, 12(2), 139-45.

Representatives of Nepetoideae Burnett subfamily are promising species of the Lamiaceae Martinov family because of accumulating such valuable groups of secondary metabolites as terpenoids and polyphenols. A  high-performance thin layer chromatography (HPTLC) fingerprint method for the qualitative determination of phenolic compounds and for the quantification of rosmarinic acid (RA) content in methanol extracts of five species of this subfamily was developed for the first time. Dried aerial parts of Dracocephalum moldavica L., Ocimum americanum L., Lophanthus anisatus (Nutt.) Benth., Monarda fistulosa L., and Satureja hortensis L.  collected in flowering period were macerated with methanol. The HPTLC analysis was conducted using the CAMAG analytical system (Muttenz, Switzerland). The comparative analysis of RA contents was performed by HPTLC densitometric detection at λ = 366nm. Identification of polyphenols in the investigated herbs was performed by comparison of a color and Rf of the chromatographic zones with six reference standards: rutin, apigenin, luteolin, caffeic acid, chlorogenic acid, and RA. HPTLC method was also validated for the quantification of RA in the extracts of investigated herbs. RA contents decreased in such a sequence: D.  moldavica (24.83 ± 0.78 mg/g) > M. fistulosa (20.32 ± 0.64 mg/g) > O. americanum (19.59 ± 0.61 mg/g) > S. hortensis (18.77 ± 0.52 mg/g) > L. anisatus (12.61 ± 0.43 mg/g). Obtained data can facilitate the differentiation of investigated species using the chromatographic fingerprints of their phenolic compounds. Developed and validated HPTLC method provides an approach to estimate RA content as a common marker of investigated herbs.

4 illus, 1 table, 30 ref

044330   GOYAL R, CHAUHAN R , ANAND R, GOYAL M (Anesthesia and Critical Care Dep, Madhukar Rainbow Children’s Hospital, New Delhi- 110 017, Email: rakheegoyalkumar@gmail.com) : A prospective single‑center observational study to assess the efficacy of the second‑generation supraglottic airway device I‑gel in laparoscopic surgeries in children. J Anaesthesiol Clin Pharmacol 2020, 36(1), 20-4.

Supraglottic airways used in pediatric surgeries are associated with a lesser number of postanesthesia respiratory complications. However, there is limited literature on the use of i‑gel for pediatric laparoscopic surgery. The aim of this study is to assess the adequacy of ventilation of i‑gel for pediatric laparoscopic surgery and note any associated adverse event.  This is a single‑centered prospective observational study including 119 children, aged 6 months to 18 years, scheduled for laparoscopic surgery, during a 9‑month period, in a tertiary care center. I‑gel was used for positive pressure ventilation, and if the post‑insertion oropharyngeal seal pressure was <25 cm H₂O, it was replaced with a tracheal tube. Adequacy of ventilation and adverse events were noted. Data from 102 cases were analyzed (17 cases excluded: tracheal intubation in 11; missing data in 6 cases). The mean oropharyngeal seal pressure was 34.2 ± 5.2 cm H₂O and mean airway pressure was 16.1 ± 2.4 cm H₂O. The adverse events included transient cough (10.7 %), sore throat (4.9 %), and desaturation (3.9 %). There was no sign of respiratory distress during the recovery and no intervention was required in any child postoperatively. I‑gel provided adequate ventilation of the lungs in children undergoing laparoscopic surgery with no major adverse event.

2 illus, 3 tables, 17 ref

044329   SARAN S, RAO N S, AZIM A (Critical Care Medicine Dep, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow- 226 014, Uttar Pradesh, Email: draazim2002@gmail.com) : New and promising anti‑bacterials: Can this promise be sustained?. J Anaesthesiol Clin Pharmacol 2020, 36(1), 13-9.

The World Health Organization (WHO) announced antimicrobial resistance (AMR) as a major threat to public health which requires that new antimicrobials need to be developed faster than ever before. The rapid development of resistance has rendered many promising antibacterials useless in treating critically ill patients. This article discusses new antibacterials, which got Food and Drug Administration (FDA) approval in the last few years, along with their key pharmacokinetic and pharmacodynamic (PK/PD) advantages, added antimicrobial spectrum, indications, strengths and weaknesses of these drugs from an intensivist point of view. A brief mention has been made on antimicrobial peptides (AMPs), bacteriophages and nanoparticles, which are likely to dominate the future of antibacterials. Finally, it must be understood that the battle against AMR can only be won by a combination of innovative therapies, good infection control practices, strong antibiotic stewardship in the hands of informed healthcare workers.

1 illus, 1 tables, 47 ref

044328   JAIN K, YADAV M, GUPTA N, THULKAR S, BHATNAGAR S (Oncoanaesthesia and Palliative Medicine Dep, Dr. Brairch Aiims, New Delhi, Email: sushmabhatnagar1@gmail.com) : Ultrasonographic assessment of airway. J Anaesthesiol Clin Pharmacol 2020, 36(1), 5-12.

Ultrasound is gaining increasing popularity among anesthesiologists as it is readily available and provides real‑time imaging for various procedures. It is considered as a “visual stethoscope” of the anesthesiologist. After establishing its use in regional blocks and central venous catheter insertion, it is now finding increasing use in anticipation of difficult airway and securing and maintaining it. It has challenged the classical approach of clinical assessment of airway and allows more dynamic bedside assessment. This article attempts to briefly outline the role of ultrasound and its applications for airway management in patients.

9 illus, 62 ref

046288   ZAABI M S R A, SRIDHAR S B, TADROSS T M (Clinical Pharmacy and Pharmacology Dep, RAK Medical & Health Sciences Univ, Ras Al Khaimah, UAE, Email: sathvik@rakmhsu.ac.ae) : Assessment of incidence, causality, severity, and preventability of suspected adverse drug reactions to antidepressant medications in a psychiatry outpatient setting of a Secondary Care Hospital. J Pharm Bioall Sci 2020, 12(2), 131-8.

Antidepressant medications are primarily used in the management of depression and various anxiety disorders. Antidepressant medications are known to cause adverse drug reactions (ADRs). Reporting ADRs can help in the rational use of medication and better patient drug management. The aim of this study was to monitor the incidence and nature of ADRs to antidepressant medications in a psychiatric outpatient setting of a secondary care hospital of the UAE.  It was a cross-sectional study conducted in the psychiatric outpatient setting of a secondary care hospital. Patients attending psychiatry outpatient department and prescribed with antidepressant medications were included. All clinical side effects or ADRs noted by physician and reported by patients were documented and assessed according to causality, severity, and preventability scales. A total of 131 patients were screened for the presence or occurrence of ADRs. During the study duration, an aggregate of 29 patients reported at least one ADR. Incidence of suspected ADR to antidepressant medications was found to be 22.1 %. Most commonly documented suspected ADR was found to be weight gain in eight (18.1 %) patients followed by somnolence in four (9.1 %) patients. Escitalopram was the most common drug implicated with ADR in 13 (29.6 %) patients followed by fluoxetine in 6 (13.6 %) patients. According to World Health Organization-The Uppsala Monitoring Centre causality assessment, the predominance of the suspected ADRs was of “possible” type in 27 (61 %) patients, and “mild” in severity in 40 (91 %) patients, and “not preventable” in 37 (84 %) patients. A statistically significant association (P  =  0.019) was observed only between the presence of drug-interaction and the occurrence of ADR (relative risk: 0.429, confidence interval: 0.211–0.872). Most of the suspected ADRs related to antidepressants were “mild,” “predictable,” and “not preventable” in nature. Continuous monitoring may help in identifying, reducing, and preventing the risk of ADRs.

7 tables, 25 ref

046287   BHARDWAJ K K, BANGARURAJAN K, NAVED T, RAJPUT S K (Central Drugs Standard Control Organization, North Zone, Ghaziabad, Email: krishan.bhardwaj9@gmail.com) : Perspective, perceptions, and promulgation of biosimilars: A questionnaire-based study to assess and understand the current challenges of biosimilars to the potential and intended users. J Pharm Bioall Sci 2020, 12(2), 124-30.

Biosimiliar, a copy of reference biological product, is making a buzz across the globe for its upper edge therapeutic usage. According to the market research report published by P&S Intelligence, biosimilars market is expected to generate $ 26.7 billion revenue by 2024, advancing at a CAGR of 29.6 % during the forecast period. The first biosimilar to medicine Omnitrope, was approved in Europe by EMA (European Medicines Agency) in year 2006. Till date countries like US, China, Japan, India and many more have generated regulatory guidelines for biosimilars. Current study addresses the issues and challenges faced by Industry and regulators with their potential solutions and recommendations. The questionnaire having 21 important questions/ comments was given to participants after explaining the purpose of the study. The response in terms of responders V/s non-responders, agree V/s disagree, yes V/s no was recorded and analyzed by descriptive statistics. The study shows the limitation regarding the qualified personnel involved in biosimilars, as approx. 91 % people believe that there is lack of expertise in this field. The same can be achieved through government initiatives for bridge courses which is also strongly felt by the major (83.6 %) stakeholders participated in the study.

5 illus, 3 tables, 16 ref

046286   SADIQ N , GILLANI S W, SAEEDY D A, RAHMOUN J, SHABAN D, KOTAIT K, JAVAHERI S (Pharmacy Practice Dep, Gulf Medical Univ, Ajman, UAE, Email: wasifgillani@gmail.com) : Clinical review of acute, recurrent, and chronic pancreatitis: Recent updates of 2013–2019 literature. J Pharm Bioall Sci 2020, 12(2), 112-23.

The increasing prevalence of pancreatic disorders worldwide has provided challenges in its clinical care and management. This review was aimed to evaluate recent literature on diagnosis, treatment, and management of acute pancreatitis (AP), recurrent acute pancreatitis (RAP), as well as chronic pancreatitis (CP) documented during the past 5–6  years. An extensive literature review was carried out based on studies within the last 6 years (2013–2019). Articles were selected based on updates and therapeutic management. Critical appraisal of literature was performed using the Mixed Methods Appraisal Tool (MMAT), and a PRISMA flowchart was used to avoid bias. The study identified recent updates on the prophylactic treatment in preventing RAP. The risk factors and the therapeutic management options were evaluated and discussed. The findings show that although many lifesaving new protocols are available for implementation in clinical practice, current literature lacks detailed and comprehensive guidelines that cover special populations and comorbidities. The literature evaluated showed that eight genes were involved in pancreatitis, CASR, CFTR, CLDN2, CPA1, CTRC, PRSS1, SBDS, and SPINK1, but the most common gene implicated was found to be CFTR, at 11 %. Therefore, it is recommended that a comprehensive guideline should be formulated to facilitate the diagnosis, management, treatment, and prophylactic measures of pancreatic disease. This could in turn reduce disease complications and hospitalization time, and improve clinical practice for management of pancreatitis.

8 illus, 1 table, 21 ref

046285   AZHAR A, GILLANI S W, MOHIUDDIN G, MAJEED R A (Pharmacy Practice Dep, Gulf Medical Univ, Ajman, UAE, Email: wasifgillani@gmail.com) : A systematic review on clinical implication of continuous glucose monitoring in diabetes management. J Pharm Bioall Sci 2020, 12(2), 102-11.

The aim of this systematic review was to evaluate the clinical implications of continuous glucose monitoring (CGM) among patients with diabetes mellitus using variables that include glycated hemoglobin (HbA1c), estimated A1c, glucose variability, and users’ perspectives. This study analyzed 17 articles that were identified and studied according to the research question criteria. PRISMA guidelines were used for identification and screening of the literature. The required data were searched using Medscape, PubMed, PROSPERO, Wiley Library, Scopus, Clinical Trial Registry, and Trip. The articles reviewed were on the use of CGM in type 1 and type 2 diabetes mellitus, which showed significant improvement in the levels of HbA1c as compared to non-CGM. The application of CGM on acute sudden onset type of adverse drug reactions (i.e., hypoglycemia) is better than fasting blood sugar or self-monitoring of blood glucose or capillary blood glucose (random blood glucose monitoring). CGM is beneficial for use in patients with type 2 diabetes mellitus including elderly patients as it gives information regarding glucose variability as well as HbA1c levels. The health-care providers require full spectrum of patients’ CGM data to design a better therapeutic plan. However, the patients experienced inconvenience on wearing the device on the body for longer periods. The findings also stated the fact that more education and training is required for the patients to interpret their own glycemic data using CGM and modify their lifestyle accordingly. Use of CGM along with HbA1c has also been used to achieve better glycemic results and it allows the health care professional to guide patients in terms of their glucose level; whether they are hypoglycemic or hyperglycemic, however its use has some controversies that minimize its application. The study concluded that CGM has significant potential in the management of not only patients with type 1 diabetes mellitus but also patients with type 2 diabetes mellitus in spite of the few limitations that are being improvised in the upcoming years. However, limited literature of CGM among patients with type 2 diabetes mellitus and pregnant women reduces the practice scope.

8 illus, 1 table, 26 ref

046284   AL-TAIE A , AL-SHOHANI A D, ALBASRY Z, ALTAEE A (Pharmacy Dep, Girne American Univ, Mersin- 10, Turkey, Email: altaii1978@gmail.com) : Current topical trends and novel therapeutic approaches and delivery systems for oral mucositis management. J Pharm Bioall Sci 2020, 12(2), 94-101.

Oral mucositis (OM) is an extremely serious and challenging complication of chemoradiotherapy, which may limit the efficacy of cancer treatment. Complications related to OM include potential nutrition impairment, high economic burden, and negative impacts on patients’ quality of life. Current therapeutic options with local traditional pharmaceutical formulations are largely focused on controlling symptoms, and only few agents are available for treatment. Several local supportive and palliative agents are used for the prevention of OM; however, a standard treatment for the disease has not been confirmed yet. The efficacy of treatment could be improved through the introduction of new medical agents with updated dosage forms that can enhance and optimize local drug delivery and create greater therapeutic effects with fewer side effects. The focus of this review was to provide clear and direct information about the currently available topical therapeutic agents in clinical practice used to cure and/or reduce the incidence of ulcerative symptoms of OM, excluding the associated pain and other coexisting complications such as bacterial and fungal infections. The review also provides recent evidences regarding agents that could be used as promising novel therapies in updated local delivering systems. This will support further encouraging options and approaches for the management of OM and will improve compliance that could be translated in better disease control and survival.

90 ref

046283   MUNZUR-E- MURSHID, HAQUE M (National Defense Univ, Kuala Lumpur- 570 00, Malaysia, Email: runurono@gmail.com) : Hits and misses of Bangladesh National Health Policy 2011. J Pharm Bioall Sci 2020, 12(2), 83-93.

National Health Policy (NHP) is a guiding principle for a country to identify the priority of health-care needs, resource allocations according to prioritization, and to achieve specific health-care goals. In addition, NHP is usually wide-ranging, all-inclusive plan that pursues each and every population to move on the road to better health. NHP targets to achieve universal health coverage and delivering quality health-care services to all at inexpensive cost, through a preemptive, protective, and prophylactic health-care program in all national and international developmental policy and planning. There are quite a few constituents that are valuable in executing health policy. These elements include novelty, technical compendium, communiqué, conglomerates, administration, supervision, and political awareness and promise. Health policies can be implemented at all levels of the government system. It helps in strengthening the overall health-care system of the country by effective public–private coordination and collaboration. In the year 1990, the Government of Bangladesh (GoB) tried to promulgate an NHP. Unfortunately, the attempt failed. The health-care system of the country operated without a policy until 2011. In the year 2011, the country’s first health policy was published by the GoB. Though the country has have achieved excellent progress in providing health care, but yet Bangladesh has a few critical challenges that need immediate attention. In this article, we will try to address the pros and cons of the Bangladesh NHP 1990 and the positive aspects and challenges of NHP 2011.

2 illus, 2 tables, 115 ref

046282   MUSLIMIN L, BURHAN A, KHAIRUDDIN K, KRISWANTY C, ARSYANDI A, MEGAWATI M (Pharmaceutical Chemistry Dep, Sekolah Tinggi Ilmu Farmasi Makassar, Makassar- 902 42, Indonesia, Email: lukman_m01@yahoo.co.id) : Chemical composition and bioactivity of Vitex cofassus Reinw. extracts on the larval and pupal stages of Aedes aegypti. J Pharm Bioall Sci 2020, 12(1), 77-81.

This study sought to investigate the chemical composition, larvicidal, and cytotoxic potentials of the fruit extract of Vitex cofassus Reinw. 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. 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. 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.

3 tables, 23 ref

046281   AL-SHAHWAN M J, GACEM S A, HASSAN N A G M, DJESSAS F, JAIROUN A A, AL-HEMYARI S S (Clinical Sciences Dep, Ajman Univ, Ajman, United Arab Emirates, Email: sabrinaaitgacem@yahoo.com) : A study to identify the most common reasons to wean among breastfeeding mothers in UAE. J Pharm Bioall Sci 2020, 12(1), 72-6.

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. 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. 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. 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. 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. 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.

2 illus, 3 tables, 21 ref

046280   BLEBIL A, DUJAILI J, ELKALMI R, TAN H L K, TAI M S, KHAN T M (Monash Univ, Selangor, Malaysia, Email: aliblebil@yahoo.com) : Community pharmacist’s role in providing oral health-care services: Findings from Malaysia. J Pharm Bioall Sci 2020, 12(1), 64-71.

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. 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. 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. 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.

2 illus, 6 tables, 17 ref

046279   MOHIUDDIN S G, AZIZ S, IQBAL M Z, NAQVI A A, AHMED R, MAHMOUD M A, GHORI S A (Pharmacy Dep, Asian Institute of Medicine, Science and Technology Univ, Kedah, Malaysia, Email: waqarghouse@gmail.com) : Knowledge, attitude, and practice of general population toward complementary and alternative medicines in relation to health and quality of life in Sungai Petani, Malaysia. J Pharm Bioall Sci 2020, 12(1), 57-63.

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. This is a crosssectional 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. 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).  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

4 tables, 18 ref

046278   SABU S M, SESHADRI S, THUNGA G, POOJARI P G, ACHARYA L D (Pharmacy Practice Dep, Manipal Academy of Higher Education, Manipal- 576 104, Karnataka, Email: leela.da@manipal.edu) : Assessment of association between antihypertensive drug use and occurrence of new-onset diabetes in South Indian patients. J Pharm Bioall Sci 2020, 12(1), 48-56.

The objective of this study was to determine the association between antihypertensive drug use and new-onset diabetes (NOD) in patients with hypertension (HTN). 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. 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). Patients on non-DHP CCBs, diuretics, and combination antihypertensives showed more chances of developing NOD.

5 illus, 5 tables, 28 ref

046277   AGGARWAL B, SHARMA P, LAMBA H S (Pharmacognosy Dep, Jaipur National Univ, Jaipur, Rajasthan, Email: aggarwalbabita10@gmail.com) : Gas chromatography–Mass spectrometry characterization of bioactive compounds from Ziziphus nummularia (Burm. f.) stem bark with promising in vitro antiplasmodial activity. J Pharm Bioall Sc 2020, 12(1), 42-7.

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. 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). 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. 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.

1 illus, 3 tables, 31 ref

046276   MAHASSNI S H, ALAJLANY K A (Biochemistry Dep, King Abdulaziz Univ, Jedda- 215 51, Kingdom of Saudi Arabia, Email: sawsanmahassni@hotmail.com) : 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. J Pharm Bioall Sci 2020, 12(1), 31-41.

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. 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 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. 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.

8 tables, 42 ref

046275   IBRAHIM N A, EDIS Z, AL-OWAIS K S (Clinical Sciences Dep, Ajman Univ, Ajman, United Arab Emirates, Email: n.ibrahim@ajman.ac.ae) : Adherence of geriatric patients and their beliefs toward their medicines in the United Arab Emirates. J Pharm Bioall Sc 2020, 12(1), 22-30.

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. We aimed to evaluate the adherence and beliefs of geriatric patients in the UAE toward their medicines and to explore the factors affecting them. 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. 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.

8 illus, 4 tables, 18 ref

046274   SHAHWAN M , SULIMAN A, JAIROUN A , ALKHOUJAH S, MOHAMMED H , ABDULLAH H (Clinical Sciences Dep, Ajman Univ, Ajman, United Arab Emirates, Email: moyad76@hotmail.com) : Attention-deficit hyperactivity disorder: Knowledge and perception of dental care providers at Ajman. J Pharm Bioall Sci 2020, 12(1), 16-21.

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. 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. 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. The existing results will be used in developing a well-planned program and clear polices to increase the level of awareness regarding ADHD.

2 illus, 3 tables, 30 ref

046273   AHMAD N J, ALTHEMERY A U, HASEEB A, YUSUF R F, HASSALI A A , KHAN A H (Clinical Pharmacy Dep, Prince Sattam Bin Abdulaziz Univ, Al-Kharj, Saudi Arabia, Email: pharmdnehadjaser@yahoo.com) : Inclining trend of the researchers interest in antimicrobial stewardship: A systematic review. J Pharm Bioall Sci 2020, 12(1), 11-5.

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. 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. 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. 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.

4 tables, 30 ref

046272   ABDULLAHI R, ABUBAKAR , HAQUE M (National Defence Univ, Kuala Lumpur, Malaysia, Email: runurono@gmail.com) : Preparation of medicinal plants: Basic extraction and fractionation procedures for experimental purposes. J Pharm Bioall Sci 2020, 12(1), 1-10.

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 microwaveassisted 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.

25 ref