##### Economic Evaluations of Cabazitaxel for Treatment of Post-docetaxel Metastatic Castration-resistant Prostate Cancer: Evidence from a Systematic Review

Nikinaz Ashrafi Shahmirzadi, Pardis Zaboli, Monireh Afzali, Bereket Molla Tigabu, Mirhamed Hajimiri, Arman Ajami, Nima Sepehri

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630324

Background and Objectives: Prostate cancer is an ever-increasing global incidence and has become the fifth leading cause of cancer-related mortality in men. A significant number of patients with prostate cancer develop metastatic castration-resistant prostate cancer (mCRPC). There are a few second-line treatment options for patients with post-docetaxel mCRPC. This systematic review aimed to assess the cost-effectiveness of cabazitaxel for the treatment of mCRPC.

Materials and Methods: Electronic bibliographic databases including: PubMed/Medline, NICE, CRD, and Scopus were searched in January 2018 for identifying full economic evaluations published in English and Persian. The risk of assessment bias and descriptive analyses of individual studies’ findings were presented.

Results: Three articles that fulfilled the inclusion criteria were included in the current study. All the included records had a reasonable quality. Cabazitaxel was not recommended as the most cost-effective option for the treatment of docetaxel-refractory mCRPC. Abiraterone acetate and radium-223 were the recommended cost-effective treatments for mCRPC treatment.

Conclusion: We found that, in general, while cabazitaxel had equal or slightly higher improvement in Quality-adjusted Life Year (QALY) as compared to the alternatives, it incurred a high cost. Despite the inclusion of a few studies in this review, cabazitaxel was not found to be a cost-effective option. Therefore, we recommend full economic evaluations to be conducted in this area.

##### Efficacy of DAA-based Antiviral Therapies for HCV Patients with Chronic Kidney Disease: A Meta-analysis

Peyman Sanjari Pirayvatlou, Seyyed Moayed Alavian, Sasan Sanjari Pirayvatlou, Pouyan Sanjari Pirayvatlou, Mina Mahboodi, Madjad Einollahi

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-10
DOI: 10.9734/jpri/2019/v31i630328

Context: HCV infection in patients with chronic kidney disease (CKD) is important to be treated because it's associated with increased healthcare costs, utilization and is pertained with decrease in survival rate of HCV-infected patients who also have chronic kidney disease. Direct acting agents (DAAs) are novel form of treatment of HCV infection in patients with CKD. The aim of this study is meta-analysis and comparison of the efficacy of different regimen of DAAs used in the treatment of HCV in such patients.

Objective: Hepatitis C is a liver disease caused by the hepatitis C virus, the virus can cause both acute and chronic hepatitis. Hepatitis C virus (HCV) is a known risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). HCV infection in CKD patients is also associated with increased healthcare costs and utilization, with further increases in those with ESRD. It should be also noted that survival among HCV-infected patients with chronic kidney disease without undertaking any treatment is low, various mechanisms such as increased liver-related mortality, low quality of life and high cardiovascular risk can explain this finding. The benefits of treatment may extend beyond the liver, with improvements in both cardiovascular and renal outcomes in patient with chronic kidney disease. Previously PEG-INTERFRON Based regimens have been used for treatment of CKD or ESRD Patients with chronic Hepatitis C but this treatment plan was associated with higher adverse effects and less efficacy. Nowadays new researches have shown the efficacy of the Direct Anti-Viral Agents (DAAs) In such patients.

Data Sources: A systematic literature searches in PubMed, EMBASE, Web of Science, and Scopus motor searches was done. Virologic response at 12 weeks after the end of treatment (SVR12) was extract from the included studies. Finally, SVR12 rate with 95% confidence intervals (CI) were pool analyzed with random-effects model.

Study Selection: Studies were included if they satisfied the following criteria: Participants being adult HCV patients with stage 3–5 CKD (age≥18 years), Interventions being DAA-based antiviral therapies, Outcomes being sustained virologic response at 12 weeks after the end of treatment (SVR12). Studies were excluded if having incomplete outcome data and had no sufficient data to calculate SVR12.

Data Extraction: The methodological quality of included observational studies was assessed by three reviewers independently by using the Newcastle–Ottawa scale (NOS), which is usually used for observational studies in meta-analyses.

Results: 20 studies comprising a total of 628 patients (from 20 studies) were included for our meta-analysis. The pooled analysis for SVR12 rate was 0.95 (95% Cl 0.92-0.96, I2= 0.00%), 0.92 (95% Cl 0.82-0.96 I2= 0.00%) and 0.95 (95% Cl 0.93-0.97, I2= 0.0%) for total population, sofosbuvir base treatment group and non sofosbuvir base treatment group.

Conclusion: DDAs have high efficacy in treatment of HCV in patient with CKD and it seems that there is no different between sofosbuvir versus non sofosbuvir based regimens for treatment of HCV infection in this patients.

##### Study of the Role of New Technologies in Pharmaceutical Industry

Zaffar Ahmed Shaikh, Anwar Ali Sathio, Asif Ali Laghari, Mashooq Ahmed Memon, Ibrar Hussain Mirani

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-11
DOI: 10.9734/jpri/2019/v31i630313

The objective of this study was to assess the importance and impact of new technologies in the pharmaceutical industry. The study also explores strategic visions for the development of technical requirements, the recognition of IT inventions that support patient care services and the assessment of pharmacists’ willingness to adopt inventions. The assumptions were therefore to assess the impact, positive or negative, of the use of new technologies on the pharmaceutical industry. Two kinds of respondents took part in collecting primary and secondary datasets. Thus, 100 participants were selected for questionnaire and 15 for interview-based data input. Pharmacy students, teachers/researchers, and employees of the pharmaceutical companies were included. The study concludes that new technologies have had a positive effect on the growth of the pharmaceutical industry. About the future, it is concluded that new technologies will give the pharmaceutical industry more advantages in expanding their businesses in their chosen fields. On the other hand, it is also concluded that some of the respondents are not satisfied with some technologies used. The study recommends that pharmacists organize training courses to educate employees on new technologies. It also suggests that Artificial Intelligence should be implemented in the pharmaceutical sector, which may not reduce the employment of individuals because this will lead to a considerable loss of Artificial Intelligence errors.

##### Ginkgo Biloba as a New Medication for Resisting Dementia: A New Proposal

Jyh-Woei Lin

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-3
DOI: 10.9734/jpri/2019/v31i630322

Ginkgo biloba has been used in traditional medicine, by which memory in the brain could be improved. In this study, a dementia patient has taken Ginkgo biloba during the time period of a year as a case study. He has taken a pill with 665 mg for a year from 08 November 2018 to 08 November 2019 (Taiwan Standard Time, TST). Later, the brain waves were largely different. However, he could only know his family name, the long term memory (LTM) could showed only a small recovery. The treatment outcome has been limited. Focusing on synapses in the brain can be a good way of interpreting the results. For future research, some new medications containing Ginkgo biloba can be devised for keeping a normal converting long-term potentiation (LTP) for healthy persons and for resisting dementia. The new proposal contributes to this study. Ginkgo biloba should be necessary as a pharmaceutical ingredient.

##### Extraction Procedure Optimization of Atenolol from Dried Plasma Spots

A. A. Chernonosov, V. V. Koval

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630330

Aims: Atenolol is one of the β-blockers widely used for the treatment of hypertension and other cardiovascular diseases. To simplify the methods for determining of drugs concentrations in blood and plasma the dried spots assays (dried blood spots or dried plasma spots) could be used. In this case high sensitive detector like mass-spectrometer is required as well as high level of drug recovery from dried spot. In this study the extraction of atenolol from dried plasma spots (DPS) was studied to offer the optimum parameters of extraction method.

Study Design: Short research articles.

Place and Duration of Study: Core Facility of Mass Spectrometric Analysis, Institute of Chemical Biology and Fundamental Medicine SB RAS, between January and October 2019.

Methodology: The organic extraction method was chosen for evaluation as the most suitable for LC-MS assay. Several parameters: % of organic solvent, presence or absence of 0.1% formic acid, time, volume and temperature of extraction were investigated to find the best combination for atenolol recovery from DPS for further LC-MS analysis.

Results: Results showed that the solvent composition and temperature has main influence on the extraction. The effect of extraction time and volume of solvent have no significant influence on atenolol recovery. Pure acetonitrile is the worst solvent for atenolol extraction from DPS. The solvents: MeOH:H2O (60:40, v:v), MeOH:0.1% FA in H2O (60:40, v:v), ACN:0.1% FA in H2O (50:50, v:v) or ACN:MeOH (60:40, v:v) provide the best recovery of atenolol. The optimum extraction temperature is 40°C, time of extraction is 15-30 min and volume of solvent - 200-300 μL.

Conclusion: Several solvents acceptable for LC-MS analysis with optimized recovery parameter from DPS can be used for routine extraction of atenolol.

##### Nutritional Viscosity Management for Renal Stones (Nephrolithiasis) Prevention According to Avicenna’s Canon of Medicine

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630374

The prevalence of renal stones in industrialized countries is about 10 to 12%, and its incidence has increased in recent years. Renal stone is strongly dependent on dietary habits, so dietary changes are the most promising intervention to reduce renal stone production. Nutrition from the perspective of traditional Persian medicine is one of the important pillars of prevention and treatment of diseases such as renal stones. In this article, we intend to outline the nutritional managements indicated in Avicenna’s book of canon of medicine on renal stones. According to Avicenna, renal stone producing foods are concentrated and viscous foods, including some dairy products, meats, cereals, fruits, pastries, breads and some foods. Many such foods discriminated by Avicenna to be viscous and thus stone forming are also shown by modern science to increase the risk of renal stone production although based on diverse mechanisms. This issue may be an example that traditional medicine may suggest experienced-founded phenotype-based shortcuts for better research hypothesis designs.

##### Phytochimic Study, Antioxidant Activity and Nutritional Interest of Extracts from Leaves of Khaya senegalensis (Desr) A. Juss (Meliaceae) Collected in the Northern Cote d'ivoire

Kone Monon, Traore Youssouf Zanga, Konan Kouadio Fernique, Toure Abdoulaye, Koko Kouakou Konan Henri Joel, Ouattara Karamoko, Coulibaly Adama

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-10
DOI: 10.9734/jpri/2019/v31i630315

Medicinal and food plants contain a large number of metabolites that have multiple interests in pharmacology, cosmetology and the food industry. The aim of this study was to determine the content of phenolic and flavonoid compounds, to evaluate the antioxidant activity and to raise the nutritional interest of extracts from leaves of Khaya senegalensis. The methodological approach consisted of carrying out extractions with distilled water, ethanol, methanol and butanol. The extracts thus obtained were subjected to phytochemical analysis by spectrophotometric assay to determine the content of minerals, total phenols and flavonoids and to evaluate the antioxidant activity. The investigations revealed that K. senegalensis leaves extract have a high calcium content (948.38 ± 11.57 mg / 100 g), magnesium (188.24 ± 0.97 mg / 100 g), phosphorus (304.98 ± 2.6 mg / 100 g) and iron (41.50 ± 1.57 mg / 100 g). A high content of total phenols and flavonoids was observed with butanol extract (91.53 ± 0.04 mg EAG / g extract) and (75.58 ± 0.05 mg EQ / g extract) respectively. The ethanol and methanol extracts recorded the best performances by reducing the residual iron while the aqueous and butanol extracts obtained the IC50 values closest to those of the reference viz vitamin C and BHT. This studyshowed that K. senegalensis leaves are a source of active substances known for their therapeutic and nutritional properties. The leaves of K. senegalensis could be used to treat various pathologies and also as an alternative in cattle feeding.

##### Community Pharmacists' Knowledge, Attitudes and Practices towards the Use of Herbal Remedies

Nehad J. Ahmed, Mohd F. Khan

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630316

Background: The use of herbal medicines and natural health products by the public is continuously being increased by the day. Community pharmacists are the most accessible healthcare providers, this necessitates that pharmacists should be aware of the appropriate use of herbal medicines.

Objective: The objective of the present study was to assess the knowledge, attitude and practice of community pharmacists in the Al-Kharj region.

Methodology: A cross-sectional study was carried out amongst pharmacists who work in different community pharmacies in Al-Kharj, Saudi Arabia. The questionnaire was prepared using surveys of previous studies and was hand-delivered to the pharmacists concerning the use of herbal medicines.

Results: All of the respondents were male and more than 50% of them were in the age range between 30-39. Most of the pharmacists reported that they have sufficient information about dietary supplements and that they are interested in updating their knowledge  about herbal drugs. Furthermore, more than 70% of the participants said that they take both medical and medication history from the buyers before supplying herbal medicines.

Conclusion: The study shows that pharmacists have good knowledge and a positive attitude toward using herbal medicines by the public in Al-Kharj city.

##### Development and Validation of Ultra High Performance Liquid Chromatographic (UHPLC) Method for the Determination of Roxithromycin in the Broiler Plasma

R. D. Singh, S. K. Mody, H. B. Patel, V. N. Sarvaiya, B. R. Patel, S. B. Gondaliya

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630318

Aims: The present study was designed to develop and validate the UHPLC method for quantitative determination of roxithromycin, a macrolide antimicrobial drug, in broiler plasma for the application of pharmacokinetic studies.

Methodology: UHPLC apparatus comprised of ultraviolet (UV) detector was used in the present study. Chromatographic separation was performed by using reverse phase C18 column. Mobile phase was combination of buffer and 55 acetonitrile in the ratio of 55: 45. Buffer part used was 0.1% trifluoroacetic acid (v/v) having pH of 2.1. Erythromycin was used as an internal standard. Isocratic elution mode was employed with flow rate of 1 ml/min and effluents were monitored at wavelength of 220 nm. Liquid-liquid extraction using ice-cold acetonitrile was performed to extract roxithromycin from plasma samples. The data integration was performed using Chromeleon™ version 6.8 software.

Results: The linear calibration curve with a mean correlation coefficient (R2) value of 0.9999 was observed for concentrations ranging from 0.20 to 12.80 µg/ml. At any concentration, accuracy was not found to be less than 90%. The mean extraction recovery (n=5) for concentrations of 0.40 µg/ml was 81.36%. The calculated intraday and interday C.V. % was not more than 7.70% and 9.42%, respectively, at any concentration studied. The specificity of the analysis was reflected by the narrow range of retention time ranging between 6.983 to 7.178 minutes. LOD and LOQ of the method under investigation were calculated as 0.131 and 0.398 µg/ml, respectively.

Conclusion: A reliable, reproducible, accurate, precise, specific and sensitive method for analysis of roxithromycin in broiler plasma was developed and validated for application in the pharmacokinetic study of the roxithromycin.

##### The Use of Topical Clobetasol among the Women in Hail Region, Saudi Arabia: A Cross-sectional Study on Knowledge and Practice

Mukhtar Ansari, Subish Palaian, Mohamed Izham Mohamed Ibrahim, Pathiyil Ravi Shankar

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630319

Aims: The current study aimed to evaluate female consumers’ knowledge and practice about harmful effects of topical clobetasol applied on the face for cosmetic purposes.

Study Design: Cross-sectional study.

Place and Duration of Study: Randomly selected community pharmacies, well known cosmetic shops and shopping malls of Hail region, Saudi Arabia from March 2018 to June 2018.

Methodology: We included 391 participants who only used ‘clobetasol’ as a topical steroid at the time of interview, responses were collected as per the study tool and analyzed using SPSS for Windows, Version 16.0. Chicago, SPSS Inc..

Results: Relatives (28.1%), friends (25.6%) and community pharmacists (15.6%) contributed significantly towards using topical clobetasol cream. In 86.2% of the cases, the pharmacists who dispensed clobetasol did not inform the consumer about the harmful effects. Purchasing the cream without prescription (P = 0.025) was significantly associated with age. In the study, 41.9 % of the females experienced adverse effects, with the commonest one being hair growth on face (23%) followed by dermatrophy (14.8%); with a significant association with frequency of use (p<0.001).

Conclusion: There was haphazard use of topical clobetasol by females and they were unaware of the adverse effects. Over-the-counter availability of topical clobetasol, lack of knowledge about harmful effects, and lack of counseling on its safety profile by community pharmacists and other healthcare professionals are mainly responsible for its misuse and harmful consequences.

##### Assessment of Efficacy of Multi Herbal Extracts Product (FluAct® Syrup) against Flu Indications in Pakistani Population

Yasir Mehmood, Hafiz Umar, Hammad Yousaf, Humayun Riaz

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630320

One of the most common diseases to human is flu which direly needs appropriate therapies. Fever, throat pain and runny nose are the eminent indication of flu which is irritating to the patients. The consumption of herbal medicines is the most reliable alternative treatment all over the globe because of its compatibility within body and rare side effects when compared to synthetic chemicals. The main objective of the study was in-vitro screening and evaluation of anti-flu potential of multi extract herbal product FluAct syrup. This cross sectional study work encapsulates observation on 250 patients for treatment of flu by using a novel multi extra for above seven days of duration. After the approval from ethical committee of Rashid Latif College of Pharmacy (RLCP), a questionnaire was designed and collects information within flu patients who used FluAct syrup. An independent statistician for analysis (Microsoft excel) was used to analyze collected data. Result showed that most of the patients’ cured by using FluAct syrup. Some of them did not completely cure in terms of headache (92.92%), sore throat (91.5), lethargy (92%) and temperature (97.7%). The findings showed abrupt improvement in patient health within three days by using FluAct syrup. It was reported that patients have excellent tolerance and showed willingness to adopt this therapy to treat flu. The study was used to confirm the data. It can be concluded that novel preparation of multi extracts (FluAct syrup) has effective herbal constituents to treat symptoms of flu in patients along with better tolerance and quick relief efficacy.

##### The Relationship between Chronic Lower Urinary Tract Symptoms and Psychological Disorders in Women Referring to Baqyiatallah Hospital Clinic in Tehran City

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630321

Introduction: Lower urinary tract symptoms (LUTS) refer to a group of medical symptoms with the prevalence of 62.5% in men and 66.6% in women. LUTS (Lower Urinary Tract Symptoms) was associated with increased risk of having clinically relevant depressive symptoms or depression and vice versa. We assumed that patients with chronic lower urinary tract symptoms who referred to urology clinic and have negative urologic evaluations, may suffer from psychological symptoms such as anxiety, depression or obsession.

Methods and Materials: This was a cross-sectional, single group survey of women living in Tehran province. Patients who were suffering from lower urinary tract symptoms for over than 6 months, were included in the study. We evaluate the presence of LUTS by asking the patients about their problems of urinary tract in two major categories: Filling or irritative symptoms - e.g. frequency, urgency, dysuria, nocturia, stress incontinence, urge incontinence. Chi square and independent T tests were used to evaluate the correlation between study variables. All statistical analysis was performed using SPSS software version 16.

Results: There was a positive correlation between irritative symptoms and depression symptoms (p‹0.001) and a negative correlation between obstructive symptoms and depression (p‹0.001). There was no association between LUTS and symptoms of OCD (Obsessive- Compulsive disorder). The mean age of participants with positive BDI (Beck depression inventory) was higher than those with negative BDI. (p= 0.007).

Discussion: The results of this study emphasized the important association of LUTS and depression. In conclusion, depressive disorder can increase the risk of developing LUTS or accelerate this process. So when a patient with either urinary or depression symptoms referred to a psychiatry center, he should be screened for the other disease. This requires an adequate interaction between urology and psychiatry departments to achieve.

##### The Relationship between Emergency Medical Services Staff Knowledge of Basic Life Support Indicators

Masoud Raeisi, Amin Saberinia, Ali Arhami Dolatabadi, Parvin Kashani

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630323

Introduction: One of the most important steps to save patients is to perform resuscitation. The aim of this study was to investigate the knowledge and practice of emergency personnel in Tehran regarding the baseline level of resuscitation operations.

Methods: This descriptive cross-sectional study was performed on 200 emergency personnel working in Tehran. The level of awareness questionnaire with 45 qualifications and the base of BLS indicators was prepared and collected.

Results: According to Chi-square test, there was a significant correlation between age and practical score. Also, there was a significant relationship between the ALS courses and the acquired theoretical score.

Conclusion: The results of the increase in awareness of this study in relation to previous studies in Iran and especially in the region show that during the last few years, the level of knowledge of medical emergencies personnel has had good improvement, while on the other hand, although there has been improvement in the performance compared with last few years.

##### Retracted: GC/MS Analysis of n-Hexane and Chloroform Extracts of Chenopodium murale Leaves in Iraq

Muthanna Saadi Farhan, Amjed Haseeb Khamees, Omar Hussein Ahmed, Amani AmerTawfeeq, Yahya Saad Yaseen

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630325

Chenopodium murale L. it is an essential annual herbaceous weed belongs to the genus Chenopodium and family Chenopodiaceae. Chenopodium murale L. commonly called as nettle leaf goosefoot. Aim of this study is the gas chromatography-mass spectroscopy analysis of chemical constituents of Chenopodium murale leaves in two different extracts; n-hexane and chloroform. These extracts contain 37 chemical components which are Monoterpenes, steroids precursor and fatty acids. Furthermore the n- hexane extract revealed about 35.22% of cyclic and acyclic monoterpenoids, fatty acid about 2.07%, also 2.31% of nitrogenous compounds and sterol precursor about 0.41%.

However the chloroform extract revealed the presence of linolenic acid representing 13.54% and neo menthol representing 18.87%, also the other minor components are carvone oxide (0.27%), alpha- pinene epoxide (1.71%), Trans- Squalene (0.77%) and other minor bioactive components.

Retraction Notice: This paper has been retracted from the journal after receipt of written complains. This journal is determined to promote integrity in research publication. This retraction is in spirit of the same. After formal procedures editor(s) and publisher have retracted this paper on 05th  November-2020. Related policy is available here: http://goo.gl/lI77Nn

##### Implementation of Stress Ulcer Prophylaxis (SUP) in an Intensive Care Unit (ICU)

Foroud Shahbazi, Hasanali Karimpur, Elham Hosseini

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630326

Background: Critically ill patients are at high risk for developing stress ulcer bleeding, which may increase the length of hospitalization and mortality rate. Stress ulcer prophylaxis could be done either with PPIs or with H2 receptor blockers, which were prescribed in critically ill patients.

Aim: This cross-sectional study was accomplished in an intensive care unit to implement new stress ulcer prophylaxis.

Methods: This study was conducted in a tertiary hospital of Kermanshah province, west of Iran. Patients who were hospitalized for at least 72 hours and received SUP prophylaxis, were included in our study. Updated ASHP guideline was used for calculating SUP risk score. Patients received either PPIs or H2RA (intravenously or enteral). Efficacy and safety of early changes to enteral route were evaluated in one year and cost was calculated in three years’ period.

Results: This study was conducted on 150 patients with a mean age of 58 ± 18 years old. More than half of patients (53.3%) were male. Stress ulcer prophylaxis was prescribed for all critically ill patients, regardless of the risk of GI bleeding while only 76.6% of patients had an appropriate indication for receiving SUP protocol. Six patients in the PPIs group (4 in intravenous and 2 in enteral) experienced gastrointestinal bleeding. Changing the route of administration from intravenous to intravenous over a three-year period resulted in a decrease in the mean use of pentoprazole vials from 12 to 4 per patient.

Conclusion: Early changing (within 72 hours) SUP from IV to enteral is safe and cost-saving approach.

##### Ovicidal and Larvicidal Activities of Saba senegalensis (A.DC) Pichon (Apocynaceae) Extracts and Fractions on Heligmosomoides bakeri (Nematoda, Heligmosomatidae)

Mohamed Bonewendé Belemlilga, Aristide Traoré, Lazare Belemnaba, Félix Bondo Kini, Sylvin Ouédraogo, Innocent Pierre Guissou

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-13
DOI: 10.9734/jpri/2019/v31i630327

Aims: To investigate ovicidal and larvicidal activities of an aqueous decoction (AD) and hydroethanolic macerate (HEM) extracts and fractions of the leaves of Saba senegalensis.

Study Design: In vitro, the ovicidal and larvicidal activities of AD and HEM extracts and fractions of the leaves of Saba senegalensis on the eggs and larvae (L1) of Heligmosomoides bakeri.

Place and Duration of Study: The experiment was conducted at the department of Medicine and Traditional Pharmacopeia-Pharmacy (MEPHATRA-PH) of Institute of Research in Health Sciences (IRSS) between June 2015 and December 2016.

Methodology: The phytochemical groups of the extract and fractions of Saba senegalensis were determined by a colorimetric and Thin Layer Chromatography methods. The eggs were obtained from feces of mice deliberately infected and the larvae from the eggs were incubated at 25 ±2℃ for 72 hours. Eggs and larvae were exposed to increasing concentrations (100; 625; 1250; 2500; 3750 µg/mL) of the different extracts, 48 hours and 24 hours for the eggs and larvae respectively. Distilled water and DMSO 0.1% were used as negative controls while albendazole and levamisole were used as positive controls.

Results: The phytochemical groups of interest are the tannins, saponins, flavonoids and triterpenes. The negative control had given 2.16% of egg hatch inhibition and 0% of larvae mortality mean while the positive control had given 100% in both cases. The extracts inhibited eggs hatching and affected larval survival. Pharmacological effects were concentration-dependent. The ovicidal and larvicidal activity of HEM is more interesting than that of AD with an Emax = 95.60% and an IC50 = 390 µg/mL. It is the same for the larvicidal activity with Emax = 100% and an LC50 = 900 µg/mL.  However, the differences were not statistically significant.

Conclusion: These results show the ovicidal and larvicidal properties of the S. senegalensis leaves.

##### Development and Validation of Analytical Method for Determination of an Important Flavonoid in Malva neglecta

Naira Nayeem Akmal, Mohd. Imran, Mohammad Ali Mujtaba

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630329

Development of genuine and dependable analytical methods which profile marker phytoconstituents in   an extract containing a mixture of several components is a challenging task. A simple, rapid, precise, and reliable HPLC method was developed for quantification of quercetin from the methanolic extract of Malva neglecta. The estimation was carried out using Phenomenex Gemini-NX-5 µm C18 .The parameters  considered for validation were accuracy, precision, linearity and robustness. The calibration curve was found to be linear in a concentration range of 20–100 μg/mL.The correlation coefficient was r2=0.9996. The % average recovery of quercetin was found to be in the range of 99.82 to 100.52% which was within the acceptance criterion indicating the accuracy of the method. The results of the robustness study indicated that there is no influence of minor changes. The developed and validated method can be successfully used for the determination of quercetin in Malva neglecta; thereby helping in authentication and quality control of this plant.

##### Influence of Excessive Mobile Phone Use on Anxiety and Academic Performance among Medical College Students

Akhtar Ali, Sehrish Mehmood, Lubna Farooq, Humaira Arif, Nadeem Akhtar Korai, Muhammad Aitmaud Uddolah Khan

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630334

Objectives: The objectives of this study were focused on finding the influence of excessive mobile phone usage on academic performance of medical students and to find association between excessive mobile phone usage and anxiety in students of a medical University Karachi.

Methods: It was a questionnaire based study, three different standardized questionnaires were used to assess the sleep pattern and anxiety, however academic performance were evaluated by their last attempted exam.

Results: Excessive mobile phone usage was significantly (p-value = 0.001) associated with disturbed sleep pattern and sleep quality. But we did not had significant results for anxiety and academic performance.

Conclusion: Excessive mobile phone use may disturb sleep pattern and quality of sleep but it does not affect academic performance and does not lead to anxiety.

##### Knowledge of Pre-hospital Emergency Medical Technician about Endotracheal Intubation: A Manikin Study

Pourazizi Parviz, Aghaei Iraj, Kazemnezhad Leyli Ehsan, Pourshaikhian Majid

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630342

Background: Pre-hospital emergency is an important part of the health-care system helping for critically ill patients in the life-threatening conditions by endotracheal intubation, preventing complications and mortality. The present study was conducted to determine the knowledge of pre-hospital emergency staff about the endotracheal intubation.

Methods and Materials: This was an analytical cross-sectional study performed on 70 pre-hospital staff in Rasht. Samples were obtained through census. Data collection tools included a researcher-made questionnaire with three parts: Demographic and job characteristics with 14 questions and knowledge questionnaire, with 15 questions. The reliability coefficient of the knowledge questionnaire was 0.87 and the interclass correlation coefficient was 0.86. Kolmogorov-Smirnov, mean and standard deviation (in the Mann-Whitney and Kruskal-Wallis tests) were used. The collected data were entered into SPSS 24 software and analyzed.

Results: The majority of study participants were in the age groups of 26-30 and 36-40 years. Regarding education, the majority had associate and bachelor's degree. The findings of the pre-hospital emergency department staff's knowledge and status of the endotracheal tube insertion based on individual and occupational variables showed that the knowledge score based on work experience in the health system (p=0.05) and having unsuccessful intubation at six months (p=0.009) was statistically different, so that employees with higher work experience were less aware of endotracheal intubation and employees who have had a history of unsuccessful intubation for the past six months have had a higher level of knowledge.

Conclusion: According to the results of the present study, the knowledge of pre-hospital emergency personnel was in moderate level and needs educational programs to reach the optimum level.

##### Evaluation of Clinical Symptoms and Serum Lead Level in Patients with History of Oral Opium Use being Admitted to Hazrat Rasoul Akram, Firoozgar, Firoozabadi and Haft Tir Hospitals, Tehran

Majid Rezaei Tavirani, Hazhir Heidari Beigvand

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630344

Introduction: Drug abuse and its complications is a socio-health problem in Middle Eastern countries such as Iran. Smugglers may add lead to drug during drug production, which is in order to increase its weight for greater benefit. Considering the frequency of the patients with various complaints among Iranians, this study was designed and conducted to evaluate the clinical symptoms and serum levels of lead in patients being admitted to Hazrat Rasoul Akram, Firoozgar, Firouzabadi and Haft Tir hospitals with any complaints.

Materials and Methods: In this case-control study, serum levels of lead were measured in 128 samples in case and control groups. The case group consisted of 64 patients using oral opium who being admitted to Rasoul Akram and Firoozgar, Haft Tir and Firouzabadi hospitals with different complaints in May 2017. The control group consisted of 64 patients with no history of addiction that were homogenized with the case group in terms of age and sex. They were evaluated for serum levels of lead and other variables. Data were analyzed by SPSS software.

Results: The mean serum lead level was 76.34±17.82 in the group using opium and was 7.68±3.72 in the control group that the difference was statistically significant (P <0.001). The most common complaints of patients were abdominal pain and symptoms of bowel obstruction. The mean rate of oral opium consumption was 1.73±0.23 in subjects under 50 years old and with a mean of 2.89±0.27 in subjects over 50 years old. Serum lead level was significantly (P = 0.032) increased compared to the amount consumed. Duration of oral opium consumption was 5 months to 30 years with a mean of 15.24 years, which was not significantly correlated to serum lead level (P = 0.213). Also, the hemoglobin range was significantly correlated to different levels of lead in patients consuming oral opium (P = 0.027).

Conclusion: The findings of the present study showed a high mean serum lead level in oral opium addicts in the study population. The results also confirm numerous reports suggesting the definitive diagnosis of lead poisoning as a justifying factor in addicted patients with nonspecific symptoms, which may indicate the need for serum lead level screening in opiate addicts to prevent more serious complications.

##### Frequency of Outpatient Inhalers Prescriptions in Riyadh

Nehad J. Ahmed, Mohd F. Khan

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-5
DOI: 10.9734/jpri/2019/v31i630345

Background: Community pharmacists help patients in making informed decisions about their treatment and prevent the problems that could be developed from self-medication. The maintenance therapy with inhaled medications is the keystone of pharmacotherapy in many respiratory diseases such as asthma and chronic obstructive pulmonary disease.

Aim: The aim of the present study was to explore the frequency of inhalers dispensing in Riyadh.

Methodology: This was a cross-sectional, observational study carried out in Riyadh city to analyze the prescriptions in outpatient pharmacies.

Results and Discussion: The total number of prescriptions is 198 prescriptions that include 650 different medications. Out of the 650 medications, the majority were in the form of a tablet (61.7%), followed by capsules. The present study showed that the use of inhalers was uncommon in Riyadh. Out of 650 drugs, 27 drugs were available as inhalers (4.15%). Out of 27 Inhalers, Ventolin inhalers is the most prescribed (48.14%), followed by Seretide Evohaler (29.62%) and Symbicort Turbuhaler (22.2%).

Conclusion: Although there is a high prevalence of respiratory diseases, inhaler prescriptions and dispensing aren’t common. This may be due to the use of these inhalers as OTC drugs. The role of pharmacists should be to dispense the regular medications only by prescriptions and to counsel patients about the information regarding the use of inhalers.

##### Attitudes Study of Students and Staff of Nursing about Euthanasia in Behbahan City, 2018

Alireza Rafi, Sanaz Khalili, Samaneh Naeimi, Fakhridokht Akbari, Najmeh Moradi, Zeinab Jamshidi, Fereshteh Hadi, Leila Amir Mohseni, Azam Karami

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-9
DOI: 10.9734/jpri/2019/v31i630346

Introduction: Nursing students are part of a clinical teaching team in the course of education. And it is important to examine their attitude toward euthanasia. Investigating the attitude of nursing students towards euthanasia has always been welcomed by researchers. These studies often indicate a lack of acceptance of euthanasia among nurses, but different percentages of opposition to euthanasia have been reported. This study aimed to determine the attitudes study of students and staff of nursing about euthanasia in Behbahan city in 2018.

Materials and Methods: This descriptive-analytical study was conducted to investigate the euthanasia attitude among nursing staff and students in 2018. The study population is nurses and nursing students of Behbahan city. Population volume was 187 in Behbahan hospital staff and 117 students respectively, that with Cochran's formula with 95% confidence interval was 126 and 83 respectively (z: equal 1.96 p=q=0.5 d=0.5). Students were selected from semesters 4 to 8 in order to understand students correctly. Data were analyzed by SPSS software version 22 and statistical methods including: mean, frequency, T-test, Chi-Square, multiple regression test and significance level p <0.05 was used.

Results: 107 nurses and 83 nursing students participated in this study. The mean age of participants was 27 years. Multiple regression was used to examine the relationship between the dimensions of euthanasia and demographic variables. Multiple regression results showed that naturalistic beliefs were significantly different between the two groups of nurses and students (p-value = 0.021). There was no significant difference between other aspects of euthanasia attitude in nurses and students. There were also significant differences between the two groups of men in terms of practical considerations (p-value=0.048).

Conclusion: Knowing the attitudes of nurses in a community towards the issue of euthanasia can be an effective step towards a better plan for improving the care of patients with euthanasia. The results of this study showed that naturalistic beliefs were significantly different between the two groups of nurses and students. But there was no significant difference between other aspects of euthanasia attitude and nurses and students; There were also significant differences in the practical considerations between the two groups of men. It is necessary to improve the knowledge of nurses in this field.

##### A Clinical Trial of Cranberry and Elderberry Extracts (Berdi® Sachet) for Urinary Tract Infection in Pakistani Population

Yasir Mehmood, Hafiz Umar, Humayun Riaz, Umar Farooq, Hammad Yousaf

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630347

Lower urinary tract infection (UTI) is very common diseases. Recurrent UTI remain challenging to treat because the main treatment option is long-term antibiotic and this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry and elderberry products (herbal products extract). However, this can lead to the advent of bacterial resistance. The cross sectional study was designed to evaluated the efficacy of above products.  The study was conducted from 23 October 2019 to 28 October 2019 in Arif Memorial Teaching Hospital, Lahore, Pakistan. The subjects were outpatients aged 20 to 65 years. UTI symptoms were recorded in the daily diary before, during and after treatment and assessed by the Jackson score. Following approval by the Ethics Committee of Rashid Latif Pharmacy College, the questionnaire (ROUTE2-002) was compiled and information of UTI patients using cranberry and elderberry extracts (Berdi® Sachet) was collected. Compliance and tolerability were considerable obstacles in this study. A total of 67 patients were screened for participation; 12 were unwilling to participate and 55 were enrolled for clinical trial and all patients had urinary tract irritation. In this study 55 (100%) UTI patients were cured with cranberry and elderberry extracts (Berdi® Sachet). Further investigation is needed to confirm this effect and to evaluate the health benefits of cranberries and elderberry.

##### The Effect of Vitamin B6 on Reducing the Number and the Size of Breast Cysts and the Amount of Recurrence after Aspiration in Women

Setareh Soltany, Hamid Reza Hemmati, Jafar Alavy Toussy, Parisa Alavi Toosi

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630348

Introduction: Palpable breast lumps are one of the most prevalent breast problems in women who visit a doctor. Most of these lumps are benign, and many of these benign lumps, have cystic nature. One of the suggested treatments for breast cyst is vitamin B6 intake. So, this study aimed to determine the effect of vitamin B6 on reducing the number and the size of breast cysts and reducing the amount of recurrence after aspiration.

Materials and Methods: This study is a double-blind randomized clinical trial. Patients simply divided into two groups randomly, intervention group (receiving 150 mg vitamin B6 twice a day for two months) and control group (placebo). After data collection, the database produced, and information came in by SPSS-22 software. Descriptive results extracted in the form of tables and graphs. In all cases was used α=0.05.

Results: At the end of the study, 65 patients (34 people in the intervention group, and 31 people in the control group) studied. At the end of the survey in the non-palpable cysts, was observed a significant decrease in the number and the size of breast cysts in each group receiving vitamin B6 or placebo. Still, the difference was not significant in comparing the two groups. 19 patients (2.29%) had palpable cysts that aspiration performed in all cases. After the study period, no recurrence of cysts observed in any of the intervention and control groups.

Conclusion: The study showed that vitamin B6 had no effect on reducing the size and the number of non-palpable breast cysts and prevent recurrence of palpable cysts after aspiration.

##### Comparing Methadone and Tincture of Opium for the Management of Opioid Withdrawal among Subjects with an Opioid Use Disorder

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-11
DOI: 10.9734/jpri/2019/v31i630349

Introduction: Drug addiction is associated with complications such as mortality, monetary burden, and various socioeconomic problems at the individual to the community level. Methadone and Tincture of Opium (TOP) are the most commonly used drugs to help addicts maintain their drug withdrawal process and eventually permanent withdrawal. Desirable clinical experiences have been reported in the use of these two agents in the management of opioid withdrawal. The purpose of this study was to compare the efficacy of methadone and TOP using Khomree method for detoxification of drug abuse.

Materials and Methods: This study was a randomized double-blind clinical trial among opium addicts (at least one year of use) referred to Arak University of Medical Sciences. Seventy subjects were enrolled in the study according to inclusion and exclusion criteria and then randomly divided into two groups (n = 35, treated with methadone) and group 2 (n = 35, treated with TOP). Furthermore, patients were evaluated for withdrawal symptoms on days 1, 3, 7, 14 and 28 after treatment. Finally, the results were analyzed using SPSS 18 software.

Results: Severity of sweating (group 1: P = 0.0001, group 2: P =0. 005), runny nose (P = 0.001), lacrimation (P = 0.001), chord reflex (P = 001.0), fecal excretion (group 1: P = 0.001, group 2: P = 0.01, muscle twitches (P = 0.001), drooling (P = 0.001) warming sensation (P = 0.0001) and substance seeking (group 1: P = 0.0001, P = 0.008) in both groups were significantly improved during 28 days of treatment.

Conclusion: Methadone and TOP detoxification are both effective in opioid withdrawal syndrome and the effect of methadone and TOP in opiate withdrawal are not preferable. However, further studies are recommended.

##### Role of an Educational Advisor from the Viewpoint of Professors and Students: A Qualitative Study from Sabzevar University of Medical Sciences, Iran

Hamid Joveini, Reza Shahrabadi, Ali Mehri, Masoumeh Hashemian

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-13
DOI: 10.9734/jpri/2019/v31i630350

Introduction: Professor of the educational advisor is responsible for the academic and counselling guidance of students in educational, research and social fields. Also should be familiar with all the indicators of the consultation and be aware of duties and responsibilities. The study aims to explain the features of the professor of an educational advisor from the viewpoint of professors and students from Sabzevar University of medical sciences, Iran.

Methods: In this qualitative study, participants were selected using purposive sampling, and it continued based on snowball and theoretical sampling. A semi-structured interview was used to collect the data. A total of 27 participants (12 Professors and 15 Students of medical science) were interviewed in 2 months. Interviews were analyzed using Graham and Landman’s content analysis method. To ensure consistency and accuracy of data, credibility, transferability, dependability, and conformability criteria were assessed.

Results: Nine main categories were conceptualized including “Improper notification in task description”, “Permanent and voluntary inaccessibility”, “Teacher-student relationship in the teaching process”, “Attention to students' comments and access”, “Lack of knowledge of task description”, “Refer to other professors”, “Specialization”, “Strengthen teacher-student relationship”, “Follow up on student affairs”.

Conclusion: Based on results, holding workshops to learn about the duties of a professor of educational advisor and the techniques of counselling, and to pay attention to student demands such as the right to choose, can be effective in improving students' satisfaction and solving their problems.

##### Comparison the Effect of Paracetamol and Ketorolac on Pain Relief after Cesarean Section

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630351

Introduction: Cesarean section is one of the most common surgical procedures in women. Effective pain control is an important component of post-operative care, as calming the mother increases her ability to take care of herself, reduce nosocomial infections, and hospitalization costs. The aim of this study was to compare the effect of paracetamol and ketorolac on the relief of post-cesarean pain in order to find a drug with minimal complications.

Methods: This study was performed on 140 women admitted to Ali Ibn Abi Talib Hospital due to cesarean section. Patients were divided into two groups of 500 mg paracetamol after cord clamp and 30 mg intravenous ketorolac group. Pain score, need for additional analgesia and visual analogue scale (VAS) were measured and compared in two groups. Data were analyzed using SPSS software.

Results: In this study, mean pain scores at 0, 6, 12 and 24 hours were significantly lower in the ketorolac group than in the paracetamol group. There was no complication in any of the experimental groups in this study. There was no significant difference between the mean time of first request for the additional analgesic of two groups. Frequency of additional analgesic request in the ketorolac group was significantly lower than in the paracetamol group.

Conclusion: Overall, the results of this study showed that the rate of pain reduction after cesarean section with ketorolac was significantly higher than paracetamol.

##### Pediatric Septic Shock: Early Recognition and Aggressive Fluid Therapy Improves Outcome

Shahzad Najeeb, Shabana Sarwar, Rafayat Ullah, Asfandyar ., Khurram Saleem, Chetan Das, Tausef Ahmed, Irfan Khan

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630352

Objective: To establish the effect of aggressive fluid resuscitation in reversing the pediatric septic shock at 1 hour in children younger than 5 years of age presenting in the emergency unit of the hospital.

Methods:  This was a descriptive, case series study, done for six months, from December 2015 to May 2016, at Pediatric Department of Ayub Medical College Abbottabad. Patients with age range of 1 month to 5 years, presenting in the emergency department with the diagnosis of septic shock having clinical features of tachycardia, tachypnea or hyperthermia along with hypotension and poor capillary refill time were included. All patients received aggressive fluid management. Clinical examination was repeated at the end of one hour for assessment of reversal of shock. Data was collected by self-made Performa.

Results: Mean age of study participants was 22.4 ± 17.6 months. Majority of participants 42(57%) were male. Mean weight was 10.3±4.3 kilograms. Mean heart rate was 173.9±17.8 beats per minutes. 67.6% were treated with a third-generation cephalosporin. At the end of one hour of treatment 51 (68.9%) showed the reversal of shock.

Conclusion: Majority of childrens who presented with septic shock showed the reversal of shock at one hour of management with weight-based fluid bolus therapy.

##### Antimicrobial, Antiquorum-sensing and Ex-vivo Antispasmodic Activity of Adhatoda vasica

Dareen Ibrahim, Fatma M. Abdel Bar, Abdelaziz Elgaml, Sahar R. Gedara, Ahmed A. Gohar

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-16
DOI: 10.9734/jpri/2019/v31i630353

Aims: To investigate the antimicrobial, antiquorum-sensing and Ex-vivo antispasmodic activity of the stem extract, fractions and isolated compounds of Adhatoda vasica.

Study Design: Preparation of the total extract, fractions of A. vasica and isolation of its phytoconstituents for investigation of antimicrobial, antiquorum-sensing and Ex-vivo antispasmodic activity.

Place and Duration of Study: Faculty of Pharmacy, Mansoura University, Egypt and College of Pharmacy, Prince Sattam Bin Abdulaziz University, KSA, between November 2014 and May 2019.

Methodology: Different phytoconstituents in obtained liquid-liquid fractionations were isolated by repeated column chromatography. The preliminary antimicrobial activity was measured via agar disc-diffusion method. The minimum inhibitory concentration (MIC) was further determined using broth microdilution method in 96-well plates. Antiquorum-sensing activity was tested against Chromobacterium violaceum in LB agar medium. While, antispasmodic activity was performed using Ach-induced contraction on rat ileum.

Results: Seven compounds have been isolated from the stems extract of Adhatoda vasica viz., β-sitosterol, daucosterol palmitate, monopalmitin, vanillin, vanillic acid, vasicinolone and vasicinone. The petroleum ether fraction, daucosterol palmitate, monopalmitin, vanillin and vanillic acid showed strong antibacterial activity towards E. coli and S. aureus. Whereas daucosterol palmitate and vanillic acid showed pronounced antifungal activity against C. albicans. Antiquorum-sensing assay showed that β-sitosterol, vanillin and vanillic acid were the most active compounds. While, petroleum ether and methylene chloride fractions, vasicinolone and daucosterol palmitate showed moderate antiquorum-sensing activity. For antispasmodic activity, petroleum ether fraction showed a remarkable inhibition of Ach-induced contraction at 200 and 250 μg/mL (89.5 and 95.2%, respectively). Also, methylene chloride fraction showed remarkable inhibition (97.6%) at 150 μg/mL. Vasicinone and vasicinolone showed significant inhibition at 150 μg/mL (89.9% and 84.8%, respectively).

Conclusion: The isolated compounds and extracts from the stem of the studied plant showed remarkable activities. This work provides further evidences for the traditional medicinal uses of A. vasica in treatment of various ailments.

##### Development of High-performance Thin-layer Chromatography (HPTLC) Validated Method for Simultaneous Quantification of Eucalyptol and α-Pinene in Lamiaceae Plants

Ahmed Ibrahim Foudah, Prawez Alam, Aftab Alam, Mohammed Ayman Salkini, Mohammed Hamed Alqarni, Hasan Soliman Yusufoglu

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-11
DOI: 10.9734/jpri/2019/v31i630354

Aim and Objective: Several plants from Lamiaceae family are used in the Saudi Arabia as a condiment and food preparation, and are generally used in the traditional preparation to treat various diseases, including anti-inflammatory, antioxidant, and microbial infections. Some of Lamiaceae species such as Mentha longifolia, Rosemarinus officinalis and Salvia officinalis having pharmacological active compounds such as α-pinene and eucalyptol. The aim of present study was to develop an accurate and precise chromatographic technique for quantification of α-pinene and eucalyptol in the Lamiaceae plants.

Methods: The high-performance thin layer chromatography (HPTLC) method was developed as per International Conference on Harmonization (ICH) guideline.

Results: Simultaneous determination of α-pinene and eucalyptol was achieved by developing a densitometric analysis of high-performance thin layer chromatography (HPTLC). Silica gel 60 F254 glass-backed plates (E-Merck, Germany, 0.2 mm layers) as stationary phase and mixture n-hexane: ethyl acetate 8 : 2 (%, v/v) as mobile phase were used to produce a sharp, symmetrical and well-resolved peak at an Rf value of 0.19 ± 0.02 and 0.52 ± 0.04 for α-pinene and eucalyptol, respectively. Linearly range for α-pinene was 100–700 ng/spot (r2 = 0.9988), whereas that for eucalyptol was 1000–7000 ng/spot (r2 = 0.9987).

Conclusion: The developed method was found to be a simple, accurate, and precise, and it may be used to simultaneously analyses of many medicinal plants samples containing α-pinene and eucalyptol.

##### Comparison of the Effect of Pregabaline and Diclofenac Suppository on Pain Relief after Elective Cesarean Section

Asadollah Shakeri, Maryam Razavi, Zeinab Mirkahnuj

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630355

Introduction: Cesarean section is one of the most common major surgeries performed worldwide. Considering the importance of post-cesarean pain, finding a drug that can provide the patient with the least amount of complications can make the patient feel the least pain and most relaxation. The aim of this study was to compare the effect of pregabaline and diclofenac suppository on pain relief after elective cesarean section with spinal anesthesia.

Methods: This study was performed in 2016 on 100 women admitted to Ali Ibn Abi Talib Hospital due to elective cesarean section. Patients were divided into two groups of 100mg rectal diclofenac half an hour before surgery and 300mg pre-gabbaline group. Data were analyzed using SPSS software. Probability level lower than 0.05 was considered significant.

Results: The mean score of after surgery pain at 6 and 12 hours after surgery in the diclofenac group was significantly lower than in the pregabaline group, but at 18 and 24 hours, the difference between the two groups was not statistically significant. The mean dose of pethidine used in the diclofenac group was significantly lower than the pregabaline group. Maternal satisfaction was significantly higher in the diclofenac group.

Conclusion: According to the results of this study, diclofenac has a stronger antinociceptive effect than pregabalin.

##### Formulation, Development and Evaluation of Ibuprofen Loaded Nano-transferosomal Gel for the Treatment of Psoriasis

Marwa H. Abdallah, Amr S. Abu Lila, Md. Khalid Anwer, El-Sayed Khafagy, Muqtader Mohammad, Mahmoud S. Soliman

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630356

The present work was aimed to develop a transferosomal gel of ibuprofen (IBU) for the amelioration of psoriasis like inflammation. Three formulation of IBU loaded transferosomes (TFs1-TFs3) were prepared using different proportions of lipid (phospholipon 90H) and surfactant (tween 80) and further evaluated for vesicle size, zeta potential (ZP), entrapment efficiency and in vitro drug release. The IBU loaded transferosomes (TFs2) was optimized with vesicle size (217±8.4 nm), PDI (0.102), ZP (-31.5±4.3 mV), entrapment efficiency (88.4±6.9%) and drug loading (44.2±2.9%). Further, the optimized IBU loaded transferosomes (TFs2) was incorporated into 1% carbopol 934 gel base and characterized for homogeneity, extrudability, viscosity and drug content. The in vivo pharmacodynamic study of gel exhibited reduction in psoriasis like inflammation in mice. The ibuprofen loaded transferosomal gel was successfully developed and has shown the potential to be a new therapy against psoriasis like inflammation.

##### The Efficacy and Safety of Simultaneous Use of Wire Stone Basket and Pneumatic Lithotripter Probe in the Treatment of Ureteral Stones: Randomized Control Trial

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630357

Introduction:  A routine treatment of ureteral stones is using ureteroscopic lithotripsy, a common problem of which is retropulsion of the stone to the renal pelvis and calyces that reduces the rate of lithotripsy’s success. In this study, we aim to investigate the safety and success of using wire basket to hold the stones along with pneumatic lithotripstic probe in endoscopic lithotripsy of ureteral stones.

Methods: Patients with ureteral stone were randomly divided to groups A and B. Group A (control) undergone lithotripsy without basket and group B (case) with wire basket along with pneumatic lithotripsy. In addition to demographic and clinical data, rate of success, retropulsion and residual stone with a size of greater than 3 mm were collected, before, during and after lithotripsy. Additionally, the total duration of lithotripsy and ureteral traumatic side effects was also recorded in both groups. All the patients were followed up until their discharge. Data was analyzed using SPPSS ve. 20.

Results: There was no significant difference between groups by the point of demographic data. When compared together, there was no significant difference between the location, side and size of the stone and duration of the lithotripsy in both groups. The rate of lithotripsy success was significantly higher in the case group. The incidence of retropulsion and need for a secondary intervention was significantly higher in the control group.  We didn’t have any ureteral trauma in neither control nor case group.

Conclusion: Based on the results of this study, using wire basked as an anti retropulsion device increases the stone free rate in addition to it’s easy applicability, So it can be useful in treatment of ureteral stone.

##### Potential Protective Role of Thymoquinone on Experimentally-induced Alzheimer Rats

Mohammad Fiasal Zaher, Mohamed Abdelfattah Bendary, Gamal Saeed Abd El-Aziz, Ahmed Shaker Ali

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-18
DOI: 10.9734/jpri/2019/v31i630358

Aim: To evaluate the neuroprotective potential of thymoquinine (TQ) on the oxidative stress status of the brain in aluminum chloride (AlCl3)-induced AD in rats.

Study Design:  Animal research study.

Place and Duration of Study: King Fahd Medical Research Center (KFMRC), King Abdulaziz University, Saudi Arabia, April 2018-June 2019.

Methodology: Thirty adult male Sprague Dawley albino rats were randomly divided into 3 groups. Group 1 (Control). Group 2 (AD): supplemented orally with AlCl3 (17 mg/kg/day) for 4 weeks. Group 3 (TQ/AD): supplemented concomitantly with oral TQ (10 mg/kg/day) and AlCl3 (17 mg/kg/day) for 4 weeks. At the end of the experiment, spatial working memory was assessed using the Y-maze spontaneous alternation test. Then, serum levels of malondialdehyde (MDA) and glutathione peroxidase enzyme (GPX) were assessed. Then, the rats were sacrificed, and the brain was isolated, and a light microscopic examination of the hippocampus was performed. Finally, the brain homogenate content of Aβ, tau protein and acetylcholine were biochemically determined.

Results: The AD group showed a significant decreased in the spontaneous alteration performance (SAP %) in Y-maze. Also, in the AD group, serum MDA, Aβ and tau protein were significantly increased with a significant decrease of serum GPX and acetylcholine. Examination of H&E-stained sections of the hippocampus of the AD group revealed decreased thickness and disorganization of the pyramidal cell layer of CA1 and CA3 where many pyramidal cells lost their triangular shape and appeared shrunken. The molecular and polymorphic layers showed increased glial cells and congested blood capillaries. The dentate gyrus showed marked disorganization with some cell loss. Co-administration of TQ with AlCl3 in TQ/AD group, improved SAP % and significantly decreased serum MDA, Aβ, tau protein. It also increased serum GPX and acetylcholine levels. Also, TQ partially attenuated the histopathological changes in the hippocampus.

Conclusion: TQ could mitigate the oxidative stress markers, neurodegenerative indices and histopathological alteration encountered in AD that all reflected on improving the cognitive behavior. This may implement TQ as an adjuvant medical strategy in ameliorating AD.

##### Effect of Vitamin D Supplementation on Serum Lipids, Uric Acid and C-reactive Protein in Patients with Type II Diabetes Mellitus

Delaram Eskandari, Niloofar Khodabandehloo, Elham Bayani, Elmira Shahmohammadi, Sina Shirzadi, Maryam Saatchi, Alireza Hejrati

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-11
DOI: 10.9734/jpri/2019/v31i630359

Background: Type II Diabetes Mellitus (T2DM) is a considerable problem of global health, and finding new therapies for treating the disease continues. Recently, attention has been focused on vitamin D as a potential lowering agent of T2DM’s risk factors and its complications. The present work was conducted to determine the effect of vitamin D supplements on serum lipids, uric acid, C-Reactive Protein (CRP) and also Homeostatic Model Assessment of Insulin Resistance  (HOMA-IR).

Materials and Methods: Sixty patients with T2DM as well as deficiency of vitamin D and referred to Rasoul-e-Akram Hospital in 2017 were selected by convenience sampling method. To begin the study, patients’ demographic information was required, so a questionnaire including age, waist circumference, sex, height, blood pressure and weight was provided. Patients with vitamin D3<30ng/ml were treated by a daily oral dose of 2000 unit of vitamin D supplementary for 12 weeks. Serum levels of triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), total cholesterol (TC), fasting blood sugar (FBS) and Hemoglobin A1C (HbA1C) were measured before and after vitamin D intake. Analysis of data was carried out through the Software Package SPSS Ver. 24.

Results: Sixty-five percent of study population (39 people) was composed of females. The mean value ± standard deviation (SD) amount of age and BMI were 46.8±8.9 years and 28.4±4.3 m2/kg. The mean ± SD systolic blood pressure (SBP), 19.3±122.8 mmHg and diastolic blood pressure (DBP) were 14.1±79 mmHg. The mean ± SD of vitamin D in patients was 11.4±4.5 ng / ml. The comparison of blood factors before and after treatment showed p value> 0.05.

Conclusions: Deficiency of vitamin D should be treated and prevented, but administration of this high-dose vitamin D supplements for prevention or improvement of T2DM has not been recommended yet. Our study showed a correlation between the vitamin D intake and decreased level of FBS and Uric Acid in diabetic patients.

##### Phytochemical, Antioxidant and Antibacterial Potential of Ducrosia anethifolia in Northern Border Region of Saudi Arabia

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630361

Ducrosia anethifolia (D. anethifolia) is a drought-tolerant plant widely distributed over Arar valley at the Northern region of Saudi Arabia. The aerial parts of this plant were investigated for its phytochemical constituents, antioxidant and antibacterial potential. GC-MS analysis of the ethyl acetate fraction of methanol extract revealed the presence of some major compounds such as 8-Ethoxypsoralen (6.5%), Prangenin (6.26%), Isoaromadendrene epoxide (7.5%), Aromadendrene oxide (0.96%) and Ferulic acid methyl ester (0.46%).  FRAP and DPPH method were used to test the antioxidant capacity of ethyl acetate fraction of D. anethifolia, the results revealed the presence of high reduction capacity (EC50 equals 0.63±0.03g/L), compared with the reducing capacity of the standard ascorbic acid and quercetin which were 0.091±0.002 g/L and 0.026±0.002 g/L, respectively.  Moreover, the results of the DPPH test showed that the extract presented a remarkable antioxidant capacity with an IC50 of 0.38±0.02 g/L, This considerable antioxidant capacity is attributed to its richness of some bioactive phytochemical compounds. The antibacterial potential was evaluated by disc-diffusion test, the plant extract was tested on nine different bacterial strains. Results exhibited that, only Gram-positive bacteria recorded good to moderate susceptibility, namely Staphylococcus epidermidis ATCC 49461, Bacillus cereus ATCC 10876, Staphylococcus aureus clinical isolate and Staphylococcus aureus ATCC 25923, which recorded 14.5, 14.0, 9.5- and 7.5-mm zone of inhibition, respectively.  In conclusion, the aerial parts of D. anethifolia are rich in some important phytochemical molecules and could be used in the formulation of antioxidant drugs. Whereas, its efficacy against some Gram-positive bacteria only should be studied in-depth. Further studies are also recommended to these phytochemical molecules against various physiological disorders and diseases.

##### Phytochemical Screening and Toxicological Study of Neptunia oleracea Lour. (Mimosaceae) Extracts, Plant Used in Traditional Medicine

Geoffroy G. Ouedraogo, Gaétan D. Somda, Sylvain Ilboudo, Noufou Ouedraogo, Jean Koudou, Pierre I. Guissou

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630362

Neptunia oleracea (Lourd.) Mimosaceae is a plant commonly used in traditional medicine for the treatment of several pathologies such as dysentery, jaundice, leucorrhoea, troubles of earache, among others.

Aim: The purpose of this study was to carry out preliminary phytochemical screening, acute toxicity studies and to evaluate the effect of the aqueous and hydro-ethanolic extracts of N. oleracea on intestinal motility in vivo.

Methodology: Preliminary qualitative phytochemical screening was conducted using standard procedures while acute toxicity studies was performed using OECD method. The effect of N. oleracea extracts on intestinal motility was evaluated using on normal and acetylcholine-induced transits.

Results: Preliminary qualitative phytochemical screening of aqueous and hydro-ethanolic extracts of N. oleracea revealed the presence of similar constituents including steroids, triterpenoids, saponins, tannins, flavonoids, anthocyanidins, coumarins and carbohydrates. Alkaloids was absent in both the extracts. The oral median lethal dose (LD50) for both extracts was estimated to be 5000 mg/kg.

The effect of extracts on intestinal peristalsis in mice showed that the aqueous and hydro-ethanolic extracts of N. oleracea stimulate normal intestinal transit by 1.29 and 8.54% respectively at the dose of 50 mg/kg body weight, thus there was inhibition at higher doses. These extracts potentiate acetylcholine-induced intestinal transit by 23.9 and 14.39% respectively at 500 mg/kg body weight.

Conclusion: The findings of this study showed that the aqueous and hydro-ethanolic extracts of Neptunia oleracea contain bioactive constituents that have practically no toxic effect. This could justify the many forms of use of this plant in traditional medicine.

##### Cytotoxic Activity of Some Spirooxindole-4H-pyran Derivatives

Zeinab Faghih, Zahra Faghih, Masoomeh Divar, Soghra Khabnadideh

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630364

Aims: Isatin is a honored scaffold and one of the most favorable class of heterocyclic systems that possesses many interesting biological activities and well-tolerated in humans. Here a series of fifteen spirooxindole-4H-pyran derivatives containing both isatin and pyran moieties (ICa-ICo) will be examine for their anti-cancer activity.

Study Design: Cytotoxic evaluation of some spirooxindole-4H-pyran derivatives in two cancerous cell lines.

Place and Duration of Study: Pharmaceutical Science Research Center and Shiraz Institute for Cancer Research, Medical School in Shiraz University of Medical Sciences, Shiraz, Iran, between June 2018 and July 2019.

Methodology: MTT assay was used to evaluate the cytotoxic activities of these compounds. The anticancer properties of the tested compounds were determined using A549 and MCF-7 cell lines.

Results: Among the tested compounds ICc, ICd and ICf showed the best cytotoxic activities  against both cancerous cell lines. Compounds ICh and ICj showed desirable cytotoxic activities against A549 cell line. Compound ICb showed desirable cytotoxic activities against MCF-7 cell line.

Conclusion: We conclude that the isatin-linked pyran analog can serve as a prototype molecule for further development of a new class of anticancer agents.

##### Novel Spectrophotometric Methods for Simultaneous Determination of Rosuvastatin Calcium, Timolol Maleate and Diclofenac Sodium in Pharmaceutical Ternary Mixture and Spiked Human Plasma

Mohamed E. M. Hassouna, Hafsa O. Salem

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-21
DOI: 10.9734/jpri/2019/v31i630365

Three sensitive, times saving, precise and accurate spectrophotometric techniques have been established and confirmed for the simultaneous determination of ternary admixture of rosuvastatin calcium (ROSCa), timolol maleate (TIM) and diclofenac sodium (DICNa). Method A, first derivative of ratio spectra spectrophotometric (1st DD) which is the most simple simplest one. Using the spectrum of an aliquot of 5 μg/mL of DICNa as a divisor, ROSCa could be determined by measuring 1DD amplitudes at 239.5 and 266.5 nm for ROSCa, while TIM could be similarly determined at 307.7 and 331 nm. DICNa could be determined at 269.7 and 292 nm when 5 μg/mL aliquot of ROSCa was used as a divisor without interference. This method showed limit of detection of 0.556, 0.567 & 0.3 µg/mL and correlation coefficients of 0.9997, 0.9998 and 0.9995 for ROSCa, DICNa and TIM respectively. Method B, depends on subjecting the ratio spectra to mean centering (MCRS). The arithmetical description of this method was explained. The method was performed for the estimation of these drugs together in one run without preseparation in authentic laboratory prepared mixtures, bulk and spiked human plasma. The wave lengths 277.9, 313.1 and 333.12 nm were used for the quantitative estimation of each of the studied drugs with good correlation coefficients (0.9998, 0.997& 0.9999 and LOD of 0.297, 0.150 & 0.24 µg/mL for the studied drugs in the previously mentioned order. Method C, successive-ratio derivative spectra method (SRDS). The mathematical description of the method was explained. By using this method, ROSCa, TIM and DICNa could be determined at 264, 339 and 300 nm, respectively. Correlation coefficients were 0.9998, 0.9999 & 0.9995 and LOD values of 0.374, 0.258 & 0.769 µg/mL in the same order. The three methods were linear in the range 5-25 µg/mL. The obtained results has been statistically compared with those obtained by the published one, showing no significant difference regarding accuracy and precision at p = 0.05. The developed methods do not need sophisticated techniques or instruments, besides being sensitive, selective and eco-friendly.

##### Controlling Post-operative Pain Intensity in Patients Undergoing Tibia Fracture Surgery: Pregabalin vs. Clonidine

Amir Sobhani Eraghi, Seyedehsan Daneshmand, Seyed Mohammad Malakooti

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630366

Introduction: The goal of this study was to compare the effect of two drugs (pregabalin and clonidine) on pain intensity within 24 hours after surgery in patients undergoing tibia fracture surgery is a step forward to choose the right drug.

Methods: In this randomized clinical trial, 64 candidates for elective tibia fractures were selected based on a randomized table. The patients were divided into two groups of those treated with clonidine (group C) and those treated with pregabalin (group P). Clonidine is given to patients in the first group one hour before surgery at a dose of 0.1 mg/kg and one hour after surgery at a dose of 0,1 mg / kg. Patients in the second group received pregabalin one hour before surgery at a dose of 200 mg and one hour after surgery at a dose of 200 mg orally. Then the variables are 6,12 and 24 hours. Finally, by using SPSS software, qualitative variables were compared according to their percentage using Chi square test, and for quantitative variables, the mean of each group was calculated and t-test was used to compare the means.

Results: The visual analog scale (VAS) scores were significantly lower in the pregabalin group compared with the clonidine group at .7 and 70 hours after surgery. A statistically significant analgesic effect was seen in the clonidine treated group compared with pregabalin.

Conclusion: Our data suggested that pregabalin improves pain relief after surgery, but it has less analgesic effect than clonidine.

##### The Effect of Aqueous Extract of Artemisia aucheri Seed on Acanthamoeba In vitro

Ramin Pazoki, Mansooreh Ghasemi Nejad Raeeni, Fatemeh Ghaffarifar, Amir Karimipour Saryazdi, Farahnaz Bineshian

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-10
DOI: 10.9734/jpri/2019/v31i630367

Aim: Acanthamoeba cause dangerous diseases in humans such as encephalitis and keratitis as an opportunistic pathogen. Due to the antioxidant, antimicrobial, antifungal, anti-Acanthamoeba and anti-leishmania activities of Artemisia, the aim of this study is investigate the effect of aqueous extract of Artemisia aucheri seed on Acanthamoeba trophozoites and cysts in vitro.

Materials and Methods: Acanthamoeba trophozoites and cysts were propagated in appropriate culture medium. Aqueous extract of Artemisia aucheri were prepared at concentrations of 2000, 1000, 500, 250, 125 and 62.5 μg/ml and were added to both protozoa forms (trophozoites and cysts). Then, three techniques including trypan blue, MTT and flowcytometry were used to investigate the effect of this extract on Acanthamoeba trophozoites and cysts.

Results: It was found that increasing the time and concentration of aqueous extract of Artemisia aucheri seed significantly reduced the number of live Acanthamoeba trophozoites and cysts (P ≤0.05). At the concentration of 2000 µg/ml the number of live trophozoites was 0% and at the concentration of 62.5 µg/ml the number of live trophozoites was 57.7%.

Conclusion: The results of this study showed that the aqueous extract of Artemisia aucheri has anti-acanthamoeba activity and seems to have beneficial pharmacological effects on some diseases and complications caused by Acanthamoeba. Further research is needed to determine this issue.

##### Investigation of Olfactory Function Following Septorhinoplasty in Iranian Population by Rapid Smell Test (RST)

Amir Yarahmadi, Kamran Kamrava, Ali Shafee, Maryam Milanifard, Mohammad Aghajanpour, Alireza Mohebbi

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630369

Introduction: All surgical procedures on nose affect the olfactory function to some extent. There are different viewpoints about olfactory function after septorhinoplasty. We aim to investigate smell perception changes in patients following septorhinoplasty. In this study the use of Rapid Smell Test (RST) as a fast and reliable clinical tool was investigated.

Methods: A prospective cohort study was done in Rasool Akram teaching hospital in 2018 and 2019. Group of 74 septorhinoplasty candidates aged over 18 was selected by convenience. Persian Smell Identification Test (PSIT) and rapid smell test (RST) was obtained from patients before surgery and one month after, if needed three months after and six months after. In addition for patients with dysfunction in any of follow up periods (one month, 3 months and 6 months after surgery) smell magnitude test (SMT) was used. All data were analyzed using Statistical Package for Social Sciences, version 24.0 (IBM SPSS Statistics Inc., Chicago, IL, USA).

Results: Out of 74 patients participating in this study 67 were female. Mean age of 25.68±5.18 years was recorded for participants. All patients before surgery had PSIT score more than 19 and the mean PSIT score before operation was 22.63±1.39. Also all patients scored 5 out of 5 in RST before surgery. Mean PSIT score one month after surgery decreased to 22.21±2.20 but still 93 percent (69 patients) of participants were in range for normal olfactory function. We recorded this to be significant (p value = 0.044). RST after one month showed the same results. The difference between RST before and after surgery was also significant (p value = 0.024). For those 5 patients with abnormal olfactory function PSIT and RST were done 3 months after operation which determines normal olfactory function for all of them. As well as PSIT, RST also shows the same results and five participants recorded 5 out of 5 three months after surgery.

Conclusion: This study showed changes in olfactory function after septorhinoplasty will resolve at most 3 months after surgery and it is safe to say there is no effect on olfactory function three months after operation. Also we demonstrated that RST can be a fast and reliable tool for assessing patients’ olfactory function in clinical setting.

##### Does Aspirin Like Enoxaparin Effective to Reduce Thromboembolic Disease in Patients with Total Knee Arthroplasty Surgery?

Gholamhossein Kazemian, Alireza Manafi Rasi, Mojtaba Baroutkoub, Mohammad Mahdi Sarzaeem

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630370

Background: Thromboembolic disease is a common complication among patients undergoing total hip and knee arthroplasty. There are a large number of clinical trials demonstrating the efficacy of aspirin and enoxaparin in preventing pulmonary emboli and deep venous thrombosis. This                study aimed to investigate the preventive role of aspirin and enoxaparin after knee arthroplasty (TKA).

Methods: In this retrospective study, 160 patients undergoing knee arthroplasty at Imam Hossein Hospital, Tehran, Iran between January 2010 and February 2012 were studied. Patients were divided into treatment groups receiving enoxaparin and aspirin and were evaluated within 28 days after surgery. After examining demographic factors including age and sex, variables such as DVT, pulmonary embolus, infection, transfusion RBCs and mortality were evaluated.

Results: A total thrombosis rate of 0.0125% (one deep venous thrombosis) was observed. The two groups were not significantly different in the number of patients with complications such as DVT, pulmonary embolism, infection, average number of packed RBCs, and mortality.

Conclusion: We believe that course aspirin is as effective and safe as enoxaparin for thromboprophylaxis.

##### Evaluation of Antidepressant and Anxiolytic Activity of Solanum melongena L. Fruits Aqueous Extract via Monoaminergic and GABAergic Pathway

Talha Jawaid, Nidhi Tiwari, Mehnaz Kamal, Osama A. Alkhamees, Ali M. Alaseem, Waleed M. Al Shagha, Saud M. Alsanad

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-9
DOI: 10.9734/jpri/2019/v31i630371

The current study proposed the in vivo antidepressant and anxiolytic activities of the aqueous extract from Solanum melongena fruits (AESM) in mice. The mice were administered with AESM 100 and 200 mg/kg, p.o. for anxiolytic (elevated plus maze test (EPMT) and locomotor action), and antidepressant (forced swimming test (FST) and tail suspension test (TST) activities. The possible mechanism of action of Solanum melongena fruits was also analyzed by measuring the level of serotonin (5HT), monoamine oxidase enzyme (MAO-A) and GABA activity in the blood of experimental animals. When mice were treated for seven days with 100 (*** P < 0.01) and 200 mg / kg, AESM p.o. and 2 mg / kg, diazepam p.o. (*** P < 0.001) showed significant increases in the average time expended and the number of entries into the open arms of the EPMT, as compared to control group in dose dependent fashion. However, when mice were treated with standard Imipramine (10 mg/kg) (***P < 0.001), AESM 100 mg/kg (**P < 0.01) and 200 mg/kg (*P < 0.05) after day 7, there was significant reduction in locomotor activity in both TST and FST in dose dependent fashion. Monoamine oxidase - A level in the entire brain of mice were significantly reduced when pretreated with AESM 100 and 200 mg/kg, p.o. for 7 days as compared to control group in dose dependent fashion.  The mechanisms of action of antidepressant effect of Solanum melongena fruits extract act by increasing serotonin and also GABA. Moreover, the extract also decreased the MAO-A enzyme in the experimental animals. These results demonstrated that both of these doses. Of aqueous extract from Solanum melongena fruits possess potential antidepressant activities in dose dependent fashion.

##### An Investigation on Vitamin B12 Serum Levels among Type 2 Diabetic Patients Treated with Metformin Compared to Normal Levels

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-9
DOI: 10.9734/jpri/2019/v31i630372

Background: Given the increasing prevalence of type 2 diabetes in the community and the use of metformin as one of its most common therapies as well as presence of some evidences on a link between the use of this medicine and vitamin B12 levels, we decided to measure and compare serum level of vitamin B12 among the diabetic patients under treatment by metformin and compare with its natural content. Decreased Vitamin B12 levels leads to some clinical problems including anemia, gastrointestinal disorders (diarrhea, constipation, decreased appetite, etc.,), neurological disorders (tingle, numbness, muscle weakness, etc.,) and mental disorders (memory impairment, depression, behavioral problems, etc.,). Therefore, we would determine if the duration of metformin use and dosage may be effective on serum levels of vitamin B12 among metformin-treated diabetic patients.

Methods: Serum vitamin B12 level in metformin-treated type 2 diabetic patients referred to Rasoul-e-Akram Hospital and Specialist Clinic of Taban in Tehran in 2016 (306 subjects selected by convenience sampling) was determined and then compared to its normal level.

Results: Of the 306 participants in the study, 120 ones were females (39.2%) and 186 ones were males (60.8%). Also, 150 ones (49%) were healthy and 156 ones (51%) were suffering from diabetes Miletus. There was a significant difference between the type 2 diabetes mellitus and healthy individuals with quantitative variables such as age, height, weight, BMI, serum cholesterol (Chol) level, LDL serum level, HDL serum level, triglyceride (TG) level. The mean blood level of Vitamin B12 level was 448.92±156.75pg/mL among all participants. A Vitamin B12 deficiency frequency of above 6% was seen among diabetic patients. In regression analysis, a model was defined based on which age, gender, diabetes and Metformin used had a significant effect on serum levels of vitamin B-12. Also, none of the variables gender, age, duration of treatment, metformin quantity, weight and BMI was associated with a deficiency of vitamin B12.

Conclusion: In the diabetic group, the prevalence of Vitamin B12 deficiency was more than6%. It was also seen that age, gender, diabetes mellitus, metformin intake and metformin content had a significant effect on serum B12 levels. Therefore, measurement of serum levels of vitamin B12 in metformin-treated subjects is recommended.

##### Elaborating Factors Affecting Maternal Nutritional Behavior; A Qualitative Approach

Seyed Saeed Mazloomy Mahmoodabad, Fatemeh Jowzi, Hassan Mozaffari-Khosravi, Aliakbar Vaezi, Hosein Fallahzade

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-9
DOI: 10.9734/jpri/2019/v31i630373

Introduction: Excessive consumption of confectionary can contribute to a high intake of sugar, fat and energy which lead to tooth decay, weight gain or obesity and related metabolic diseases. This study conducted to identify the effective factors on mothers’ nutrition behavior (reduction of confectionary consumption) on the basis of health action process approach.

Methods: This qualitative research has been conducted through Directed Content Analysis. Data were collected through semi structured interviews. Participants were mothers who had at least one child over 6 months and consumed all sorts of confectionary. The collected data were analyzed according to Granheim and Landman's method.

Results: The analysis of the interviews data resulted in 87 codes. The codes were organized into 6 categories and 26 subcategories and the 5 main themes are as follows: action planning, coping planning, action control, maintenance self-efficacy and social support

Conclusion: Our study suggested that one of the community supports is media education and it should be considered in implementing community-based educational programs

##### Evaluating the Synergistic Activity of Metformin and Apple Cider Vinegar in Type 2 Diabetics

Momina Abid, Farah Ahmed, Shehla Shaheen, Zahida Memon, M. Zaman Shaikh, Faiza Agha

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630376

Aims: The aim of this study was to observe the effect of Apple Cider Vinegar (ACV) in combination with Metformin on the Body Mass Index (BMI) and glycemic control of newly diagnosed type 2 diabetic patients.

Study Design: Single arm pre post quasi experimental clinical trial.

Place and Duration of Study: Department of Medicine of a tertiary care hospital and a Diabetes and Endocrinology clinic, based in Karachi, Pakistan from April to July 2019.

Methodology: A total of 30 newly diagnosed type 2 diabetic patients were enrolled in the study (Males: 17; females: 13; age range: 27-55 years) after obtaining written informed consent. The parameters of Body weight, BMI, Fasting Blood Sugar (FBS) and Hemoglobin A1c (HbA1c) of each patient were assessed before and after 12 weeks of treatment with Metformin 750 mg plus 2 tablespoons of ACV per day. The baseline and post treatment values of the aforementioned were compared with each other.

Results: In all the 30 patients assessed after 12 weeks of treatment, the weight was significantly reduced from 85.66±18.30 kg. to 82.96±18.43 kg with a consequently significant change in the BMI from 29.38±5.08 kg/m2 to 28.43±5.16 kg/m2. Moreover, the glycemic control, assessed as FBS and HbA1c also showed significant reduction in the FBS (127.76±9.17 to 121.23±9.54) and HbA1c (7.14±0.29 to 6.92±0.29) after 12 weeks of treatment in all 30 patients (p<0.01).

Conclusion: Apple Cider Vinegar seems to be effective therapy in combination with metformin for newly diagnosed type 2 diabetic patients in improving glycemic control as well as augmenting weight reduction.

##### Economic Analysis of an Ambulatory Care Service Delivery Model for Hemophilia a Patients; A Cost Minimization Study

Abolfazl Sadeghi, Majid Davari, Zahra Gharibnaseri, Roya Ravanbod, Peyman Eshghi

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-6
DOI: 10.9734/jpri/2019/v31i630377

Aim: This study aimed to perform an economic evaluation of Hemophilia ambulatory service delivery model (HASDM) comparing to the traditional home-episodic treatment model.

Study Design: Tehran university of medical science, department pharmacoeconomics and pharmaceutical administration, between Jun 2016 and September 2018.

Methods: A cost-minimization analysis (CMA) was conducted for evaluating potential savings of HASDM in comparison to the traditional home-episodic treatment model. The main cost of regular episodic service delivery, basic arm, consists of the cost of recombinant factor VIII (FVIII). In the comparator arm, HASDM, the costs of HASDM for 1660 hemophilia A patients (HAPs) in Tehran were calculated. One-way sensitivity analysis was done to investigate the robustness of the results and to investigate the impact of uncertainty in the percentage of mistakes in bleeding sensation.

Results: There were 1660 patients with severe Hemophilia A (PWSHA) in Tehran in 2018. The mean utilization of annual per patient FVIII was 44814 international units (IUs) in Iran. The total annual cost of FVIII concentrate for 1660 hemophilic patients in Tehran was estimated at $11,001,816. The cost of running HASDM, personal, and equipment is equal to$ 580,956. The cost of FVIII in HASDM would be $4,004,661. Therefore, the total cost of HASDM is estimated at$ 4,585,617. The amount of savings was \$ 6,416,199. Sensitivity analysis indicated the robustness of the results up to 94.64% of the variation in the model parameters.

Conclusions: HASDM, compared to episodic model, can save 58.32% of the funding for controlling bleeding in HAPs annually. This can save more than 38 times of HAPs annual cost over their lifetime.

##### The Evaluation of Concentration of Harmful Chemical Pollutants in Fume Caused by Surgical Cauterization in Hospital Surgery Rooms Related to Pharmacological Aspects

Abolfazl Abdollahpour, Maryam Azizzadeh, Ali Kermani, Daryoush Pahlevan

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630378

Background: Harmful chemical pollutants of pharmaceutical origin present in the environmental pollutants especially surgical room may have the same toxic specifications of chemicals from industrial sources. The aim of this study was to evaluate the concentration of harmful chemical pollutants in fume caused by surgical cauterization in hospital surgery rooms.

Methods: This is a quantitative, cross-sectional and practical study. The study population consisted of all personnel who are working in hospital surgery rooms. Samples were prepared according to NIOSH standard method. The tool for data collection is Occupational Exposure Limits booklet (OEL).

Sample Size: 30 samples were required according to surgery room conditions. In order to evaluate and measure the concentration of workplace air pollutants and individual exposure to them, the individual sampling method is used compliant with the standard procedures of the NIOSH or OSHA organizations, that according to the type of material and for each material, a particular method is mentioned and has a specific code. In this study, NIOSH Organization Method No. 1501 was used. The data were analyzed based on the data obtained from sampling and comparing them with the allowed limits.

Results: In this study, the organic aromatic hydrocarbons including, Benzene, Ethylbenzene, Toluene and Xylene were investigated and fortunately, in all samples, these pollutants are below the permitted level.

Conclusion: According to the results, the measured concentration of pollutants are less than the allowed limit. It is also recommended that other pollutants be evaluated at any time in order to gain the necessary knowledge of the personnel exposure status.

##### Ameliorating Effects of Omega-3 Fatty Acids on Underlying Mechanisms of Type 2 Diabetes

Abroo Fatima Qazi, Din Muhammad Shaikh

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630379

Aims: The current study investigated the effects of polyunsaturated Omega-3-fatty acids on underlying mechanism linked with diabetes in streptozocin induced type 2 diabetic Wistar rats.

Study Design:  Experimental analytical Study.

Place and Duration of Study: The study was conducted at Isra University Hyderabad and Sindh Agricultural University, Tandojam between November 2016 and November 2018.

Methodology: Seventy-five Wistar rats were assorted to five groups (15 rats per group): negative control group A and positive control group B and experimental groups C, D and E. Rats within group B,C,D, and E were injected with streptozocin (65 mg/kg body weight) to induce diabetes. Experimental groups C, D and E received Omega-3-fatty acid supplemented food in 0.3 g, 0.4 g and 0.5 g/kg bodyweight dosage for 12 weeks, respectively.

Results: Omega-3-fatty acids treated rats showed significant decrease in blood glucose level and rise in serum insulin as compared to positive control group (p-value = 0.001). At the same time, they showed significantly increased expression of insulin gene along with transcription factors: PDX1 and NKX6.1 as compared to group A (p-value = 0.001).

Conclusion: It is concluded that O3FAs reduces insulin resistance in Streptozocin-induced diabetic Wistar rats by modulating the transcription factors essential for insulin gene expression.

##### Cone-beam Computed Tomography Guidance in Functional Endoscopic Sinus Surgery: A Retrospective Cohort Study

Hesam Jahandideh, Azam Yarahmadi, Shahin Rajaieh, Amin Ostvar Shirazi, Maryam Milanifard, Amir Yarahmadi

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630380

Introduction: Using image-guided intra-operative navigation systems in surgeries like functional endoscopic sinus surgery (FESS) has become widely accepted as an effective tool for improvement of surgical outcomes and reduction of complication. Cone-beam CT (CBCT) is a variant of computed tomography imaging that has developed as a cross-sectional and potentially low-dose technique to visualize bony structures in the head and neck. In current study, it was tried to evaluate surgeons’ satisfaction with CBCT intra-operative navigation imaging as well as image quality prior to FESS and post-operative complications.

Methods: In this prospective study, the included patients who were candidates for FESS underwent CBCT from January to June 2019. The data regarding demographic information, CBCT findings and diagnosis were extracted. The surgeons’ satisfaction with intra-operative navigation imaging and image quality was quantified using Visual Analogue Scale (VAS) (ranging 0 – 10). Furthermore, patients were contacted 3 months later to ask for their satisfaction with the operation using VAS and post-operative complications evaluated.

Results: Totally, 39 patients were included. The mean age was 40.74±5.75 and 20 patients (51.28 percent) were male. Two surgeons performed this operation separately; one of the surgeons performed 20 (51.28 percent) FESS and the other performed 19 (48.71 percent). The mean satisfaction of the surgeons of CBCT guided FFESS was 8.69±0.92. After the 3-month  follow up, patients’ satisfaction score was 8.21±1.89. No postoperative complications were reported.

Conclusion: Based on the surgeons’ point of view, CBCT was shown to be reliable for image-guided FFESS. Furthermore, the outcome and complications of performed surgeries were similar to those performed with computed tomography intra-operative navigation imaging.

##### Computational Design of New Analogues from Lyngbyastatin-2 against Epidermal Growth Factor Receptor (EGFR) through Molecular Docking

Rajendran Vijayakumar, Faiz Alfaiz, Mohammad Saleh Al-Aboody, Muniraj Sangeetha, Muniraj Menakha

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-10
DOI: 10.9734/jpri/2019/v31i630382

Cyanobacteria are considered as a rich source of secondary metabolites with potential applications in oncology to find out new therapeutic agents to suppress cancer. Lyngbyastatin-2 is a secondary metabolite from marine cyanobacteria and has antimicrobial and anticancer properties. It acts as an inhibitor molecule against cancer cells. In the present study, Lyngbyastatin-2 a bioactive compound from Lyngbya majuscula was selected as a ligand and four types of analogues were prepared using ChemDraw software. These analogues docked with Epidermal Growth Factor Receptor (EGFR), which is key molecule play a major role in ovarian cancer using Hex 8.0.0 molecular docking method. Among 4 analogues tested, Lyngbyastatin-2 analogue-1 (L2A1) showed high energy bonding (-618.27 KJ/mol) with EFGR molecule and considered as an effective inhibitor molecule to treat ovarian cancer based on e-values. A strong chemical interaction observed between EGFR protein and L2A1 ligand molecules and it may be leads to improve the efficiency of inhibitor. This study is the first attempt to analyze the analogues of lyngbyastatin-2 with EGFR and further in vitro, in vivo studies are required to prove its anticancer potential against ovarian cancer based on the predictions of in-silico studies.

##### The Effect of Nursing Communication Skills Training on Satisfaction of Patients Undergoing Hemodialysis

Zahra Salmani, Hossein Shiri, Malahat Nikravan Mofrad, Malihe Nasiri

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-8
DOI: 10.9734/jpri/2019/v31i630383

Background: Communication skills of nurses include two important verbal and non-verbal communication dimensions and have of great importance in hemodialysis patients. This study aimed to investigate the effect of nursing communication skills training on satisfaction of patients undergoing hemodialysis.

Methods: This quasi-experimental (pretest and posttest design) was carried out on 64 nurses working in the dialysis ward and 90 hemodialysis patients in the hospitals affiliated with Alborz University of Medical Sciences. In this study, nurses and patients were selected by convenience and randomized sampling methods, respectively. In this regard, subjects were selected from the hemodialysis wards of Bahonar, Rajaei and Shariati hospitals in Karaj.

Results: Most nurses were female (76.7%) and the age range of the participants was 23-54 years. Nurses achieved a high score in all dimensions of communication skills and a high total score of communication skills after the intervention, and none of them obtained a low score. There was a significant increase in nurses' communication skills after the intervention, compared to before the intervention (106.98±4.18 and 117.97±3.35) (P<0.001). Moreover, the results showed a significant change in nurses’ perception after the intervention in various dimensions of communication skills, such as ability to receive and send messages, emotional control, listening skills, nurses' insight into the communication process and assertive communication skills, compared to before the intervention (66.90±5.15 and 95.62±5.34) (P<0.001).

Conclusion: Studying communication skills in the form of educational workshops could increase these skills in nurses and clinical personnel in general. More importantly, improved communication skills in nurses could increase patient satisfaction, which is the ultimate goal of healthcare centers.

##### A Comparative Study on Antioxidation and Antibacterial Activities Triphala Herb Extracts from Chae Son, Lampang, Thailand

Wilart Pompimon, Wipanoot Baison, Angkhana Chuajedton, Phansuang Udomputtimekakul, Punchavee Sombutsiri, Boonthawan Wingwon, Chatchanok Udomtanakunchai

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-14
DOI: 10.9734/jpri/2019/v31i630384

Introduction: Triphala, a herbal medicine which is a product from Chae Son, Lampang, Thailand, is an unequal-proportional mixture of fruits of three herbs, Phyllanthus emblica, Terminalia chebula, and Terminalia bellirica (2:1:1).

Materials and Methods: The contemporary study concentrated on extracts detection and comparative analysis between various annual year (A.D.2017/2018) activities in hexane, ethyl acetate, and methanolic extracts of Triphala. The determination of antioxidant was using by 1,1-diphenyl-2-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP). The broth dilution and agar well diffusion assay were determined antibacterial.

Results: Results exposed the valuable biological activity extracts from ethyl acetate and methanol solvents of T. chebula and T. bellirica, which strength is accountable for biological activities. Extracts displayed acceptable radical-scavenging activity analogous with ascorbic acid. The methanol extract of T. bellirica (0.0013 mg/mL), ethyl acetate extract of P. emblica (0.0009 mg/mL), in A.D. 2017 and the ethyl acetate extract of P. emblica (0.0090 mg/mL), the methanol extract of Triphala (0.0176 mg/mL) in 2018, were exhibited higher antioxidant activity. Also, extracts indicated hopeful antibacterial potential against tested strain comparable to chloramphenicol.

Conclusion: The results in A.D. 2017 showed that inhibition zone of P. emblica in ethyl acetate extract; S. aureas (8.67 mm), E. aerogenes (8.67 mm), E. coli (EPEC) (7.67 mm), P. mirabilis (7.73 mm) , S. typhimurium (8.33 mm), S. flexneri (8.33 mm) and V. cholera (7.33 mm) together with P. emblica methanol extract; S. aureas (6.67 mm), E. aerogenes (7.76 mm.)  and V. cholera (4.0 mm). Therefore, it could be concluded that Triphala may be a talented candidate in pharmaceutical and future medicine.

##### Efficacy of Matricaria chamomilla L. in Infantile Colic: A Double Blind, Placebo Controlled Randomized Trial

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-11
DOI: 10.9734/jpri/2019/v31i630385

Objective: Infantile colic is one of the most common problems in neonatal and early infancy, the prevalence of which has been reported as 10-20%. The present clinical trial was conducted to investigate whether topical use of chamomile oil reduces crying and fussing in breastfed colicky infants.

Methods: A total of 102 breastfed colicky infants were divided into two groups to receive topical chamomile or placebo oil 6 times a day for 7 days. Both groups also received 5 mg of Simethicone syrup 4 times a day. Parents reported on crying and fussing duration, exertion times and side effects using a questionnaire.

Results: 90 babies could complete the trial including 47 patients in chamomile group and 43 patients in the placebo group. Babies in both groups were the same in terms of gestational age, birth weight, birth order, gender, delivery type, crying and fussing on the day before the treatment. At the end of the study, crying and fussing was found to be lower in chamomile group than the placebo group (p <0.001). Also, 39 and 27 patients responded to the treatment in chamomile and placebo groups respectively. The effect of chamomile oil on crying (p<0.01) and fussing (p< 0.001) was significant. No serious adverse event was reported.

Conclusion: Results revealed that chamomile oil reduced symptoms in breastfed colicky infants compared to the infants in the placebo group. This suggests that topical use of chamomile oil may be effective in the treatment of colic.

##### A Clinical Trial of Multi Herbal Preparation (EZCol) Syrup for Constipation in Pakistani Population

Yasir Mehmood, Hammad Yousaf, Umar Farooq, Rana Khalid Mahmood, Mahpara Gondal, Humayun Riaz, Hafiz Umar, Hafiza Aisha Sadiqa, Mueen Mohsin

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-7
DOI: 10.9734/jpri/2019/v31i630386

Background: Constipation is one of the symptoms of intestinal syndrome which would be happened along with some other disease in patients. There are several treatment available to cure the constipation but use of stimulant laxative in chronic and acute constipation is more safe and useful of any age patients. In this cross sectional study we clinically observed the efficacy of multi herbal extract (Cassia senna, Rheum palmatum and Cuscuta reflexa) in constipation. We have used local company syrup (EZCol syrup). This syrup contains multi herbs and senna leaves extract is main ingredient of this syrup. The active constituents of enna leaves are Sennosides which considered as an effective treatment for constipation. Sennosides increase the transfer rate of materials from the large intestine. We aimed to assure the effect of senna leaves extract along with other herbal extract (Rheum palmatum and Cuscuta reflexa) for the treatment of constipation.

Materials and Methods: In this study, 35 patients were observed after taking the syrup (dose 15 mL 2 time/daily for 3 days). A questionnaire (ROUTE2-003) was developed and distributed to the patients after prescription of EZCol syrup. The study was approved form ethical committee of Rashid Lateef Medical College and Arif Memorial Teaching Hospital, Lahore Pakistan.

Results: Treatment was continued for 3 days and data was compiled and result shown significant cure in constipation. Maximum patients felt relief from constipation just within 3 days. Some patients felt diarrhea at third day. Moreover no further significant complications were found in patients.

Conclusion: Senna is an FDA-approved over-the-counter (OTC) laxative. Senna leaves extract is a safe, effective and well-tolerated herbal supplement for the treatment of constipation having no significant adverse effect.

##### Retracted: A Review on Medicinal Plants with Antiangiogenic Activity Available in Iraq

Amjed Haseeb Khamees, Enas Jawad Kadheem, Hayder Bahaa Sahib, Omar Hussein Ahmed

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-10
DOI: 10.9734/jpri/2019/v31i630331

Aims: To correlate the antiangiogenic effect of medicinal plants available in Iraq.

Study Design: Study design by correlate different study and article about the antiangiogenic activity of different plant available in Iraq and make collection of different information of medicinal plant grow in Iraq.

Methodology: We included the irregular growth of blood vessels contributes to the pathogenesis of many diseases, which has a major impact on human health. Indeed, a long list of disorders is characterized and caused by excessive angiogenesis. Historically, the best known disorders stemming from angiogenesis are cancer, psoriasis, arthritis and blindness, but many additional common disorders such as obesity, asthma, atherosclerosis and infectious disease and correlate different plant by activity with antiangiogenic properties.

Results: The plant sources of Iraq are likely to provide effective antiangiogenic substances. All examples that are provided in this review of promising bioactive materials obtained from different plants with other therapeutic uses.

Conclusion: Aerial part of different plant in Iraq possess antiangiogenic activity has crucial activity to treat disease relate angiogensis.

Retraction Notice: This paper has been retracted from the journal after receipt of written complains. This journal is determined to promote integrity in research publication. This retraction is in spirit of the same. After formal procedures editor(s) and publisher have retracted this paper on 05th  November-2020. Related policy is available here: http://goo.gl/lI77Nn

##### Ethnobotanical and Pharmacological Importance of Western Himalayan Fir Abies pindrow (Royle ex D. Don) Royle: A Review

Dwaipayan Sinha

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-14
DOI: 10.9734/jpri/2019/v31i630360

Aims: Abies pindrow (Royle ex D. Don) Royle., colloquially known as the Western Himalayan fir, is a conifer that grows along the Himalayan mountains from Afghanistan to Nepal. The plant is extensively used by locals for the treatments of various ailments. Thus based on the available reports about its importance in traditional system of medicine, an attempt has been made to review this species in context of its medicinal and pharmaceutical importance.

Study Design: The review article has been designed based on literature survey. The article is grossly divided into four broad phases consisting of compiled information of Abies pindrow: (1) Ethnobotanical information (2) Chemical Constituents (3) Pharmacological activities (4) Discussion mainly highlighting the mode of action of the bioactive compounds in relation to its pharmacological activity.

Methodology: Extensive literature search have been performed in the web using PubMed, PubMed Central, google scholar as search platform. Efforts have also been taken to compile information from research papers and review articles not more than 10 years old. Information from old literatures were preferably avoided unless found to be very relevant to the subject.

Results: The literature survey revealed that the plant has been used to treat cough and cold, diabetes, cataract and bladder diseases. The plant is also considered to be carminative, astringent, antispasmodic, diuretic, tonic and anti-inflammatory. The plant is also rich in terpenes and terpene alcohols. Testing for antidiabetic, neuroprotective, anticataract and antixiolytic activities have been promising and the bioactive constituents and efforts are made to interpret the possible mechanism of action of bioactive compounds in bringing about the pharmacological activities.

Conclusion: It is concluded that the plant can be explored and bioprospected for an affordable source of drug and nutraceutical for better management of health related issues of people of Indian subcontinent.

##### Sonochemistry (Applications of Ultrasound in Chemical Synthesis and Reactions): A Review Part III

Menshawy A. Mohamed

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-19
DOI: 10.9734/jpri/2019/v31i630363

As the need for friendly environment increasing the need for Sonochemistry increasing. Sonochemistry has become an important field of research for organic synthesis of diverse types of reactions, that decrease environmental hazardous and increase the yield of those reactions. The aim is to continue reviewing applications of ultrasound in chemical synthesis and reactions as reported in part I [1] and part II [2]. In this article I am trying to illustrate green sonochemical approaches for organic synthesis as one of the applications of ultrasound that minimize or eliminate the use and generation of hazardous substances and reduce environmental pollution.

##### The Innovative Potential of Antibody Engineering Enhanced the Clinical Value of Immunotherapy

Taha Nazir, Saeed Ur Rashid Nazir, Azharul Islam, Misbah Sultana, Humayun Riaz, Muhammad Amer, Nida Taha

Journal of Pharmaceutical Research International, Volume 31, Issue 6, Page 1-13
DOI: 10.9734/jpri/2019/v31i630381

The improvements of counter acting antibody generation systems of various types of immunoglobulins have been created on a vast scale. Miscellaneous scientific tools and skills used to design the most efficient and accurate method. The hybridoma innovation opened a new era in the production of antibodies against target antigens of desirable pathogens, life-threatening infections including immune system issue and various intense poisons. Despite that, these clinical acculturated or chimeric murine antibodies have a few constraints and complexities. The study aims to review and explain the advanced antibody engineering to enhance the innovative potential of antibodies. Therefore, our major effort focusing to defeat the current challenges, late advances in hereditary building methods and phage display system that permitted the creation of exceedingly particular recombinant antibodies. These antibodies have been built in the chase for novel remedial medications furnished with improved immune protective capacities. That will potential connects with the resistant effector's capacities; compel advancement of combination proteins, proficient tumor and tissue entrance and high-liking antibodies coordinated against moderated targets. Propelled counteracting agent designing systems have broad applications in the fields of immunology, biotechnology, diagnostics and helpful prescriptions. Even so, there is constrained learning with respect to element immune response improvement approaches. Along these lines, this study reaches outside of our ability to comprehend traditional polyclonal and monoclonal antibodies. Besides, late advances in immunizer designing systems together with counteracting agent sections, show advances, immunomodulation and expansive utilization of antibodies are examined to upgrade creative neutralizer generation in the expedition for a more advantageous future for people.