##### Isolation and Antibiotic Resistance of Achromobacter xylosoxidans from Non-respiratory Tract Clinical Samples: A 10-year Retrospective Study in a Tertiary-care Hospital in Hungary

Márió Gajdács

Journal of Pharmaceutical Research International, Page 1-7
DOI: 10.9734/jpri/2020/v32i130387

Aims: To assess the prevalence of A. xylosoxidans isolated from non-respiratory tract samples from adult inpatients and outpatients and the antibiotic resistance levels at a tertiary-care teaching hospital in Szeged, Hungary retrospectively, during a 10-year study period.

Study Design: Retrospective microbiological study.

Place and Duration of Study: 1st of January 2008 - 31st of December 2017 at the University of Szeged, which is affiliated with the Albert Szent-Györgyi Clinical Center, a primary- and tertiary-care teaching hospital in the Southern Great Plain of Hungary.

Methodology: Data collection was performed electronically. Antimicrobial susceptibility testing (AST) was performed using disk diffusion method and when appropriate, E-tests on Mueller–Hinton agar plates.

Results: During the 10-year study period, a total of 68 individual A. xylosoxidans isolates were identified (6.8±3.6/year, range: 0-11 isolates). The frequency of isolation in the first half of the study period (2008-2017) was n=22, while in 2013-2017, this number was n=46. The majority of isolates (51 out of 68) were from inpatient departments. 32 out of 68 patients were female (female-to-male ratio: 0.89). The susceptibilities of the respective A. xylosoxidans isolates (n=68) were the following: high levels of susceptibility for imipenem and meropenem (n=63; 92.6%), and moxifloxacin (n=55; 80.9%), while higher rates of resistance were detected for sulfamethoxazole/trimethoprim (susceptible: n=36; 52.9%), ciprofloxacin (susceptible: n=40; 58.8%) and almost all isolates were resistant to ceftazidime (susceptible: n=3; 4.4%) and cefepime (n=2; 2.9%).

Conclusion: The existing literature on Achromobacter infections in the context of non-respiratory human infections is scarce, as the incidence of these pathogens in clinically-relevant syndromes in low. The developments in diagnostic technologies in routine clinical microbiology will probably lead to a shift in the isolation frequency of these bacteria in the future.

##### The Increasing Interest in Antibiotic Stewardship Programs

Nehad J. Ahmed, Mohd. F. Khan

Journal of Pharmaceutical Research International, Page 8-12
DOI: 10.9734/jpri/2020/v32i130388

Background: The inappropriate use of antibiotics leads to many adverse effects and also leads to bacterial resistance. A hospital-based program, commonly referred to as antibiotic stewardship programs, is used to improve the usage of antibiotics. This study aims to explore the increasing interest of the public in antibiotic stewardship programs by using data from Google Trends and Twitter.

Methodology: A search trends feature that shows how frequently a given search term is entered into Google’s search engine (Google Trends) and a social network site (Twitter) were used.

Results: The public and the health care professionals are now more interested in antibiotic use and antibiotic resistance due to the development of more severe infections that were caused by bacteria resisted to many antibiotics which lead to high morbidity and mortality rates.

Conclusion: There is a high prevalence of infections caused by multi-drug resistant organism that could lead to more mortality and morbidity rates, as a result the interest in antimicrobial stewardship programs in internet is increased. So it is important to increase the knowledge of health care professionals regarding the appropriate antibiotic use and to encourage them to change their unsuitable prescribing patterns.

##### Using Mobile– iPhone as New Visible Colour Detector for Determination of Pharmaceutical (Potassium Permanganate)

Mustafa Abdulkadhim Hussein, Lamia Abdultef Risan Al-Iessa, Mohauman Mohammed Majeed Alrufaie, K. H. Al–Sowdani

Journal of Pharmaceutical Research International, Page 13-17
DOI: 10.9734/jpri/2020/v32i130389

In this work the use of a mobile phone as a spectrophotometer using camera resolution by installing the software (application store AAP) on the phone (i Phone 6), which analyzes the colour images (RGB) in results with a colour length where it was possible to calculate the colour value of each image representing a specific concentration of the solution under study. A calibration curve with a range of (1 × 10-3 - 6.25 × 10-4) mmole.L-1 using optical image analysis with the concentration of the preparation of potassium permanganate (KMnO4). A calibration curve for statistical correlation range of 0.993 (R2) was found.

##### Stomach Cancer and Parabens

Lama Alloujami, Sophi Barguil

Journal of Pharmaceutical Research International, Page 18-24
DOI: 10.9734/jpri/2020/v32i130390

Background and Objectives: Parabens are one of the chemicals used widely in preserving foods and pharmaceutical preparations. Although it was safe for many years, recently it has been proven that its action mimics estrogen in the body when it is linked to its receptors, known as estrogen receptors which are present in many systems of the body and that it may have a link with breast cancer, especially after it was found in samples of breast cancer. As known that estrogen receptors are placed in different areas in the body, including the stomach, therefore it may have a role in cancer formation and development in the stomach.

The purpose of this manuscript is to investigate the presence of Methyl, Ethyl and Propylparaben in stomach cancer in men and women.

Methods: Samples of stomach cancer have been collected immediately after surgery in Al Assad University Hospital and after extracting parabens from samples, they have been analyzed by HPLC / MS in the science faculty at Damascus University.

Results: All samples have the three types of parabens with total mean concentration (22.5 ± 0.4 ng/g).

The concentration of Methylparaben was the highest (8.2 ± 0.3 ng/g) then Propylparaben (7.4 ± 0.4 ng/g) and finally Ethylparaben (6.9 ± 0.2 ng/g).

Conclusion: Because of the presence of parabens in all stomach cancer samples, so more studies must be done to research if parabens may have any effect in the formation of abnormal cells and the formation of cancer in the body systems which have estrogen receptors.

##### Investigation of the Relationship between Trauma, Anxiety, Depression and Stress in Kerman Emergency Medical and Emergency Center 115

Journal of Pharmaceutical Research International, Page 25-31
DOI: 10.9734/jpri/2020/v32i130391

Introduction: The efficacy of psychological and pharmacological approaches is broadly similar in the acute treatment of psychopharmacology disorders.

One of the most important stressful environmental stimuli that can cause chronic stress is people's jobs. And since promoting the mental health of individuals in a society, especially its constituent classes, is essential to the dynamics and growth of that society, this research was conducted with the aim of investigating the relationship between trauma caused by accident and anxiety, depression, and stress in Kerman Emergency Medical and Emergency Center during 2019.

Methods: This is a descriptive-correlational study. The statistical population was all 70 personnel members of Emergency Medical and 115 Emergency Centers in Kerman. The Depression, Stress and Anxiety Scale 21 and Trauma Screening were used as the instruments of measurement. Pearson and Spearman correlation coefficients through SPSS software were used to test the hypotheses.

Results: There is a significant and direct correlation between trauma caused by accidents and personnel anxiety with a correlation coefficient of 0.407. Also, there is a significant and direct correlation between trauma caused by accidents and personnel depression with a correlation coefficient of 0.407. There is also a significant and direct relationship between trauma caused by accidents and personnel stress with a correlation coefficient of 0.388.

Conclusion: Our data suggested that mental health along with personality traits is a solution to reduce stress and anxiety resulting from the personnel facing trauma caused by accidents.

##### Antimicrobial Resistance in Uropathogenic Escherichia coli Strains Isolated from Beasat Hospital in Sanandaj, West of Iran

Nasrin Bahmani, Noshin Abdolmaleki, Afshin Bahmani

Journal of Pharmaceutical Research International, Page 32-36
DOI: 10.9734/jpri/2020/v32i130392

Background and Objectives: Urinary tract infection (UTI) is one of the most frequent infectious diseases which is caused by Gram-negative bacteria especially Escherichia coli. Multiple resistance to antimicrobial agents are increasing quickly in E. coli isolates and may complicate therapeutic strategies for UTI. The propose of this study was to determine the antibiotic resistance patterns and the multidrug-resistance (MDR) phenotypes in uropathogenic E. coli (UPEC).

Materials and Methods: A total of 153 UPEC isolates were collected from both hospitalized patients (95 isolates) and outpatients (58 isolates) from March to October 2018. In order to determine the MDR among UPEC isolates, we have tested 15 antimicrobial agents on Muller Hinton agar by the disk diffusion method.

Results: The percentage of MDR isolates (resistant to at least three drug classes such as fluoroquinolones, penicillins and cephalosporins) was 55.5% in the hospitalized patients and the outpatients. Antibiotic resistance to ampicillin, ceftazidime, nalidixic acid and trimethoprim/ sulfamethoxazole was higher than 60%. Meropenem, Imipenem and norfloxacin indicated markedly greater activity (93.3%, 80% and 85.6%, respectively) than other antimicrobial agents.

Conclusions: Urinary tract infection due to MDR E. coli may be difficult to treat empirically due to high resistance to commonly used antibiotics, so, empirical antibiotic treatment should be reviewed periodically at local studies.

##### Comparison of Two Different Ozone Injection Sites for Knee Osteoarthritis, Tibio-femoral Joint versus Supra-patellar Recess: An Open Randomized Clinical Trial

Journal of Pharmaceutical Research International, Page 37-49
DOI: 10.9734/jpri/2020/v32i130393

Background: The aim of this study was to compare the efficacy of ozone injection at Tibio-femoral joint with Supra-patellar recess on knee osteoarthritis (OA).

Methods: In this randomized, controlled clinical trial, 99 patients with symptomatic knee OA were randomized into two groups. 47 patients selected to receive 7-8 ml ozone (20 µg/ml) through Tibio-femoral joint injection, and 49 patients received 10 ml ozone (20 µg/ml) through supra-patellar recess injection by using in-plane ultrasound-guided. The primary outcome was the change from baseline in the visual analogue scale (VAS) (0-100 mm) pain score during 3 months after injection. Secondary outcome measures included the Western Ontario and McMaster universities OA Index (WOMAC), Lequesne index, time “Up and Go” (TUG) test, single-limb stance (SLS) tests, patient satisfaction, and adverse effects. All of these measurements were evaluated at the base time, 48 hours, 2 weeks, 1 month, 2 months, and 3 months after injection.

Results: Both groups had significantly improvement in the primary and secondary outcome measures. VAS pain score except at the 3–month follow-up (16.8±13.3 versus 18.1±16.6, 95% CI, -7.33 to 4.73, p =0.6), WOMAC pain score, WOMAC stiffness score at all evaluated times, and WOMAC total score at 48 hours after injection (95% CI, -19.4 to -4.9) were significantly better among Tibio-femoral ozone injection compare to Supra-patellar recess injection (95% CI, -20.68 to -6.51, p<0.001)). In both groups satisfaction, TUG and SLS times were improved, but no significant difference was seen between groups (p>0.05). At the 3-month follow-up, WOMAC pain and total scores for only Tibio-femoral joint injection group as well as WOMAC function, TUG and SLS times for both groups were gradually coming back to the baseline.

Conclusion: Ozone injection in both groups was associated with pain relief, functional improvement, and quality of life in patient with knee OA. Pain and stiffness of joint were improved better in Supra-patellar recess ozone injection.

##### Chitosan-sodium Alginate Nanoparticle as a Promising Approach for Oral Delivery of Rosuvastatin Calcium: Formulation, Optimization and In vitro Characterization

Md. Ali Mujtaba, Nawaf M. Alotaibi

Journal of Pharmaceutical Research International, Page 50-56
DOI: 10.9734/jpri/2020/v32i130394

Rosuvastatin calcium is the most effective antilipidemic drug and is called "super-statin" but it exhibits low aqueous solubility and poor oral bioavailability of about 20%. The present work aimed to develop and optimize chitosan-alginate nanoparticulate formulation of rosuvastatin which can improve its solubility, dissolution and therapeutic efficacy. Chitosan-alginate nanoparticles were prepared by ionotropic pre-gelation of an alginate core followed by chitosan polyelectrolyte complexation and optimization was done in terms of two biopolymers, crosslinker concentrations. The chitosan-alginate nanoparticles were characterized by various techniques such as particle properties such as size; size distribution (polydispersity index); Zeta-potential measurements and Fourier transform infrared spectra respectively. The designed rosuvastatin loaded chitosan-alginate nanoparticle had the average particle size of 349.3 nm with the zeta potential of +29.1 mV, and had high drug loading and entrapment efficiencies. Fourier transform infrared spectra showed no chemical interaction between the rosuvastatin and chitosan-alginate nanoparticle upon the encapsulation of rosuvastatin within the nanoparticles. Nanoparticles revealed a fast release during the first two hours followed by a more gradual drug release during a 24 h period. Hence, our studies demonstrated that the new chitosan-alginate nanoparticle system of rosuvastatin is a promising strategy for improving solubility and in turn, the therapeutic efficacy of rosuvastatin. Therefore, the rosuvastatin-loaded chitosan-alginate nanoparticles are a promising approach for the oral delivery of rosuvastatin.

##### Investigating the Effect of Follow-up Care on the Self-concept of Patients under Coronary Artery Bypass Grafting

Journal of Pharmaceutical Research International, Page 57-63
DOI: 10.9734/jpri/2020/v32i130395

Introduction: Since coronary artery angina pectoris is a chronic disease, it negatively affects patients self-concept. In this study, the effect of follow-up care on the self-concept of patients undergoing coronary artery bypass grafting was investigated.

Materials and Methodology: In this study, the clinical trial was measured using self-concept questionnaire considering the effect of follow-up or constant care on 60 patients under coronary artery bypass grafting in Seyed-al-shohada heart center of Urmia. Eight to twelve weeks after the operation, the follow-up care, which is an Iranian native model was administered through telephon. Data collection tools included patients demographic data collection form as well as self-concept questionnaire consisting of 25 Likert-scale items of 1 to 5 (totally positive, positive, neutral, negative, totally negative), which measured 25 features.

Results: In the current study, the mean age of patients in both groups (intervention and control) was 59.68±7.43 and 59.48±5.79 years old, respectively. In addition, the mean weight of patients in both groups (intervention and control) equaled 77.82±10.67 and 75.22±7.53 kg. According to the results of the mean, the perceived threat after the intervention was 45.16±4.28 in the intervention group and it was 40.43±5.22 in the control group, showing a significant statistical difference between two groups (p<0.001). The perceived challenge after the intervention was 70.86±6.82 in the intervention group and it was 67.13±6.37 in the control group, showing a significant statistical difference between two groups (p=0.028).

Conclusion: The mean of self-concept score increased after the intervention and the observed results could have positive effects on the treatment of patients.

##### Phenylethyl Resorcinol Loaded in Liposomal Cream Formulation for Cosmeceutical Application

Panithi Raknam, Sirirat Pinsuwan, Thanaporn Amnuaikit

Journal of Pharmaceutical Research International, Page 64-76
DOI: 10.9734/jpri/2020/v32i130396

Phenylethyl Resorcinol (PR) is a cosmeceutical skin lightening agent and the purpose of this study was to enhance its stability by using liposomal cream formulation which increases local efficacy and safety. Liposome formulation was prepared by modified ethanol injection method, and it contained soy phosphatidyl choline (SPC), cholesterol (CHO), Tween 80 (TW80) and deoxycholic acid (DA) mixed with 2% PR. The physicochemical properties, skin permeation as well as cellular study were evaluated in order to obtain the optimized formulation. The optimized liposome formulation composed of SPC:TW80:DA (84:16:2.5) and exhibited vesicle size, polydispersity index (PDI) and zeta potential of 286.4±8.04 nm, 0.317±0.03 and -39.20±3.85 mV, respectively. Entrapment efficiency (EE) of liposome formulation was 93.55±0.05%. The vesicle was spherical in shape and showed good physicochemical stability for 4 months. The skin permeation study demonstrated that liposome with a negative charge could result in a high PR skin deposition value of 1732.76±216.24 µg/cm2 after 24 h. Cellular study showed that liposome formulation could inhibit melanin content in B16 melanoma cells and enhance cell viability in HaCaT keratinocyte cells. The optimized PR liposome was incorporated in cream and investigated physicochemical properties, stability and skin permeation. Liposomal PR cream showed a good stability and a superior result than PR cream in skin permeation parameters, as well as in tyrosinase inhibition.