Determination of phytoconstituents of n-hexane extract of leaves of Morus nigra and evaluation of their effects on biochemical and histopathological parameters in paracetamol intoxicated mice liver

In-vitro investigation of Morus nigra L. (Moraceae) has demonstrated the evidence of several antioxidant compounds. Current study was aimed to determine the phytoconstituents and hepatoprotective potential of n-hexane extract of Morus nigra. Swiss albino mice were divided into five groups: normal control, paracetamol control, silymarin control, 250 mg/kg p.o. extract for 7 days plus paracetamol 3 h later, 500 mg/kg p.o. extract for 7 days plus paracetamol 3 h later. Serum levels of liver enzymes and total bilirubin were assessed and compared between the groups by using one-way ANOVA to confirm hepatoprotective activity. HPLC analysis revealed the presence quercetin, oleanolic acid, luteolin, apigenin, vitamin C and kuwanon C. n-hexane extract of Morus nigra at dose of 250 mg/kg reduced elevated ALT by 54.3% (p<0.001), AST by 55.1% (p<0.01), ALP by 28.5% (p<0.01) and TBR by 56.4% (p<0.01) as compared to paracetamol control. The dose of 500 mg/kg of the extract reduced the ALT levels by 62.9% (p<0.001), AST by 56.7% (p<0.01), ALP by 33.6% (p<0.01) and TBR by 54.5% (p<0.01), as compared to paracetamol group. However, the reduction of liver enzymes and total bilirubin after administration of extract was comparable to the silymarin. Current study demonstrated potential hepatoprotective activity of n-hexane extract of Morus nigra

Effect of Cyclodextrin Derivatization on Solubility and Efficacy of Drugs

Cyclodextrins (CDs) possess cyclic structure having (α-1,4)-linked glucopyranose units making them less vulnerable to enzymatic degradation as than the linear dextrins. Commonly used natural CDs are α-CD, β-CD, and ɣ-CD with truncated cone-like appearance having lipophilic central cavity and hydrophilic exterior surface. The problem of low aqueous solubility of natural CDs can be addressed by reacting them with various reagents to produce water-soluble derivatives. CD derivatives can be categorized in many ways depending upon their substituents, biological activity, polarity, and size. The derivatization of natural CDs produces noncrystalline and amorphous forms with higher water solubility that are physically and microbiologically stable for prolonged time period. Variety of methods can be used to determine average degree of substitution for a modified CD. Dissociation by dilution is considered as major release mechanism of drugs from complex. It is essential to optimize the amount of CDs for a given preparation because they can either retard or promote drug delivery through biological membrane

Commentary: Outbreak of Chikungunya in Pakistan

Rauf et al. in their recent correspondence in “Lancet Infectious Diseases” reported the first chikungunya outbreak in Karachi, Pakistan with 30,000 suspected and 4,000 confirmed cases (1). However, these estimates have been denied in a subsequent report by the National Institute of Health (NIH) indicating 818 suspected and 82 laboratory-confirmed cases of chikungunya (2). Rauf and colleagues have highlighted warm climate and wretched sanitary conditions as contributing factors of current outbreak and urge national and international health-organizations to address these momentous issues (1). We agree that climatic features and sanitation issues potentially lead to vector proliferation and the importance of these concerns cannot be disregarded. However, we felt inclined to share our point of view about the recent outbreak of chikungunya in Pakistan. We believe that there are some more important factors that should be considered as causes of this outbreak and must be addressed by the Government of Pakistan in haste to quell the further disease spillover. One of these factors is unchecked cross-border movements between Pakistan and India

Hepatoprotective activity of methanolic extract of Malva parviflora against paracetamol-induced hepatotoxicity in mice

Malva parviflora (cheeseweed) is traditionally used as hepatoprotective. The current study was conducted to determine its hepatoprotective activity of aqueous methanolic extract of whole plant. Two doses of plant (250 mg/kg and 500 mg/kg) were administered in paracetamol intoxicated mice and results were compared with silymarin. Observational parameters were ALT, AST, ALP and total bilirubin. The results showed that the extract of M. parviflora produced significant (p<0.001) reduction in liver enzymes and total bilirubin. Results were supported by histopathological investigation, phytochemical screening and detection of hepatoprotective constituents (kaempferol and apigenin) by HPLC. So, the current study showed that aqueous methanolic extract of M. parviflora possesses hepatoprotective activity

Short-term adverse effects of COVID-19 vaccines after the first, second, and booster doses : a cross-sectional survey from Punjab, Pakistan, and the implications

Safety and efficacy concerns regarding coronavirus disease 2019 (COVID-19) vaccines are common among the public and have a negative impact on their uptake. We aimed to report the adverse effects currently associated with the vaccine in Pakistan to build confidence among the population for its adoption. A cross-sectional study was conducted in five districts of the Punjab province of Pakistan between January and March 2022. The participants were recruited using convenience sampling. All data were analyzed using SPSS 22. We recruited 1622 people with the majority aged between 25-45 years. Of these, 51% were female, including 27 pregnant women and 42 lactating mothers. Most participants had received the Sinopharm (62.6%) or Sinovac (17.8%) vaccines. The incidences of at least one side effect after the first (N = 1622), second (N = 1484), and booster doses (N = 219) of the COVID-19 vaccine were 16.5%, 20.1%, and 32%, respectively. Inflammation/erythema at the injection site, pain at the injection site, fever, and bone/muscle pain were common side effects of vaccination. No significant differences were observed in the adverse effect scores between all demographic variables except for pregnancy (P = 0.012) after the initial dose. No significant association was observed between any variable and the side effect scores of the second and booster doses of the vaccine. Our study showed a 16-32% prevalence of self-reported side effects after the first, second, and booster COVID-19 vaccinations. Most adverse effects were mild and transient, indicating the safety of different COVID-19 vaccines

Pre-existing Diabetes Mellitus, Hypertension and KidneyDisease as Risk Factors of Pre-eclampsia: A Disease of Theories and Its Association With Genetic Polymorphism

Pre-existing diabetes, hypertension and kidney disorders are prominent risk factors of pre-eclampsia (PE). It is a multifactorial pregnancy disorder associated with high blood pressure, proteinuria, and multiorgan failure, which develops after the 20th week of pregnancy. It is one of the most feared pregnancy disorders, as it consumes thousands of fetomaternal lives per annum. According to clinical and pathological studies, the placenta appears to be a key player in the pathogenesis of PE; however, the exact origin of this disorder is still under debate. Defective placentation and angiogenesis are the hallmarks of PE progression. This angiogenic imbalance, together with maternal susceptibility, might determine the severity and clinical presentation of PE. This article comprehensively examines the mechanisms of pathogenesis of PE and current evidence of the factors involved in its progression. Finally, this article will explore the genetic association of PE, various candidate genes, their proposed mechanisms and variants involved in its pathogenesis

Awareness and knowledge of Chikungunya infection following its outbreak in Pakistan among health care students and professionals: a nationwide survey

Background The World Health Organization (WHO) declares Chikungunya (CHIK) infection to be endemic in South Asia. Despite its first outbreak in Pakistan, no documented evidence exists which reveals the knowledge or awareness of healthcare students and workers (HCSW) regarding CHIK, its spread, symptoms, treatment and prevention. Since CHIK is an emergent infection in Pakistan, poor disease knowledge may result in a significant delay in diagnosis and treatment. The current study was aimed to evaluate the awareness and knowledge of CHIK among HCSW. Methods A cross-sectional study was conducted among HCSW from teaching institutes and hospitals in seven provinces of Pakistan. We collected information on socio-demographic characteristics of the participants and their knowledge by using a 30-item questionnaire. The cumulative knowledge score (CKS) was calculated by correct answers with maximum score of 22. The relationship between demographics and knowledge score was evaluated by using appropriate statistical methods. Results There were 563 respondents; mean age 25.2 ± 5.9 years with female preponderance (62.5%). Of these, 319 (56.7%) were aware of CHIK infection before administering the survey. The average knowledge score was 12.8 ± 4.1 (% knowledge score: 58.2%). Only 31% respondents had good disease knowledge while others had fair (36.4%) and poor (32.6%) knowledge. Out of five knowledge domains, domain III (vector, disease spread and transmission) and V (prevention and treatment) scored lowest among all i.e. percent score 44.5% and 54.1%, respectively. We found that socio-demographic characteristics had no influence on knowledge score of the study participants. Conclusion Approximately one-half of participants were not aware of CHIK infection and those who were aware had insufficient disease knowledge. Findings of the current study underscore the dire need of educational interventions not only for health care workers but also for students, irrespective to the discipline of study

Antimicrobial dispensing practices during COVID-19 and the implications for Pakistan

Antibiotics are one of the most frequently dispensed classes of medicines. However, excessive misuse and abuse enhances antimicrobial resistance (AMR). Previous studies in Pakistan have documented extensive dispensing of 'Watch' and 'Reserve' antibiotics, which is a concern. In view of this, there is a need to assess current dispensing patterns following COVID-19. A cross-sectional study was undertaken collecting dispensing data from 39 pharmacies and 53 drug stores from November 2022 to February 2023. Outlets were principally in urban areas (60.9%) with pharmacists/pharmacy technicians present in 32.6%. 11,092 prescriptions were analyzed. 67.1% of patients were supplied at least one antimicrobial, 74.3% were antibiotics, 10.2% antifungals and 7.9% anthelmintics. 33.2% of antimicrobials were supplied without a prescription. Common indications for dispensed antibiotics were respiratory (34.3%) and gastrointestinal (16.8%) infections, which can be self-limiting. 12% of antibiotics were dispensed for the prevention or treatment of COVID-19. The most frequent antibiotics dispensed were ceftriaxone (18.4%) and amoxicillin (15.4%). 59.2% antibiotics were 'Watch' antibiotics followed by 'Access' (40.3%) and 'Reserve' (0.5%) antibiotics. Of the total antibiotics dispensed for treating COVID-19, 68.3% were 'Watch' and 31.7% 'Access'. Overall, there appeared to be an appreciable number of antibiotics dispensed during the recent pandemic including for patients with COVID-19. Alongside this generally extensive dispensing of 'Watch' antibiotics. This needs urgent addressing with appropriate programs among pharmacists/pharmacy technicians to reduce AMR

Relationship between the use of drugs and changes in body weight among patients: A systematic review and meta-analysis

Purpose: To investigate the impact of drugs on the body weight of patients.Methods: All the randomized controlled trials that evaluated the impact of medications on the body weight of patients were searched in various databases. Studies quantifying the impact of drugs on body weight when compared to placebo or any other treatment were considered for this review. Moreover, the quantitative synthesis of evidence was also performed by generating the forest plot.Results: A total of 20 studies involving 18,547 participants were included in the current review. Weight gains ranging from 0.5 to 2.6 kg were associated with the use of pioglitazone, espindolol, brexpiprazole, glimepiride and ezogabine while weight loss ranging from 1.1 to 12 kg was linked with the use of betahistine, naltrexone, bupropion, liraglutide, phentermine, topiramate, orlistat, zonisamide, duloxetine, semaglutide, metformin and linagliptin. The quantitative synthesis suggested that drugs can significantly reduce body weight by -0.53 kg (CI 95 % -1.01, -0.04, p &lt; 0.04) when compared to standard treatment.Conclusion: The findings of this review suggest substantial association of drugs and weight change during pharmacotherapy. Pioglitzone, brexpiprazole, espindolol, ezogabine and glimepiride cause weight gain while naltrexone, bupropion, betahistine, topiramate, phentermine, zonisamide, semaglutide, linagliptin, liraglutide, orlistat, duloxetine and metformin were associated with weight loss. Drug-induced changes in body weight might cause serious consequences and should be addressed before initiating treatment

Knowledge, attitude and practices of self-medication including antibiotics among health care professionals during the COVID-19 pandemic in Pakistan; findings and implications

Since the emergence of COVID-19, several different medicines including antimicrobials have been administered to patients to treat COVID-19. This is despite limited evidence of the effectiveness of many of these, fueled by misinformation. These utilization patterns have resulted in concerns with patients’ safety and a rise in antimicrobial resistance (AMR). Health care workers (HCWs) were required to serve in high-risk areas throughout the pandemic. Consequently, they may be inclined towards self-medication. However, they have a responsibility to ensure any medicines recommended or prescribed for the management of patients with COVID-19 are evidence based. This though is not always the case. A descriptive cross-sectional study was conducted among HCWs in six districts of the Punjab to assess their knowledge, attitude and practices of self-medication during the ongoing pandemic. This included HCWs working a a range of public sector hospitals in Punjab Province. A total of 1173 HCWs were included in the final analysis. The majority of HCWs possessed good knowledge regarding self-medication and good attitudes. However, 60% were practicing self-medication amid the COVID-19 pandemic. The most frequent medicines consumed by the HCWs under self-medication were antipyretics (100%), antibiotics (80.4%) and vitamins (59.9%). Azithromycin was the most commonly purchase antibiotic (35.1%). In conclusion, HCWs possess good knowledge of, and attitude, regarding medicines they pur-chased. However, there are concerns that high rates of purchasing antibiotics, especially ‘Watch’ antibiotics, for self-medication may enhance AMR. This needs addressing