Efficacy of Kabab Chini (Piper cubeba Linn) in Chronic Kidney Disease: A Randomized Controlled Clinical Trial

Background: Chronic Kidney Disease (CKD) is a major public health problem with a global prevalence of approximately 13% with the majority stage 3 and is a global threat to health in general and for developing countries in particular, because therapy is expensive and life-long. In India 90% patients cannot afford the cost of treatment for CKD, over 1 million people worldwide alive on dialysis or with a functioning graft. It is the need of the time to find alternate treatment to control CKD. Hence this study aims to evaluate clinically the efficacy of Kabab Chini (Piper cubeba) in CKD stage 1-3 and also to compare the effectiveness of the marketed drug NEERI KFT® scientifically. Objectives: To evaluate the efficacy of Kabab Chini (Piper cubeba) in chronic kidney disease (CKD) stage 1-3 patients. Methods: In this open-labeled randomized controlled clinical trial, 30 participants, randomly allocated to two groups, received 4 g of either sufoof (powder) of Kabab Chini in a divided dose thrice a day (Test group, n=15) or 10 mL of Syrup NEERI-KFT three times a day (Control group, n=15) for 42 days. The objective parameters were serum creatinine, blood urea (BU), estimated glomerular filtration rate (eGFR), and urine routine and microscopy, whereas subjective parameters were anorexia, easy fatigability, and edema. Objective and subjective parameters were assessed at weekly follow-ups, and safety parameters were assessed at baseline and after 42 days. Results: Intragroup data suggest significant improvements in anorexia, easy fatigability, and eGFR in both groups (P=0.001), whereas the intragroup serum creatinine value was significantly reduced in the test (P=0.028) and control (P=0.256) groups. No significant improvement in edema and albumin was observed in both groups (P>0.05). The test drug was found to be tolerable with no adverse effects. Conclusion: The results of the present study revealed that Kabab Chini is effective in reducing serum creatinine, eGFR, anorexia, and easy fatigability moderately superior to Syrup NEERI-KFT® with respect to efficacy without any adverse effect and accepted alternate hypothesis

Bacterial contamination of Saudi Arabian paper currency: A report from Al-Kharj

Background: Currency is a public support tool for exchange of commodity and services. It’s prevalent practice for acquiring bread to broast and bath to bed has connected all human being together irrespective of race and occupation. Currency notes along with their denomination values also carry pathogens if contaminated and will act as an agent for infection transference. Therefore the objective of this cross-sectional study was to assess the load microbial pathogens of paper currency collected in selected public places of Al-Kharj, Saudi Arabia.Methods: Currency notes under study were assessed through microbiological culture, microscopic and biochemical visualization techniques.Results: The results from this cross-sectional study suggested that lower the currency denominations higher was the microbial contaminations, frequency percentage was lower with higher isolations. Small eateries were the biggest source of contaminated currency from the ten selected centres. Percentage microorganism occurrence for Bacillus sp., Staphylococcus sp., Klebsiella sp. and E. coli was 56.84%, 25.03%, 13.40% and 04.71% respectively in all currency notes under study.Conclusions: The outcomes of this study revealed that currency notes can be a source for microbe transmission causing infectious diseases represent public health hazards to the community and individuals

DEANSHIP OF GRADUATE STUDIES

In the name of Allah, the Most Gracious and the Most Merciful All praise and glory be to Allah, for giving me an opportunity to pursue the M.S. program at King Fahd University of Petroleum and Minerals. I am very thankful to KFUPM for the research facilities and the work environment provided to me. These facilities enabled me to enrich my knowledge and carry out my research. My appreciation and heartfelt gratitude goes to my thesis adviser Dr. M. Deriche for his constant endeavor, guidance and the time he devoted for this research work. I also wish to thank the other members of my thesis committee Dr. Sheikh, A.U.H and Dr. Zerguine, A. The greatest moral support I always carry with me is from my father. He always supported me with his love affection and advise, which kept me going. From the bottom of my heart I appreciate my family for the patience, the support and the encouragement they gave me in carrying out this research work while I was away from home. ii And last but not the least I would like to acknowledge my friends Riyaz, Anees

A Rare Case of COVID-19-Associated Acute Hemorrhagic Necrotizing Encephalopathy in a Young Patient

Coronavirus disease-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2, a strain of coronavirus. It can also present with neurological sequelae. It has been related to intracranial cytokine storm. Here, we present a case of acute hemorrhagic necrotizing encephalopathy in a young patient who presented with the characteristic magnetic resonance imaging findings. As the pandemic continues, we can expect that the spectrum of neurological presentations will widen. Knowledge of these neuroimaging features may assist in the detection and early management of neurological complications

GLIMPSE STUDY: IMPACT OF TRIPLE THERAPY ON LUNG FUNCTION, HEALTH STATUS, AND MORTALITY RISK IN PATIENTS WITH ADVANCED CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objectives: The objectives of the study were to estimate the relative impact of triple therapy on lung function, health status, and mortality risk compared with combination inhaled corticosteroid (ICS)/long-acting β-agonist (LABA) therapy in symptomatic chronic obstructive pulmonary disease (COPD) patients with frequent exacerbations in an Indian clinical population. Methodology: The GLIMPSE (Lung Function, Health Status, and Mortality Risk Assessment in COPD using Triple Therapy) was as a prospective, parallel design, single-center observational study comparing 24 weeks of triple therapy (twice-daily combination of budesonide [BUD]-formoterol [FOR] [100/6 μg] and once-daily tiotropium [TIO] [9 μg]) with ICS/LABA (twice daily BUD-FOR [100/6 μg]). The primary outcome was the mean change in forced expiratory volume in the 1st s (FEV1%) predicted and COPD assessment test total score from baseline at week 24. Secondary outcomes were variation in dyspnea grade and BODE total score from baseline. Results: At week 24 in triple therapy (n=70) and ICS/LABA therapy (n=70), mean difference from baseline in FEV1% predicted were 5.40 (95% confidence interval [CI]: 1.29–9.50) and 1.90 (95% CI: –1.87–5.68) respectively, and mean difference in CAT total score from baseline was –5.10 units (95% CI: –3.49–−6.71) and –1.80 units (95% CI: –0.052–−3.548), respectively. In addition, there was a statistically significant reduction in dyspnea grading and BODE score with comparable adverse events in both groups. Conclusion: Overall, the results favored triple therapy over dual therapy in advanced symptomatic COPD patients

Association between oral manifestations and inhaler use in asthmatic and chronic obstructive pulmonary disease patients

Objectives: To examine the association between oral manifestations and type, frequency and duration of inhaler usage, also type and dosage of medication used in asthmatic and chronic obstructive pulmonary disease (COPD) patients. Materials and Methods: A cross-sectional study was conducted on 250 patients of both sexes suffering from asthma and COPD who were using inhalers. Frequency of oral manifestation seen on the tongue, buccal mucosa, teeth, periodontium, palate, floor of the mouth, lips, and xerostomia in inhaler users depending on the type of inhaler, type and dosage of medication, frequency and duration of use of inhaler were examined. Chi-square test was used for statistical analysis and P < 0.05 was considered statistically significant. Results: Ulceration (36.6%) and candidiasis (27.1%) on the tongue were most commonly found among those who were 25-50 years old and the elderly group, respectively. The differences were not statistically significant (P = 0.081). A significant association was observed (P 0.05). Gingivitis/gingival enlargement (53.6% and 51.5%) was almost similar but periodontitis was higher in those using >500 μg. Significant association (P < 0.05) was observed with duration <1 year; oral manifestations seen were taste alterations (53.2%) in tongue, ulcerations (63.6%) in the buccal mucosa, teeth affected (87%), gingivitis/gingival enlargement (66.2%), and xerostomia (89.6%). Conclusions: As asthmatics and COPD patients are at a higher risk of developing oral diseases during inhalation therapy, it is necessary to educate patients on proper oral health care and maintenance

Design and Evaluation of Solid Lipid Nanoparticles Loaded Topical Gels: Repurpose of Fluoxetine in Diabetic Wound Healing

The current study aimed to prepare a topical gel containing solid lipid nanoparticles (SLNs) encapsulating fluoxetine for diabetic wound healing effects. Fluoxetine (FX) was loaded into SLNs by employing an emulsion solvent evaporation technique using stearic acid as a lipid, and soya lecithin as a surfactant. SLNs were then evaluated for particle size, polydispersity index (PDI), zeta potential (ZP), percent entrapment efficiency (%EE), percent drug loading (%DL), and in vitro drug release. The optimized SLN (FS3) composed of FX (100 mg), SA (150 mg), and SA (100 mg) displayed mean particle size (467.3 ± 2.2nm), PDI (0.435 ± 0.02), ZP (−32.2 ± 4.47mV), EE (95.8 ± 3.38%), and DL (16.4 ± 2.4%). FTIR and DSC studies denote drug-polymer compatibility and the amorphous nature of FX in the SLNs. The drug release at 24 h was found to be (98.89 ± 2.57%) which followed the fickian diffusion mechanism. SLN (FS3) was further loaded into carbopol gel and tested for pH, spreadability, and extrudability of pharmaceutical parameters. In-vitro release of FX from the SLN gel and plain gel was compared, diabetic wound healing gel (DWH) showed sustained drug delivery. An in vivo study was also performed for DWH gel in streptozotocin-induced diabetic rats. Histopathological examination exhibited DWH gel-treated wounds have increased hydroxyproline, cellular proliferation, a rise in the number of blood vessels, and the level of collagen synthesis. Thus, DWH gel-loaded SLN encapsulated with FX could be a potential carrier for the effective treatment and management of diabetic wounds

Cost-effectiveness analysis of three different combinations of inhalers for severe and very severe chronic obstructive pulmonary disease patients at a tertiary care teaching hospital of South India

Background: This study aims at simplifying the practical patient management and offers some general indications for pharmacotherapeutic choice by the implementation of (Global Initiative for Chronic Lung Disease) guidelines. This study was designed to evaluate the clinical and economic consequences of salmeterol/fluticasone (SF), formoterol/budesonide (FB), and formoterol/fluticasone (FF) in severe and very severe chronic obstructive pulmonary disease (COPD) patients. Objectives: The aim was to find out the most cost-effective drug combination between the three combinations (SF/FB/FF) in COPD patients. Materials and Methods: A prospective observational comparative study (cost-effectiveness analysis), in which 90 severe (30 ≤ forced expiratory volume in 1 s [FEV 1 ] 30% predicted) COPD patients (outpatients/inpatients) who are prescribed with any one of the following combinations (SF/FB/FF) were selected. In our study, we have divided 90 COPD patients into three groups (Group I, Group II, and Group III) each group consisting of 30 patients. Group I was prescribed with medication SF, Group II with medication FB, and Group III with medication FF. We used five different parameters such as spirometry test (mean FEV 1 initial and final visit), number of symptom-free days (SFDs), number of moderate and severe exacerbations, Number of days of hospitalization and direct, indirect, and total cost to assess the cost-effectiveness of SF/FB/FF. Comparison of cost and effects was done during the period of 6 months of using SF/FB/FF. Results: The average FEV 1 for Group I, Group II, and Group III subjects at initial visit was 33.47%, 33.73%, and 33.20% and was increased to 36.60%, 35.8%, and 33.4%, respectively. A 3% increment in FEV 1 was reported for Group I subjects (SF) and was highly significant statistically (t = −8.833, P = 0.000) at 95% CI. For Group II subjects (FB), a 2% increment in FEV 1 was reported and was highly significant statistically (t = −9.001, P = 0.000) at 95% CI. For Group III (FF) subjects 0.2% increment in FEV 1 . The overall mean total cost for Group I, Group II, and Group III subjects during the 6 months period was found to be Rs. 29,725/-, Rs. 32,602/- and Rs. 37,155/-. Incremental cost-effectiveness of FB versus SF was Rs. 37,781/- per avoided exacerbation and Rs. 661/- per SFD. Conclusion: This study highlights the favorable therapeutic performance of combined inhaled bronchodilators and corticosteroids (SF/FB/FF), thus suggesting that healthcare costs would be also affected positively. Results from our study showed that SF and FB were the most effective strategies in the treatment of COPD, with a slight clinical superiority of SF. The FF strategy was not much effective (i.e. associated with fewer outcomes and higher costs)