Incidence of drug interactions in intensive care units in tertiary care settings: Classification, facts and measures

Drug-drug interactions [DDIs] are extremely significant concern, particularly in sensitive population including pediatric and geriatric. Propensity for the development of DDIs is high in patients admitted at intensive care units [ICU]. This study was conducted to evaluate the DDIs incidence, facts and measures in ICU. From a total of 150 cases studied for ICU patients, with the mean age of 56.37+/-12.45 years, 55.33% were male and the rest were female 44.66%. The demographic information like age, gender and main diagnosis details of study participants that were extracted from the patients' clinical record. A statistically significant association between the drug interaction and the number of drugs prescribed per prescription was observed [p <0.0001]. Concerning the onset of outcome, 52% of DDIs distinguished as delayed onset of effect [past 24 hours] and 35% were categorized as rapid onset [within 24 hours]. Despite the facts regarding patient safety and minimizing DIs error, polypharmacy is still frequent in critically ill patients admitted in ICU attributed high risk of adverse reactions due to use of multiple interventions to treat severity of disease condition. Such studies may be used to develop an effective tool for the diagnosis and management of DDIs

Mini Review: herbal medicinal products regulation in Pakistan

Pakistan is gifted with a rich prosperity of curative plants from All Mighty Allah. Herbs have always been most important form of medicine in Pakistani population and currently plants have got popularity throughout the globe. Standardization, quality control and import and export of raw materials and herbal formulations materialize the key dispute for herbal drug manufacturers which is due to the non availability of sufficient regulatory strategy, principally for good manufacturing practice [GMP], no execution of good agricultural and collection practices [GACP], and weak implementation of the Herbal product drug act from the ministry of health of Pakistan. Now there are several opportunities for the development of quality of herbal products on the basis of data based studies which is essential for the establishment of the herbal products quality, safety and efficacy in the domestic and export market. Finally, strong Regulatory implementation becomes now necessary to moderate the hindrance for the commercialization of the herbal medicinal drug in Pakistan with the help of scientific research at Institutions, Universities and hi-tech advancement in the field of herbal medicine and their related products

Traditional remedy of morus nigra L. herb formulated into lozenges to enhance the localized effect

Allopathic system of medication is the most popular and preferable approach of the treatment in the current scenarios, but in spite of the wide use of allopathic medicine, the trend of use of herbal medicines are also valuable contributor with the current medicinal therapies in the health care professions. In this connection, an eastern use of Morus nigra L. fruit was formulated into solid dosage from named as Lozenges. The lozenges consisted of Morus nigra L. aqueous extract, which dissolves in the mouth providing localized effect against sore throat and cough. A full-scale batch of lozenges trial was manufactured to ensure uniform process and analytical parameters. The un-packed lozenges were evaluated for qualitative specifications like, average weight which was about 2.250-2.750 [2.5 g +/- 10%] and uniformity of weight was 18/20-NMT +/- 10% 2/20. The results were found within the official limits. The appearance of the lozenges was checked organoleptically while dimensions were evaluated using calibrated vernier caliper. Packed and finished lozenges dosage form were evaluated for microbiological test like, aerobic bacteria, fungi, P.aeruginosa, E. coli, Staphylococcus aureus, Salmonella and other enteric bacteria. Thin Layer Chromatography [TLC] confirmed the presence of flavonoids as anthocyanins at 254 nm. The quantity of flavonoids as anthocyanin [cyaniding-3-glucoside] was determined as not less than [NLT] 0.80 mg/Loz. Caffeic acid was also estimated quantitatively using High Performance Thin Layer Chromatography [HPTLC] and was found NLT 0.002 mg/loz

Histopathologic changes in liver and kidney of male sprague dawley rats treated with extract of Cardiospermum halicacabum L.

In traditional medicine Cardiospermum halicacabum L. [Sapindeaceae] is used against various ailments such as rheumatism, nervous diseases, stiffness of the limbs and snakebite. Leaves are crushed and made into a tea, which aids itchy skin. Salted leaves are used as a poultice on swellings. Young leaves can be cooked and used as vegetables. The leaf juice has been used as a treatment for earache as well. In this study we evaluate acute toxicity [10, 50,100 and 500 mg/kg] and pathologic changes in esophagus, stomach, liver and kidney tissues with a magnifying glass and microscope in a row to mark changes to both morphological and histological in comparison to control with the treatment of ethyl acetate extract [dose of 40mg/kg] in male Sprague Dawley rats. The rats were divided into 4 groups consisting of 3 rats per group for acute toxicity and histopathological change. In conclusion, no lethality was observed in acute toxicity study for 7 days. The treatment of ethyl acetate extracts at 40 mg/kg did not show lethal toxicological changes as observed by histopathological examination in the kidney and liver tissues

Antidepressant activity of ethanolic extract of Hibiscus rosa sinenesis Linn

The present study was undertaken to assess the antidepressant effect of crude ethanolic extract of floral part of Hibiscusrosa sinensis [HRS] at doses l00mg/kg, 250mg/kg and 500mg/kg using three parameters which are forced induced swimming test [FST], tail suspension test [TST] and open field test[OFT]

Flouxetine (15mg/kg, body weight) was used as standard. Significant dose dependent decline in immobility time was observed in all the three doses in FST and TST while in case of OFT none of the dose of HRS exhibited effectual results. To determine MAO[A] and MAO[B] activity HRS extract was used and the results revealed that each dose of this plant exhibited marked effect on MAO[A], while on MAO[B] only 250mg/kg dose was found significant

Antihyperglycemic and hypolipidemic effects of Hibiscus schizopetalus [Mast] Hook in alloxan-induced diabetic rats

The antihyperglycemic and hypolipidemic activities of Hibiscus schizopetalus [Mast] Hook [Malvaceae] flower and leaves extracts were investigated in alloxan-induced diabetic rats. The hypoglycemic activity of both the extracts [100mg/kg, body weight] was tested in fasting normal rat, glucose loaded rats. Observation on body weight was also recorded. The extracts showed a significant [P<0.001] reduction in blood glucose level in normal fasting rats. In glucose tolerance test, significant [P<0.01] decreased observed in all glucose loaded animals. While in alloxan induced diabetic rats, the percent blood glucose reduction was 59.94% and 45.14% in extracts treated groups. The results obtained were compared with the reference standard drug Tolbutamide [100mg/kg, body weight]. The diabetic rats showed sign of decreased in their body weight during the treatment period. Cholesterol and triglycerides levels were significantly decreased [P<0.001] by HFE. The results obtained demonstrated the potential hypoglycemic activity of methanolic extracts of H. schizopetalus. There is need of bioassay-directed assay of the active principles responsible for the anti-diabetic activity. The methanolic extracts showed the presence of carbohydrates, alkaloids, steroids, terpenes, saponins and glycosides.

Assessment of total phenolic content and antioxidant potential of methanol extract of Peltophorum pterocarpum [DC.] Backer ex K Heyne

Plants are rich in a variety of chemical compounds. Many are secondary metabolites including aromatic substances most of them are phenols or their oxygen substituted derivatives. Medicinal plants are also rich in antioxidant constituents such as phenols, tocopherols, ascorbic acid, carotenoids, and flavonoids etc. They are found to acquire free radical scavenging activity and used worldwide for the treatment of various immune system dependent diseases. Peltophorum pterocarpum [DC] Backer ex K. Heyne [Caesalpiniaceae] is a beautiful ornamental tree, widely grown in tropical regions and its parts are used in traditional medicine as an effective therapeutic agent. Fresh pods of Peltophorum pterocarpum was evaluated for its antioxidant potential by using various methods including DPPH, superoxide anion, nitric oxide scavenging, and metal chelating activity. TPC via Folin-Ciocalteau's reagent and anti haemolytic activity red blood cells respectively have also been measured. The methanol extract of pods of Peltophorum pterocarpum was found to possess the significant amount 439.21 +/- 0.17 mg GAE [gallic acid equivalents] / g of TPC. The antioxidant potential of pods extract at mature stage showed potent activity and measured as, free radical scavenging activity 73.29 +/- 0.81%, superoxide anion scavenging activity 89.03 +/- 1.07%, nitric oxide scavenging activity 84.25 +/- 1.18%, and metal chelating activity 64.12 +/- 0.11%. The extract also showed potent anti haemolytic activity 79.09 +/- 75%. Peltophorum pterocarpum exhibited strong but varying level of antioxidant and anti haemolytic activity in various methods along with total phenolic contents

Atomic absorption spectroscopic analysis of some Pakistani herbal medicinal products used in respiratory tract infections

Heavy metals are one of the major causes of widespread occurrence of respiratory tract infections [RTIs]. Unani system of medicines utilizing plant extracts and herbal medicinal products [HMPs] are known to have remedial potential in different RTIs [flue, cough, bronchitis, allergy, asthma, nasal and chest congestion]. Being natural in origin chances of metal contamination cannot be ignored in Phytopharmaceuticals, therefore toxic metal contents [Pb, Cd, As, and Hg] were determined in some Pakistani branded HMPs being used in various RTIs through atomic absorption spectrophotometer. Research findings showed detectable levels of metals in all these formulations. Daily metals intakes via these HMPs were calculated as: 0.86-277.44 [Pb], 1.442-10.986 [Cd], 0.16-5.83 [As], and 0.00-0.09 microg/ day [Hg]. Prevalence of toxic metals in HMPs especially elevated levels of Pb and Cd, pose severe health risks to the consumers. Statistical interpretation of data using ANOVA followed by LSD [p<0.05], revealed significantly different metal concentrations among HMPs. To identify the metal contaminant of HMPs and highlight their toxic manifestations is the basic aim of this research. The study is not a bias to the beneficial effects of the Phytopharmaceuticals, rather is done to improve their quality and safety parameter according to the international health standards

Chlorpheniramine maleate: an effective antiallergic agent

Chlorpheniramine maleate is Hi receptor antagonist and is useful in the management of allergic and non-allergic rhinitis. It is commonly used to treat different symptoms associated with rhino conjunctivitis and urticaria. This article briefly reviews the therapeutic uses, drug-drug interactions, incompatibilities and side effects of chlorpheniramine maleate

Analgesic activity of various extracts of Holoptelea integrifolia [Roxb] Planch leaves

The various extracts of leaves Holoptelea integrifolia [Ulmaceae] were investigated for analgesic activity in mice by tail flick method. The fresh plant leaves of H. integrifolia were collected, dried, cleaned, weighed and chopped into small pieces and percolated in ethanol. The fractionation of crude extract, followed by the addition of distilled water, ethyl acetate and n-butanol to an aqueous portion of each solvent, to obtain the dried masses of each four layers. Qualitative chemical examination indicates the presence of secondary metabolites such as alkaloids, flavones, phenol, steroids, tannins and triterpenoids. No acute oral toxicity was observed and extracts considered being safe at the dose of 50-2000 mg/kg body weight. At the dose of 500 mg/kg various extracts of leaves of H. integrifolia were found statistically significant [P<0.05]. A maximum effect was established at 150 min, after drug administration. Diclofenace sodium used as a standard

Pharmacognostic Study of coccinia grandis L.

Coccinia grandis [kanduri] belonging to Cucurbitaceae family is one of the important plant drug used in Unani system of medicine. It is used by local healers in combination with other drugs to cure skin ailments such as psoriasis, eczema, and scabies. It is also employed in bronchitis and ulcer. Part of plant is recommended in diabetes mellitus. This paper deals with its literature survey regarding diabetes mellitus cultivation, chemical information and medicinal importance. The detailed chemical, histo-chemical color test, botanical features, pharmacognostic parameters and microscopic and macroscopic evaluation of different morphological parts i.e leaf and stem were performed for the identification of genuine samples and for its utilization not only in health care system as medical aid but as raw material in detection of the adulteration in the market sample which is necessary for providing the standardized plants drug material to pharmaceutical industry and, study of the quality control parameters of the drugs

Holoptelia integrefolia, a drug of universal importance in herbal medicine

Plant drugs identification is a very crucial problem in the utilization of herbal drugs when used either as a crude drug or as raw material in pharmaceuticals. Various methods are used for the identification and standardization of herbal drugs. Sometime faulty or adulterated drug causes severe health hazard, not only for the patients but also for normal healthy persons. Many drugs which are available in the markets are adulterated and misleading as they are substitutes of the original article. The standardization of herbal drug is therefore necessary to ascertain the genuineness of the herbs. In this paper the methods of standardization [organoleptic and microscopic evaluation] of the drug Holeptelea integrifolia [Roxb] Planch has been presented to establish the quality and purity of this valuable drug

Pharmacognostic studies on roots of Operculina turpethum Linn

Adulteration of drug is a huge problem when using herbal drugs in disease condition and utilization of herbal drugs in such condition is not free from doubt. In this paper we have presented the methods of standardization [macro and microscopic features, fluorescence characteristics under UV light and quantitative analysis on the basis of colour reactions] of Operculina turpethum Linn, root to establish the quality and purity of this valuable and popular remedy which is beneficial in a variety of disorders