Preparation And Characterization Of Hydroxypropyl Methylcellulose Produced From Α-Cellulose Betung Bamboo (DENDROCALAMUS Asper) And It’s Evaluation On Gel Formulation

Objective: This study aim to obtain the optimum condition of preparation of hydroxypropyl methylcellulose (HPMC) produced from α-cellulose betung bamboo, physicochemical properties of HPMC powder and its characteristics in a gel formulation. Methods: HPMC of betung bamboo (HPMC BB) were optimized by central composite design (CCD) using three variables (sodium hydroxide concentration, dimethyl sulfate concentration, and temperature) and five levels (0,±1, and±α). The suggested optimum condition was subjected to further characterization. HPMC BB was characterized using Fourier transform infrared (FTIR) spectrometry, particle size analyzer (PSA), x-ray diffraction (XRD), scanning electron microscope (SEM) and compared to HPMC 60SH as the reference. Then, HPMC BB was used as a gelling agent in a gel formulation and the gel was evaluated, including appearance and homogeneity, pH, viscosity, and spreadability. Results: Optimum condition of preparation of HPMC BB was using sodium hydroxide 27.68% (w/v) and 1.26 ml dimethyl sulfate (based on 1 g α-cellulose) at 58.11 °C which resulted in molar substitution 0.21 and degree of substitution 2.09. The results showed that HPMC BB was a fine powder with yellowish-white color, odorless and tasteless, pH 7.02, residue on ignition 1.39%, methoxy groups content 28.56%, hydroxypropoxy groups content 7.09%, mean particle size 98.595 μm, loss on drying 3.62%, and moisture content 7.47%. Flow properties of HPMC BB classified in the fair category. The infrared spectrum and diffraction patterns were relatively similar to HPMC 60SH. The gel has a good homogeneity and spreadability and viscosity 142.5 mPa⋅s. pH 6.37. Conclusion: Based on the comparison to reference, HPMC BB showed relatively similar physicochemical and powder properties. However, HPMC BB is not recommended as a gelling agent in gel formulation because it has a low viscosity.

Analgesic and Anti-inflammatory Activities of the Fruit Extract of Ampelocissus latifolia (Roxb) on Laboratory Animals.

Aim of Study: This study was aimed to evaluate the possible analgesic and antiinflammatory properties of the ethanol extract of fruit of Ampelocissus latifolia (Roxb). Study Design: Assessment of analgesic and anti-inflammatory activities. Place and Duration of Study: Department of Pharmacy, North South University, Dhaka, Bangladesh, between June 2012 and March 2013. Methodology: The crude ethanol extract was investigated for the anti-inflammatory effect on Long Evans rats using carrageenan induced rat paw edema method. For antiinflammatory study, 20 rats were divided into 4 different groups, each receiving either distilled water, standard drug or the extract at the doses of 250 and 500mg/kg body weight (BW). The analgesic activity was evaluated by hot plate and acetic acid induced writhing method in Swiss albino mice divided into 4 different groups (control, standard and extract at two different doses of 250 and 500 mg/kg BW). Results: The results of preliminary phytochemical study revealed the presence of alkaloids, flavonoids, tannins, glycosides in significant amounts. The results of anti inflammatory activity study showed that the fruit extracts at a dose of 250 mg/kg and 500 mg/kg inhibited carrageenan-induced paw edema in Long- Evans rats. Both the extracts were able to show a dose dependent anti-inflammatory activity as compared to diclofenac sodium used as a standard drug. The extract elicited a highly significant (p<0.001) analgesic activity in a dose dependent manner on hot plate method, acetic acid-induced writhing test. In the hot plate method, the extract increased the reaction time of heat sensation to 94.71% and 82.7% at the doses of 250 and 500 mg/kg BW while that of the standard drug was 61.45% at the 3rd hour of study. In acetic acid induced writhing test, the percent inhibition of writhing response by the extract was 50.57% and 59.77% at 250 and 500 mg/kg doses respectively (p<0.001). Conclusion: The anti-inflammatory and analgesic effect of the ethanol fruit extract of Ampelocissus latifolia (Roxb) may be due to the presence of various chemical constituents especially flavonoids, tannins, alkaloids or terpenoids. These experimental findings would further establish the scientific basis of the traditional uses of the plant in the management of inflammatory conditions as well as control of pain.

Analysis of blood/tracheal culture results to assess common pathogens and pattern of antibiotic resistance at medical intensive care unit, Lady Ridgeway Hospital for Children.

Background: Intensive care units (ICUs) are burdened with a high frequency of nosocomial infections often caused by multi resistant nosocomial pathogens. Objectives: To determine the common pathogens in medical intensive care unit of Lady Ridgeway Hospital for Children (MICU-LRH) and to look for the pattern of antibiotic resistance of these pathogens. Design & Setting: This retrospective study was performed by tracing all the culture reports of MICU-LRH done at microbiology laboratory of LRH in the year 2006. Results: Total number of blood cultures done in 2006 was 659. Of them 123(18.7%) became positive. Out of positive blood cultures 38.2% were for spores and 24% for coliforms. Staphylococcus aureus (10.6%), streptococcus spp. (4.1%), pseudomonas spp. (4.1%) and candida spp. (4.9%) were the other pathogens in blood cultures. Out of 457 tracheal cultures done in 2006, 251(56%) were positive. Contamination with spores was 3.1%. Majority (43%) of tracheal cultures were positive for coliforms. Other common pathogens were pseudomonas spp. (19.5%) and candida spp. (9.8%) Resistance pattern of coliforms varied in blood cultures and tracheal cultures. There was significant resistance to aminoglycosides. Imipenem & meropenem resistant isolates were not found in blood cultures but in tracheal cultures 44% of isolates were resistant to imipenem & 42% were resistant to meropenem. Resistance pattern of pseudomonas to amikacin was around 34% in both blood & tracheal cultures. 25% of isolates in blood cultures and 50% of isolates in tracheal cultures were resistant to ceftazidime. Although, there was no resistance to ticarcillin in blood cultures, 51% pseudomonas isolated in tracheal cultures showed resistance. Resistance rate to ciprofloxacin was 50% in blood cultures and 34% in tracheal cultures. Eighty three percent of staphylococcus spp. in both blood & tracheal cultures were resistant to cloxacillin. More than 70% were resistant to gentamicin. Around 33% isolates in blood cultures & 22% in tracheal cultures were resistant to fusidic acid. However, all staphylococcus spp. were sensitive to Vancomycin. Conclusions: There were more positive tracheal cultures than blood cultures. Majority of septicaemia were due to coliforms. Coliforms and pseudomonas were major pathogens in tracheal cultures. There was significant colonization of candida spp. in respiratory tract of patients at MICU-LRH in contrast to candida septicaemia. Emergence of antibiotic resistance to broad spectrum antibiotics is a significant problem.

Perception of medical students undertaking a problem-based learning curriculum: experiences during the pre-clerkship phase

Student's perceptions of pre-clerkship phase concerning their experience of the Problem-Based Learning [PBL] curriculum are variable. To determine how students in the pre-clerkship phase perceive problem-based learning and the changes in these perceptions with increasing experience. College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain. Students were interviewed in focus groups and responses were used to develop a structured questionnaire, with 25 sets of questions on five components of the PBL process, which was distributed to 148 students. Response rates were 96%, 76% and 46% for years 2, 3 and 4, respectively. Students perceived PBL as interesting and it develops self-confidence. During tutorials, most of the students were willing to challenge each other but not the tutor. Students preferred discussions with peers to consulting seniors. As the seniority increase, students tended to discuss more during the second tutorial and tended to ask more questions. While preparing for end-of-unit examinations students attempted inter-problem integration less than intra-problem integration. Students perceived PBL as an interesting, though difficult, method of learning, which helps to develop their self-confidence but may result in gaps in their knowledge. The tendency to focus on clinical aspects of a given problem at the expense of its basic science concepts should be discouraged by careful construction of the problems and tutor guides. While students challenge their peers during discussion, all students do not prepare adequately for the second tutorial. Integrated learning can be further enhanced through focusing on the themes identified in the unit booklets and the use of integrated questions on these themes

Extended-spectrum beta-lactamase [ESBL] in Omani Children: Study of prevalence, risk factors and clinical outcomes at Sultan Qaboos University Hospital, Sultanate of Oman

Antimicrobial resistance is a growing problem worldwide, which imposes difficulties in the selection of appropriate empirical antimicrobial therapy. This study evaluated extended-spectrum ?-lactamase [ESBL] isolates in 2005 in The Department of Child Health at Sultan Qaboos University Hospital [SQUH], Oman. During the 12 month period from January 2005 to December 2005, ESBL isolates from paediatrics inpatients were identified and analysed. Risk factors for the patients who grew ESBLs were analysed. 13.3% of E. coli and 16.6% of Klebsiella pneumoniae isolated were ESBL producers. Most of the ESBLs were from urine [46.2%] and blood [42.6%]. The main risk factors for ESBL in these children were previous exposure to antimicrobials [100%], prolonged hospital stay, severe illness [92.3%] and female gender [84.6%]. Sensitivity of 100% was observed to carbapenems whereas 92% of the isolates were susceptible to amikacin. The oximino-cephalosporins were 100% resistant. Klebsiella pneumoniae were 100% resistant to piperacillin-tazobactam and nitrofurantoin. E. coli was 100% resistant to trimethoprim-sulfamethoxazole and ciprofloxacin. No resistance was recorded for the following combinations: amikacin plus piperacillin-tazobactam, amikacin plus nitrofurantoin and gentamicin plus nitrofurantoin. ESBL-producing organisms are becoming a major problem in Omani children. Exposure to antimicrobials and long admissions are modifiable risk factors that should be targeted for better control. Carbapenems are the most sensitive and reliable treatment options for infections caused by ESBLs. Amikacin plus piperacillin-tazobactam or nitrofurantoin are good alternatives

Prevalence of extended-spectrum beta-lactamases-producing isolates over a 1-year period at a University Hospital in Oman

To evaluate the prevalence of extended-spectrum beta-lactamases isolates over one year period at Sultan Qaboos University Hospital. We identified the ESBL isolates during a 12-month period from July 2004 to June 2005, using a commercial system, and confirmed the result using the National Committee for Clinical Laboratory Standards-approved double-disk diffusion method. Sensitivity was recorded for a wide range of antibiotics, aminoglycosides, carbapenem, cephalosporins, quinolones, aztreonam, ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, piperacillin-tazobactam, trimethoprim/ sulfamethoxazole and nitrofurantoin. Of the total ESBL isolated, 29.6% were from medical ward, followed by outpatients clinic, 24.3%. Urine was the main source of ESBLs 70.4%, followed by 16.5% from blood. We observed a 100% sensitivity to carbapenems, whereas 93.9% of the isolates were susceptible to amikacin. Cephalosporins were 100% resistant, except for cefoxitin, which demonstrated sensitivity of 77.4%. Aztreonam, ampicillin, co-amoxyclav and ampicillin/sulbactam were 100% resistant. Of the isolates, 57.4% were sensitive to nitrofurantoin, whereas Tazocin showed 49.6% sensitivity and co-trimoxazole 13.9%. To quinolones, 74.8% of the isolates were resistant. Excess use of third generation cephalosporins led to increase rate of ESBLs, which are difficult to treat. Carbapenem are most reliable for treatment of infections caused by ESBL isolates. However, overuse of carbapenem may lead to resistance of other gram-negative organisms. Therefore, justifiable use of third-generation cephalosporins, will be an effective means of controlling and decreasing the spread of ESBL isolates

Bandemia in sickle cell disease: a marker for differentiating osteomyelitis from vaso-occlusive crisis

Find out if bandemia [increase in the absolute band cell count] can differentiate osteomyelitis from vaso-occiusive crisis involving the bones in patients with sickle cell disease. Meaningful cut-off-points in the absolute band count [>/= 1000 and >/= 500] differentiation are also looked at. A retrospective review of records of 50 patients from each category for comparison was performed. Two cut-off-points were considered namely bandemia of >/= 1000 and >/= 500 and these were subjected to analysis. Bandemia [both >/= 1000 and >/= 500] was generally more prominent in cases of osteomyelitis as compared to VOC. There were problems with sensitivity and specificity of bandemia as a single criterion for differentiation between the two entities. Although seemingly we encounter higher counts of band white blood cells in cases of osteomyelitis occurring in patients with SCD as compared to VOC, yet because of low sensitivity in case of >/= 1000 as a cut-off-point and low sensitivity as well as non-specificity in case of >/= 500 as a cut-off-point, bandemia cannot be recommended as single diagnostic criterion

Glucose-6-phosphate dehydrogenase deficiency in neonates.

OBJECTIVE: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited deficiency that may be the cause of neonatal hyperbilirubinemia, as has been found in several countries and among widely different ethnic groups, especially in Mediterranean region. Our aim was to study the prevalence of G6PD deficiency in relation to neonatal jaundice. METHODS: From March 1998 to April 2001 we studied 705 clinically icteric neonates who were admitted to Al-Zahra and Beheshti hospitals, two teaching hospitals in Isfahan, Iran. Laboratory investigations included determination of direct and indirect serum bilirubin concentrations, blood group typing, direct coomb's test, hemoglobin, blood smear, reticulocyte count and G6PD level. RESULTS: In only 53 (7.5%) of cases G6PD deficiency was diagnosed. In all G6PD deficient neonates no evidence of other factors known to cause hyperbilirubinemia were detected. The sex distribution was 13 (24.5%) females and 40 (75.5%) males in the G6PD deficient group. The mean bilirubin level in G6PD deficient and G6PD normal groups were 22.26 +/- 8.36 and 18.14 +/- 3.85 mg/dl, respectively (p=0.001). Phototherapy was required in G6PD deficient and other icteric neonates with duration of 3.76 +/- 1.93 and 3.13 +/- 2.14 days, respectively (p=0.045). Twenty-seven of the 53 (50.9%) G6PD deficient infants required exchange transfusion. None of them developed kernicterus. CONCLUSIONS: Since the prevalence of severe hyperbilirubinemia among our neonates was relatively high and about half of them required exchange transfusion, early detection of this enzymopathy regardless of sex and close surveillance of the affected newborns may be important in reducing the risk of severe hyperbilirubinemia and exchange transfusion.

Bandemia in shigellosis

Bandemia is a phenomenon observed in infections caused by gram negative organisms, particulary of shigella species. The occurrence has not been quantitated as a diagnostic guideline implicating shigella organisms prior to availability of culture results. We have looked at bandemia in 55 patients with documented shigellosis and compared it to that in 36 non-shigella diarrhea cases. A 5% or more band cells in the peripheral blood smear is being proposed as a significant indicator of possibility of shigellosis given the proper clinical set up

Hemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency in hospital virths in Bahrain

In view of the high prevalence of clinical cases of sickle cell anemia, hemoglobin-H-disease and glucose-6-phosphate dehydrogenase deficiency in the archipelago of the State of Bahrain, a cord blood screening study was undertaken over a 15 month period [October 1984 to December 1985] to determine the gene frequency of these diseases. All the state hospitals participated in this study and a total of 10,327 cord blood samples obtained from babies born to Bahraini parents were analyzed. These represented over 80% of all neonates born in the country during the study period. The phenotypes detected included: AF, AF-Barts, SFA and SFA- Barts. Homozygous sickle cell disease was detected in 2.1%, and in 11.2%, the sickle cell trait was present. The incidence of alpha-thalassemia gene based on elevated Bart's hemoglobin was 24.3% in these neonates. The incidence of G6PD-deficiency was as high as 20.9%. Availability of these statistics has enabled the authorities in the Ministry of Health in collaboration with the National Hereditary Anemia Society to plan a comprehensive health care program for patients with these hereditary diseases and their families

Alpha-thalassaemia in Bahrain: haemoglobin H disease - not so benign

A retrospective analysis of the records of 76 in-patients seen at Salmaniya Medical Centre, Bahrain, during the period 1985-86 was carried out. The aim of the study was to determine the clinical manifestations of haemoglobin H disease. These patients were classified into three groups; their clinical and haematological details were carefully recorded. The study has revealed one important finding: contrary to old-held belief, haemoglobin H disease can have diversified and at times severe clinical manifestations. However, haemoglobin H disease still remains intriguing and requires the collaborative research efforts of Arabian Gulf countries