Development of standard operating procedure [SOP] of a unani pharmacopoeial formulation

In various Unani pharmacopoeias thousands of formulations are present which have been formulated by eminent physicians of Unani System of Medicine. The majority of these formulations are based on plant origin drugs and their efficacy may get altered as a result of seasonal variation, use of different drying methods, their storage conditions and microbiai contamination. To avoid these alterations, standardization of drugs is necessary especially in case of compound formulations the use of Standard Operating Procedures [SOPs] for their manufacturing is essential. It will help to prepare a formulation repeatedly with the same quality. The present study was designed to develop the SOP of a Unani pharmacopoeial formulation i.e., Habbc Gule Aak [HG]. Total eight batches of HG were prepared with different conditions i.e., binder, particle size, time of drying and temperature of drying'. All the eight batches of HG were evaluated thrice for the hardness, friability and disintegration time. The batch with minimum friability, hardness nearest to standard value and minimum disintegration time as per pharmacopoeias was selected as final batch and all conditions regarding powder size, binder, temperature of drying and time of drying used in the preparation of frnal batch were fixed as its Standard Operating Procedure. Out of eight batches the Batch No. 2 with 150 micron particle size [100 mesh sieve], mucilage of 30% w/w samaghe arabi [binder], dried at 80°C for 150 minutes was selected as final batch. The final batch showed minimum friability [0.05 +/- 0.01], hardness nearest to the standard value [4.59 +/- 0.30] and considerable disintegration time [33.67 +/- 0.33]. The resulting SOP will be helpful in setting the pharmacopoeial standards of HG and the methodology of the work will help in the development of SOPs for other Unani formulations too

Incidence and risk factors of bacteria causing infectious keratitis

To study the incidence and risk factors of the bacteria causing infectious keratitis among patients in Qassim province of Saudi Arabia. This is a cross sectional study conducted at the Department of Optometry, College of Applied Medical Sciences, Qassim University, Qassim, Kingdom of Saudi Arabia from December 2010 to May 2011. One hundred patients suspected of keratitis were subjected to clinical examinations. A total of 115 corneal swabs from these cases were collected under aseptic conditions for bacteriological examinations. Culture of the corneal swabs revealed Pseudomonas aeruginosa [25.2%], Staphylococcus aureus [15.7%], and unclassified bacteria [13.9%]. However, 52 swabs of infectious keratitis cases [45.2%] were negative to bacteria. Contact lens wearing [44.4%] was the most common risk factor among the examined patients, followed by corneal trauma [21.7%], ocular surface disease [11.3%], and corneal surgery [7%]. No significant correlation was observed between systemic risk factor and clinical presentation. It could be concluded that infectious keratitis was mostly due to Pseudomonas aeruginosa and Staphylococcus aureus. Therefore, strict measures are recommended to control and treat infectious keratitis to avoid visual complications

Isotope effects of neodymium in different ligands exchange systems studied by ion exchange displacement chromatography

The isotope effects of neodymium in Nd-glycolate ligand exchange system were studied by using ion exchange chromatography. The separation coefficients of neodymium isotopes, epsilon's, were calculated from the observed isotopic ratios at the front and rear boundaries of the neodymium adsorption band. The values of separation coefficients of neodymium isotopes, epsilon's, for the Nd-glycolate ligand exchange system were compared with those of Nd-malate and Nd-citrate, which indicated that the isotope effects of neodymium as studied by the three ligands takes the following direction Malate > Citrate > Glycolate. This order agrees with the number of available sites for complexation of each ligand. The values of the plate height, HETP of Nd in Nd-ligand exchange systems were also calculated

Effectiveness of weekly iron supplementation in anemia in pregnancy

Iron deficiency has been a serious health issue especially in pregnancy. Various studies now consider daily iron as an excessive source of iron supply. In present study we compare effectiveness of daily verses weekly iron treatment. It was a randomized longitudinal study. Study included 110 pregnant anemic women attending out patient department of Gyne and Obs, CHK receiving 200 mg ferrous sulfate daily or weekly [n=55 in each group]. Overall 80% patients completed the study. 76% in daily group while 83% in wkly group completed the study. Hb conc., SFC, RBC count, Red cell indices and reticulocyte count were assessed to compare the effectiveness of two regimens. Hb was determined using the cyanmethemoglobin method. SFC was determined using a commercial kit [Enzymun-Test Ferritin; Roche Diagnostics GmbH, Mannheim, Germany]. Other hematological parameters were determined by using automated analyzer by Hiroshi Yamamoto, Kobe; Masaaki Oka, Kakogawa, Japan. All parameters improved significantly in women of both treatment groups. Hb% [p<0.05], RBC count [p<0.01] and Reticulocyte count [p<0.05] were significantly increased in weekly group when compared with daily group. Serum ferritin increases non-significantly in daily group when compared with weekly group [p>0.05]. It was concluded that weekly supplementation of iron is equally effective in controlling IDA, when compared with daily iron supplement. A non-significant greater increase in SFC in daily group might support iron overload theory

Preoperative anxiety in children risk factors and non-pharmacological management

It is important for anesthesiologists to appreciate the impact of preoperative anxiety in children. Not only does it cause suffering in many children prior to their surgical experience, it has a negative impact on their postoperative recovery and possibly long afterwards. Because of these concerns, continued research is warranted to seek ways of minimizing their fears in the perioperative setting. In this review, we will examine the risk factors for preoperative anxiety, tools for quantifying children and parent's anxiety, and strategies that may play a part in decreasing preoperative anxiety. Variables, which influence preoperative anxiety in children, include their age, temperament, prior hospital experience and parent coping abilities. This review will also explore issues surrounding parental presence during a child's anesthesia induction and how understanding child development can enhance their cooperativeness during the preoperative period, especially during anesthesia induction. Non-pharmacological interventions as a means of decreasing pediatric anxiety will be explored. Finally recent trends and new directions will be touched upon

Enhance transdermal delivery of flurbiprofen via microemulsions: Effects of different types of surfactants and cosurfactants

Microemulsions are therniodynamically stable, clear dispersions of water, oil, surfactant, and cosurfactant. This study was aimed to develop flurbiprofen microemulsion for enhanced transdermal delivery and investigate the effects of different surfactants and cosurfactants on its delivery and phase behavior. Method: Various surfactant-cosurfactant mixtures in ratio of 2:1 [Smix] along with oleic acid [oil] were selected and phase diagrams were constructed. Six microemulsions each containing 5% drug, 5% oil, 56% Smix and 34% water, were prepared and compared for their permeation and phase behaviors to determine the effects of the type of Smix. In vitro transdermal permeation through rabbit skin of all microemulsions was high than saturated aqueous drug solution. Tween 20 and ethanol as Smix produced the highest flux amongst all the Smix, and were used to prepare formulations with different values of oil and Smix. While the type of surfactant did not affect the droplet size, propylene glycol as cosurfactant produced the largest droplets and highest viscosity. Decrease in oil or Smix concentration resulted in decrease of the droplet size and increase in permeation flux while decrease in viscosity'also increased the permeation flux of microemulsions. Finally the selected microemulsion formulation comprising 5% flurbiprofen, 5% oleic acid, 46% Tween 20:ethanol [2:1] and 44% water, showed the highest transdermal flux and caused no skin irritation. Type of surfactant and cosurfactant affect both the phase behavior and transdermal drug delivery of microemulsion; and results of this study showed that they are promising vehicles for improved transdermal delivery and sustained action of flurbiprofen

Pharmacodynamic study of cardiotonic property of a poly herbal drug [MUYM] in pithed frogs

This study was performed to evaluate the cardiac effects of a Poly herbal drug Mufarreh Yaqooti Motadil [MUYM]. The product is being manufactured by Hamdard Laboratories [waqf] Pakistan for the last several years and has produced immense effects on cardiovascular system. These tests were performed by using kymographic tracing method and results were evaluated statistically by using kymographic tracing method and results were evaluated statistically by using students-t-test and one way ANOVA. The results obtained on the cardiac force, heart rate and cardiac cycle were compared with Digoxin and confirmed the positive inotropic and negative chronotropic property of MUYM

Frequency of osteoporosis in patients with cirrhosis due to hepatitis B and hepatitis C: a study of 100 cases

Osteoporosis is the disease of bone that affected King David of Israel 3000 years ago. This condition is no long considered to be due to aging alone and is increasingly recognized as a major health concern and accounts for about 1.5 million fractures annually in United States. Objective of this study was to see the frequency of osteoporosis in patients with cirrhosis due to Hepatitis B and C, and any correlation between the Bone Mineral Density [BMD] and duration and stage of the liver disease. The study was conducted in the Department of Gastroenterology, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from January 2008 to December 2008. All patients from the OPD or Ward fulfilling the criteria and consenting were included. Physical examination, with special emphasis on any signs of chronic liver disease was performed. Full blood count, platelet count, prothrombin time and INR, liver function tests including serum albumin, and renal function tests were done on all patients. Viral serology was checked for those patients who were either newly diagnosed as cirrhotic or were cirrhotic but not screened for viral markers. Abdominal sonogram was recorded on all patients. The child's score was calculated for each patient using the clinical and lab parameters. The BMD was calculated for all patients using computer based ultrasound probe. Calcaneum was used for evaluation of BMD. The information collected was entered on structured data collection sheets and was analysed using SPSS version 11. Osteoporosis was found in 26% of subject and osteopenia in 42%, while 32% had BMD in the normal range. The mean T score was -1.483 [ +/- 1.29]. The mean duration of liver disease was 3.77 [ +/- 1.56] year. Majority of the patients [81%] were in Child's Class C, followed by Class B and A [16% and 3% respectively]. Fifty-nine percent of the patients were males with a mean age of 37.65 years, while 41% were females with mean age of 37.76 years. Osteoporosis is a common finding in patients with cirrhosis due to Hepatitis B and C. Osteoporosis is more frequent in patients with long duration of liver disease but there is no significant correlation between the aetiology or severity of liver disease and osteoporosis

Preliminary neuropharmacological studies on herbal drug aftimooni

The herbal drug aftimooni has been used for relief of anxiety and insomnia, however, no pharmacological studies have been reported. Therefore, the drug Aftimmoni was given orally to rats and mice to study its action on central nervous system. It is observed that aftimooni significantly potentiated pentobarbitone induced sleeping time at the dose of 1.070ml/kg [5 times greater dose than human dose]. Moreover, it significantly increased the rearing and number of square crossed in open field test. In elevated plus- maze, Aftimooni showed an anxiolytic effect by increasing the time spent in open arm. Additionally, a significant and dose dependent inhibition on writhing response induced by acetic acid was observed at the doses of 0.214ml/kg and 0.428ml/kg. However, Aftimooni did not affect immobility time in forced swimming test. These observations suggest that the drug Aftimooni possesses potential anxiolytic, hypnotic, exploratory and analgesic effects

Hypotensive activity of methanolic extract of berberis vulgaris [root pulp and bark]

Many plants have been recommended in alternative systems of medicine for hypotensive activity although few systematic studies have been done. In this study, the hypotensive activity was studied in normotensive albino rats at different doses of BRPM and BB. The receptor activity was assessed by the drugs Ach on rat heart. Administration of different methanolic extract [BRPM, BB] showed significant reductions in blood pressure comparable to its respective control. Both methanolic extract completely blocked the Ach receptors in heart. This study suggests that the methanolic extract [BRPM, BB] have significant Ach receptor blocking and hypotensive activity and may be recommended for further investigation

Role conflict and ambiguity and its relationship with stress level among nurse interns

Considering the importance of identifying sources of role conflict and role ambiguity that contribute to effective positive change in a hospital setting to provide opportunities for nurses to be more productive, it became necessary to develop a systematic organized study to investigate role conflict and role ambiguity and their relation with role stress among nurse interns. This study aimed to assess perceived levels of role conflict and ambiguity and their relationship with stress level among nurse interns. This exploratory study was conducted at the inpatient units in Zagazig University Hospitals. The sample of the present study consisted of 105 nurse interns, 50 of them are assigned in general units and 55 in specialty units. Questionnaire sheets were used for data collection. Results revealed that role conflict had a significant effect on stress level of nurse interns. The study recommended formulate clear and detailed intern job description and introduce mentorship program so that the mentor provides an opportunity to share information with the nurses intern, review their work, provide feedback, explore issues, plan strategies to solve their problems

Clinical investigation of hypoglycemic effect of Eugenia jambolana in type-II [NIDDM] diabetes mellitus

The present study was designed to investigate clinically the hypoglycemic effect of Eugenia jambolana in type-2 diabetes mellitus. After assaying fasting plasma and urinary glucose, 10 patients of type-2 diabetes mellitus with no previous medication, 10 patients of type-2 diabetes mellitus taking oral hypoglycemic agents with history of inadequate control and six control subjects were given low [2 gm thrice daily] and high [4gm thrice daily] doses of powdered part, aqueous extract and alcoholic extract of seeds of Eugenia jambolana - for 14 days. On l5thday blood and urine samples for glucose were taken. Based on results obtained it was found that Eugenia jambolana has significant hypoglycemic activity both in low and high doses

Clinical and angiographic findings in patients with significant left main coronary artery stenosis

To evaluate the clinical and angiographic features of patients with significant [>50%] left main coronary artery [LMCA] stenosis. In this prospective descriptive study, we evaluated clinical and angiographic features of 100 consecutive patients with significant LMCA stenosis, which were selected from 1284 patients undergoing coronary angiography at Punjab Institute of Cardiology, Lahore. Significant LMCA stenosis was seen in 7.7% patients. There were 83 males [83%] and 17 females [17%]. Age of the patients ranged from 35 to 72 with mean age of male patients 55.84 +/- 9.99 years and that of female patients 54.12 +/- 9.89 years. Severe angina [NYHA class III-IV] was the most common finding. 54% of the patients had ST depression in resting ECG while ECG was found to be normal in 19 [19%] patients. Hypercholesterolemia was the most commonly found risk factor. 94% patients had disease in other coronary arteries and left anterior descending artery [LAD] was the most commonly involved vessel. Majority of the patients [>70%] had preserved left ventricular [LV] systolic function. All patients underwent coronary angiography safely without any serious complication. Among patients undergoing routine coronary angiography about 8% had significant LMCA stenosis. Most of these had disease in other coronary arteries, especially in males. Severe angina along with diffuse ST depression in multiple ECG leads and strongly positive exercise test were common findings in patients with LMCA stenosis However no specific clinical features were found which could distinguish the patients with LMCA stenosis from other patients with coronary artery disease [CAD]

Pericardial effusion in acute myocardial infarction: frequency and in-hospital course

To determine the frequency and in-hospital course of pericardial effusion in acute myocardial infarction in our population. Prospective observational study. The study was conducted in the Department of Cardiology and Medicine, Mayo Hospital, Lahore. One hundred consecutive patients presented within first 24 hours of first episode of ST elevation myocardial infarction [STEMI] were studied. Patients with known coronary artery disease [CAD], chronic renal failure, collagen vascular disease, cardiac surgery and metastatic disease were [PE] was considered to be present when separation between two pericardial layers persisted throughout the cardiac cycle. Among 100 patients who were enrolled, 27 developed PE. Frequency of baseline variable like age, gender, and risk factors for coronary artery disease including hypertension, smoking, and diabetes mellitus were same in patients who developed PE when compared to those who did not. Most of the PE was detected on day 5 of the admission. About 82% patients had mild PE [only posteriorly and <10 mm]. Moderate PE was detected on day 5 of the admission. About 82% patients had mild PE [only posteriorly and < 10 mm]. Moderate PE was detected in 18% [present all around and between 10-20 mm]. None of the patients developed large PE [>20 mm]. About 15% patients who were thrombolysed and 40% who could not be thrombolysed developed PE [p <0.01]. Frequency of PE was statistically highly significant [p <0.001] among patients with higher Killip class and lower ejection fraction at the time of presentation. Patients who developed PE had statistically significant longer hospital stay [p <0.001] and higher in-hospital mortality [p<0.05].Thrombolysis decreased the frequency of PE in acute STEMI. Development of PE during the course of acute STEMI has prognostic implications and early invasive strategy may be offered for patients who develop this complication

Clinical investigation of hypoglycemic effect of coriandrum sativum in type-2 [NIDDM] diabetic patients

The present study was designed to investigate clinically the hypoglycemic effect of Coriandrum sativum in Type-2 diabetes mellitus. After assaying fasting plasma and urinary glucose, 10 patients of type-2 diabetes mellitus with no previous medication, 10 patients of type-2 diabetes mellitus taking oral hypoglycemic agents with history of inadequate control and six control subjects were given low [2.5 g tid] and high [4.5 g tid] doses of powdered part, aqueous extract and alcoholic extract of Coriandrum sativum for 14 days. On 15[th] day blood and urine samples for glucose were taken. Based on results obtained it was found that Coriandrum sativum has significant hypoglycemic activity in high dose and can be successfully combined with oral hypoglycemic agents in type-2 diabetic patients whose diabetes is not controlled by these agents

Clinical investigation of hypoglycemic effect of leaves of Mangifera inidca in type-2 [NIDDM] diabetes mellitus

The present study was designed to investigate clinically the hypoglycemic effect of leaves of Mangifera indica in Type-2 diabetes mellitus. After assaying fasting plasma and urinary glucose, 10 patients of type-2 diabetes mellitus with no previous medicaion, 10 patients of type-2 diabetes mellitus taking oral hypoglycemic agents with history of inadequate control and six control subjects were given low [0.5 g/kg/d in two divide doses] and high [1 g/kg/d in two divided doses] doses of powdered part, aqueous extract and alcoholic extract of leaves of Mangifera indica for 14 days. On 15[th] day blood and urine samples for glucose were taken. Based on results obtained it was found that Mangifera indica has significant hypoglycemic activity in high dose and can be successfully combined with oral hypoglycemic agents in type-2 diabetic patients whose diabetes is not controlled by these agents

Toxicological studies of a poly herbal drug Mufarreh Yaqooti Motadil

Mufarreh Yaqooti Motadil was investigated for its toxicological activity in human dose, in rats. The drugs was found to be non-toxic and well tolerated even if treated for a long period of time. The biochemical studies revealed that drug decreased the serum level of cholesterol, triglycerides, glucoseand bilirubin non-significantly [P>0.05]. On liver the drug showed very good affects as caused a significant decrease [P<0.05] in GGT, SGPT and SGOT

Attitudes of medical students towards psychiatry in QMC [Bahawalpur] Pakistan

The present study is a comprehensive investigation of the attitude toward psychiatry from Quaid-e-Azam Medical College, Bahawalpur [Pakistan]. A total of 538 students were studied using a 50-item Scale [ATP 30]. Responses of the students were collected from classes of 1st year and 4th year and a comparison was calculated on year wise and gender wise basis. The results are presented and discussed

Clinical investigation of hypoglycemic effect of seeds of azadirachta-inidca in type-2 [NIDDM] diabetes mellitus

The present study was designed to investigate clinically the hypoglycemic effect of seeds of Azadirachta indica in Type-2 diabetes mellitus. After assaying fasting plasma and urinary glucose, 10 patients of type-2 diabetes mellitus with no previous medication, 10 patients of type-2 diabetes mellitus taking oral hypoglycemic agents with history of inadequate control and six control subjects were given low [0.5 g tid] and high [2 g tid] doses of powdered part, aqueous extract and alcoholic extract of Azadirachta indica for 14 days. On 15th day blood and urine samples for glucose were taken. Based on results obtained it was found that Azadirachta indica has significant hypoglycemic activity in high dose and can be successfully combined with oral hypoglycemic agents in type-2 diabetic patients whose diabetes is not controlled by these agents