Out of Pocket Expenditure among Cancer Patients Availing Treatment at A Tertiary Care Centre in Hyderabad, India

Background: The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer or State) is known as 'Out of Pocket Expenditure' (OOPE). These expenses could be medi-cal and non-medical. About 150 million people face financial catastrophe every year due to health care pay-ments and cancer is one of the leading causes of high OOPE. Objectives: This study was conducted to estimate the OOPE among cancer patients and to determine the OOPE in relation to type of cancer and treatment modality.Methodology: A cross sectional study was conducted at a tertiary care centre in Hyderabad during August and September,2022 with a total study population of 400 cancer patients. After consenting the participants, data was collected via face-to-face interview using a semi structured questionnaire. Results: The mean OOPE per patient was found to be $1032.65 (₹84,643.20). This includes the medical and non-medical costs. Leukaemia was found to have the highest OOPE amongst all cancers followed by colon cancer. Similarly, radiotherapy + surgery was found to have the highest OOPE followed by chemotherapy + radiotherapy + surgery.Conclusion And Interpretation- This study is unique in its way that no other study has considered OOPE for different cancers in single research. We would like to highlight the quantification of OOPE among various types of cancers and its variation based on treatment modality used. It is necessary that future government in-itiatives consider the importance of mitigating the OOPE along with provision of cancer care.

Silymarin-Laden PVP-Nanocontainers Prepared Via the Electrospraying Technique for Improved Aqueous Solubility and Dissolution Rate

Abstract The aim of the present research was to develop a silymarin-laden PVP-nanocontainer providing ameliorated aqueous solubility and dissolution of the drug. Several silymarin-laden formulations were formed with varying quantities of PVP and SDS via the solvent evaporation method using the electrospraying technique. The influence of the hydrophilic carriers on solubility and dissolution was explored. The solid-state characterization was carried out by particle-size analysis, PXRD, DSC, FTIR and SEM. All of the formulations demonstrated better solubility and dissolution than did silymarin plain powder. Both the SDS and PVP had positive effects on solubility and dissolution of silymarin in the aqueous media. An increased solubility was attained as the drug/PVP ratio was 1/4; however, further increase in PVP did not provide significant improvement. In particular, a nanocontainer formulation prepared with silymarin, PVP and SDS (1/4/0.5, w/w/w) exhibited the best solubility (26432.76 ± 1749.00 μg/mL) and an excellent dissolution (~92 % in 20 min) than did silymarin plain powder. Also, it demonstrated similar dissolution profiles compared to a commercial product; therefore, might be bioequivalent to the commercial product (f 1 = 3 and f 2 = 69). Moreover, cumulative undersize distribution values as represented by X10, X50 and X90 were 201 ± 21.01 nm, 488 ± 36.05 nm and 392 ± 48.10 nm, respectively. The drug existed in the amorphous state in the PVP-nanocontainers with no strong chemical bonding with other excipients. Thus, this formulation might be used for more effective administration of silymarin via the oral route.

Association of serum P1NP [N-terminal propeptide of type1 collagen] and bone mineral density [BMD] in osteoporosis

Objective: To access the variation of P1NP levels in normal, osteopenic and osteoporotic females and to study its correlation of with BMD in pre and post-menopausal women at hip and spine. Study Design: Cross sectional study. Place and Duration of Study: Ziauddin Hospital, Clifton Campus, Karachi during Jan to Dec 2017

Material and Methods: A sample of 267 randomly selected females that fulfilled the exclusion and inclusion criteria were included in the study. BMD was assessed by DEXA Scan while P1NP levels were measured using electrochemilluminescnet technique using Roche Cobas analyzer at Ziauddin hospital Karachi. Elecsys 2010, Modular analytics E170 Cobas e immunoassay analyzer. Data was collected using a self-designed Questionnaire. ANOVA was applied to compare mean differences of P1NP levels in pre and post-menopausal women in normal, osteopenic and osteoporotic groups. Regression analysis was used to determine association between P1NP level and BMD levels at spine and hip

Results: A significant negative correlation was found between P1NP and BMD at both the sites, while a strong association was established in P1NP and BMD spine, while for hip bone this association was non significant

Conclusions: Our study concludes that P1NP is a reliable biomarker for prediction of bone density of spine and is negatively correlated with the density

Comparative analysis of serum proangiogenic biomarkers between those with and without diabetic retinopathy

Objective: To compare the serum proangiogenic biomarkers in diabetic patients suffering from with and without diabetic retinopathy [DR]

Study Design: An observational study

Place and Duration of Study: Arif Memorial Teaching Hospital, Lahore, Pakistan and Institute of Molecular Biology and Biotechnology/Centre for Research in Molecular Medicine, The University of Lahore, Lahore, Pakistan, from March to December 2017

Methodology: Forty patients with DR were included in group A and 15 patients without retinopathy [controls] were included in group B. Twelve serum pro-angiogenic biomarkers [Angiopoietin 2, Human Growth Factor [HGF], Epidermal Growth Factor [EGF], Fibroblast Growth Factor [FGF], Placental Growth Factor [PLGF], Vascular Endothelial Growth Factor-A and C [VEGF-A and VEGF-C], Bone Morphogenetic Protein 9 [BMP9], Follistatin, Leptin, Interleukin-8 [IL8], Endothelin [ET]] were analysed by xMAP flow cytometry technique, results were compared between the two groups and statistical analysis was done using Mann-Whitney U test

Results: Serum ET, Follistatin and EGF were significantly raised in group A as compared to group B having p-values of 0.001, <0.001, and 0.033, respectively. Serum BMP9, Leptin, HGF, FGF and VEGF-C had p <0.001, 0.023, 0.020, and 0.009, respectively and were higher in group B than group A

Conclusion: Serum ET, Follistatin and EGF were significantly higher in DR patients as compared to those without DR and should be considered to be significant biomarkers of retinal complications in diabetes mellitus

case of t-cell lymphoproliferative disorder associated with hypereosinophilia with excellent response to mycophenolate mofetil

Hypereosinophilic syndrome [HES] is a group of rare blood disorders characterized by a persistent elevation of blood eosinophil count >/= 1.5 * 10[9]/L and clinical manifestations attributable to eosinophilia or tissue hypereosinophilia. Lymphocytic variant of HES [HES-L] is a known subtype according to World Health Organization classification. It is well documented in the literature that patients with HES-L are predisposed to develop T-cell lymphoma. We report a case of T-cell lymphoproliferation associated with hypereosinophilia, which has been successfully treated with mycophenolate mofetil, with resolution of skin lesions and normalization of eosinophil count and immunoglobulin E level. We believe this is a clinically relevant case since this is a rare disease with little known knowledge on its best treatment modality

Attitudes of final year dental students towards postgraduate specialization

Objective: The aim of this study was to understand the preferences of final year dentistry students in postgraduate specialization and explore the factors which influence them in making decisions regarding their future in pursuing postgraduate studies

Methodology: A cross-sectional survey was carried out between August 2017- January 2018 at four dental colleges across Karachi, including, three private sector and one public sector institution. A multiple choice, closed-ended questionnaire consisting of 8 statements was prepared and distributed among all the final year BDS students. 225 used and 200 student responses were recorded. Data was analyzed using SPSS version 23 and Chi Square was applied to achieve the results

Results: 81% of the respondents were females. 79% were in the age range of 22-23years. 63% age of students had parents that came from a professional background. 75% of the total respondents wanted to pursue postgraduate studies. The link between the age of the student, gender and the willingness to pursue postgraduate studies was found to be insignificant whereas with parental profession, it was significant [p value=0.016]. 60% students believed that they had received enough specialty exposure and encouragement from their institutions to be able to decide on their postgraduate plans. The first choice of specialty for 28% students was Oral Surgery followed by Orthodontics and Endodontics for 22% respondents. The second choice of specialty for the students was Operative Dentistry for 30% of the students followed by 17% who preferred Orthodontics. The rest were divided among the other subjects. 36% of the students cited their aptitude for a specific field as the most common factor for affecting their decision on specialization. 28% cited job status/ prospects and financial reasons as the factor most likely to influence their decision on specialization

Conclusion: According to the study, there was no significant association between the age, gender and the preferences of the student towards postgraduate specialization. However, parental occupation was bound to play a role. The choices of the students as regards specialty selection and influencing factors are varied. As the trend towards postgraduate specialization in dentistry is gaining momentum, it is imperative to research this area more for better planning and allowing students to make informed decisions

Ameliorative effect of hydro-methanolic extract from roots of Rauwolfia serpentina on some biochemical parameters of type 1 diabetic mice

Present work seeks to investigate the biochemical parameters in terms of hypoglycemic and hypolipidemic effects of hydro-methanolic roots extract [HyMREt] of Rauwolfia serpentina in type 1 [alloxan induced] diabetic mice. Animals were divided into seven groups, four control groups, and three were test groups [HyMREt at 50, 100, and 150mg/kg]. Each treatment was repeated for 14 days regularly in all seven respective groups and afterwards the body weights, fasting blood glucose [FBG], insulin, and serum lipid levels were determined. Total body weights of diabetic mice treated with HyMREt extract were dose dependently [p

Homeostasis model assessment of insulin resistance in non-diabetic heart failure patients: a case-control investigation at tertiary care Hospitals of Karachi

Heart failure is a progressive, chronic disorder. Insulin resistance [IR] has been more and more involved as a preliminary metabolic perturbance predisposing to hyperglycemia, hyperlipidemia and atherosclerosis with others heart diseases. To investigate the relation of insulin resistance [IR] in non-diabetic heart failure patients this case-control study was carried out to ascertain the presence of IR with the aid of Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] in non-diabetic heart failure patients [NDHF patients] compared with healthy controls. The sample size was calculated for both, cases [NDHF patients] and control [healthy subjects], which was initially consisted of 113 respondents each. The study consisted of two phase duration. In Phase I, NDHF patients were approached initially; only 80 patients with NDHF completed the study procedure. In Phase II, 80 healthy subjects were targeted and matched. Fasting blood glucose level [FBGL] and serum insulin was estimated. Mathematical model to quantify beta-cell function and insulin resistance was also computed through Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] in both groups. Data was analyzed on SPSS version 16. Mean values with +/- standard deviation [SD] of insulin [10.2+/-4.36] and HOMA-IR [2.52+/-1.15] were significantly [p <0.05] higher in NDHF patients as compared to control subject [6.4+/-3.39, 1.45+/-0.80]. Average insulin to glucose ratio was 0.10+/-0.044 in NDHF patients which was significantly [p <0.0001] lowered in controls i.e., 0.073+/-0.039. Marginal and matrix plot analysis revealed that a higher patients count have had the HOMA-IR values <1.5 units while opposite scenario was observed in control group. Regression analyses of HOMA-IR with FBGL [as independent indicator] also authenticate the similar pattern. The present study concludes that insulin resistance [decreased insulin sensitivity] is a characteristic finding in Pakistani population of heart failure as compared to matched healthy controls

Comparison between intravenous boluses versus infusion of tranexamic acid [TXA] to reduce bleeding in paediatric cyanotic congenital heart disease [CHD] surgeries

Objective: To compare the intravenous boluses and intravenous continuous infusion of tranexamic acid [TXA] to reduce postoperative bleeding in cyanotic congenital heart disease surgeries

Study Design: Single-blinded randomised clinical trial

Place and Duration of Study: Anaesthesia Department, The Aga Khan University Hospital, Karachi, from July 2016 to April 2017

Methodology: Sixty patients of cyanotic congenital heart disease, undergoing either palliative or corrective surgery involving cardiopulmonary bypass [CPB], were recruited. These 60 patients were divided randomly into two groups. The infusion group received intravenous infusion of TXA at 5 mg/kg/hour while the bolus group received three intravenous boluses of 10 mg/kg after induction, after going to bypass and after protamine reversal. Data was collected through predesigned proforma. There were two primary outcomes: postoperative bleeding in the first 24 hours, and chest closure time

Results: Postoperative bleeding was 13.94 [10.27-20.18] ml/kg in the first 24 hours in infusion group and 15.05 [9.04-23.50] ml/kg in the bolus group. Chest closure time was 38.5 [25-45] in infusion group and 30 [20-46.25] minutes in the bolus group. There was no statistically significant and clinical difference between both groups regarding postoperative bleeding in the first 24 hours and chest closure time

Conclusion: These infusion and bolus groups had comparable postoperative bleeding and chest closure time

Misplaced central venous catheter in carotid artery during emergency surgery for the total correction of tetralogy of fallot of an adolescent boy

Ultrasound-guided central venous cannulation is now considered as the standard of care, and this has largely replaced blind central venous cannulation using anatomical landmarks. We are reporting a case of inadvertent placement of central venous catheter in the right common carotid artery with the use of ultrasound guidance during emergency surgery for the total correction of Tetralogy of Fallot [ToF]. This patient luckily had a favourable outcome despite this inadvertent catheter placement which was not recognised even after completion of surgery .The patient also received drug infusions of inotropes and vasopressors through this malplaced central line into the aorta. The possible mechanism, consequences, prevention and management of this inadvertent cannulation are discussed in this report

Physicians’ perspective regarding direct to consumer marketing of nutraceuticals products

Objectives: Recently pharmaceutical marketers have expanded their audience by directly to the consumers advertising [DTCA] which is almost always limited to non-prescription drugs. DTCA has substantial effects on patient behavior and physician prescription. The aim of this study was to assess the perspectives of physicians regarding the rapidly proliferating trend of direct to consumer marketing of nutraceutical drugs [ND]

Methods: It was a cross-sectional study from June 2016 to December 2016 which included 325 physicians from various cities of Pakistan who completed a structured questionnaire after providing informed consent. Questions were asked to assess physicians' perception of the increasing trend of Direct to Consumer advertisement of nutraceuticals and its influence on their practice. The data was analyzed using SPSS [SPSS Inc., Chicago, Illinois, USA]

Results: There were 182 [56%] male and 143 [44%] female physicians in the study. Most of them were general practitioners [48%], spent an average weekly time of 1-2 hours gaining medical knowledge [56%], and most of them [52%] utilized internet as their source. Most physicians [88%, n=286] experienced knowledgeable patients who inquired about their diseases and treatment plans. Most of the physicians believed that e-detailing [72%, n=234] and DTCA [68%, n=221] of nutraceuticals helps practitioners in shaping a more effective treatment plan. Almost [62%, n=201] physicians prescribed medications their patients requested them to

Conclusion: Physician perception of DTCA and e-detailing of nutraceuticals seems to be promising. However, physicians must be more prepared to deal with knowledgeable patients and put in maximum efforts to counsel them in such a manner that the prescription doesn't contain "request specific" drugs but only the ones that are most beneficial for the patients

Role of posterior-anterior vertebral mobilization versus thermotherapy in non specific lower back pain

Background and Objective: Low back pain [LBP] is the foremost cause to hamper an individual's functional activities in Pakistan. Its impact on the quality of life and work routine makes it a major reason for therapeutic consultations. About 90% of the cases with LBP are non-specific. Various options are available for the treatment of LBP. Posterior-anterior vertebral mobilization, a manual therapy technique; and thermotherapy are used in clinical practice, however evidence to gauge their relative efficacy is yet to be synthesised. This study aimed to compare the effectiveness of posterior-anterior vertebral mobilization versus thermotherapy in the management of non-specific low back pain along with general stretching exercises

Methods: A randomised controlled trial with two-group pretest-posttest design was conducted at IPMandR, Dow University of Health Sciences [DUHS]. A total of 60 Non-specific low back pain [NSLBP] patients with ages from 18 to 35 years were inducted through non-probability and purposive sampling technique. Baseline screening was done using an assessment form [Appendix-I]. Subjects were allocated into two groups through systematic random sampling. Group-A [experimental group] received posterior-anterior vertebral mobilization with general stretching exercises while group B [control group] received thermotherapy with general stretching exercises. Pain and functional disability were assessed using NPRS and RMDQ respectively. Pre and post treatment scores were documented. A maximum drop-out rate of 20% was assumed. Recorded data were entered into SPSS V-19. Frequency and percentages were calculated for categorical variables. Intragroup and intergroup analyses were done using Wilcoxon signed ranked test and Mann-Whitney Test respectively. A P-value of 0.05 was considered statistically significant

Results: Pre and post treatment analysis revealed that P-values for both pain and disability were less than 0.05, suggesting significant difference in NPRS and RMDQ scores. Whereas, median scores for both pain and disability were decreased by 75% in experimental group and 50% in control group. For inter group analysis p-values for both pain and disability were found to be less than 0.05

Conclusion: Both physiotherapeutic interventions, the PAVMs and thermotherapy, have significant effects on NSLBP in terms of relieving pain and improving functional disability. However PAVMs appeared to be more effective than thermotherapy

Collating Spirometry reference values in Asian children and Adolescents; puzzle out the reasons for variations

Lung function tests are essential for the diagnosis and management of different respiratory tract diseases; among them the spirometry is the gold standard technique. The accurate diagnosis, management and monitoring require proper interpretation of the results which depends upon the availability of spirometry reference data for that particular region to differentiate the diseased condition from the normal ones. Multiple studies had been done to find out their own area specific reference ranges but it is still lacking. This need was fulfilled by the Global Lung Function Initiative [GLI] in 2012, which reported the first global spirometry equation for all of the age groups. But some of the studies reported difference among GLI reference range and the measured range for that particular region. So here is the review of the reference ranges among 35,603 Asian children and adolescents from the 32 studies done specifically in Asia. The aim was to compare them with the study done by GLI team, along with these, tried to rule out the causal factor that are responsible for the variations in the reference ranges among the children and adolescents of different population. The literature was searched by using Google scholar and PubMed during the month of March up to July 2017. The review of all the articles published in Asia, specifically accounting for normal reference ranges in children and adolescent exhibit a wide variation among the reference ranges. This also suggest involvement of multiple modifiable and non-modifiable risk factors. So it's necessary to update the reference ranges for spirometry and its prediction equation as well

Hematopoietic cell transplantation for acute lymphoblastic leukemia in adult patients

Acute lymphoblastic leukemia [ALL] consists of precursor B ALL or T ALL phenotypes. In the pediatric population, ALL patients enjoy an 80% long-term survival with the current pediatric chemotherapy protocols as compared with 50% long-term survival in the adult population. In adults, complete remission rates are similar to those of pediatric patients; however, long-term survival is much lower with the majority of deaths attributable to relapsed disease. Postremission consolidation strategies in adults include chemotherapy, autologous, or allogeneic transplant. Pediatric-inspired chemotherapy protocols are being explored as a consolidation modality in adults. Assigning patients to either modality depends on patient and disease characteristics. Here, we review the literature on the use of hematopoietic cell transplantation as a consolidation modality in the treatment of adult ALL

Relationship of physical stress and hypertension among cardiovascular disease patients

Objective the aim of the study is to find out amount of physical stress among cardiovascular disease [CVD] patients and its relation with hypertension

Background physical stress is defined as a pressure - force and strain a state of physical mental tension. Stress is among the mental factors that has for some time been recorded among the potential. Furthermore, essential hazard variables of hypertension and coronary illness

Methodology a cross-sectional study was conducted in the patients of department of Cardiology at tertiary hospitals, Karachi, from January 2014 to December 2014. Sadaf stress scale [SSS] 2.0 was used to find out the physical stress

Results it showed physical stress among CVD patients about n=39 [43.3%] have moderate physical stress. which was decreased over time after 5 year of illness as compared to the patient who have disease for less than 5 years. While systolic blood pressure among subjects with severe physical stress showed an average systolic B.P. of 147mmhg, moderate have 146mmhg and patients with mild physical stress have 135mmhg

Conclusion this report concluded moderate physical stress among CVD patients which was decrease over time due different coping mechanism and blood pressures are directly related to severity of physical stress mainly systolic which lead to hypertension

THPO–MPL pathway and bone marrow failure

Single or multilineage bone marrow failure can be a serious health problem caused by hereditary and non-hereditary causes such as exposure to drugs or environmental toxins. Normal hematopoiesis requires the integrity of several pathways including the THPO–MPL pathway. Over the last two decades, significant advances in the underst and ing of normal and abnormal functions of this and related pathways have led to novel diagnostic and therapeutic options

Frequency of Gc-globin promoter 158 [C>T] XmnI polymorphism in patients with homozygous/compound heterozygous beta thalassaemia

BACKGROUND: Response to hydroxyurea therapy in homozygous or compound heterozygous beta thalassaemia [BT] has been reported as more favourable in the presence of XmnI polymorphism. The prevalence of XmnI polymorphism may vary with BT phenotypes and genotypes, and differs geographically in distribution. Prevalence of XmnI polymorphism is not known in northern Pakistan. Objective: To determine the frequency of Gc-globin promoter 158 [C>T] XmnI polymorphism [XmnI polymorphism] in patients with homozygous or compound heterozygous beta thalassaemia. MATERIALS: Polymerase chain reaction [PCR] for common beta thalassaemia mutations and Gc-globin promoter 158 [C>T] XmnI polymorphism was performed on 107 blood samples of transfusion dependent beta thalassaemia [BT] patients in Pakistan. One hundred samples of unrelated BT traits and 94 samples of healthy subjects as controls were also analysed for BT mutations and XmnI polymorphism. Results: Out of 301 DNA samples, XmnI polymorphism was detected in 71[24%]; in normal controls, XmnI polymorphism was detected in 34/94 [36%] subjects; while in homozygous/compound heterozygous BT, it was detected in 14/107[13%] patients [Fisher's exact test, p =. 0002]. In heterozygous BT group, XmnI polymorphism was detected in 23/100 subjects [Fisher's exact test, p =. 03 with normal controls, and p =. 049 with homozygous/compound heterozygous BT]. The most common BT genotype was Frame Shift [Fr] 8–9/Fr 8–9, and none of the patients with this genotype had XmnI polymorphism. The second most common genotype was IVSI-5/IVSI-5; 4/26 [15%]. Cases with this genotype had XmnI polymorphism. Conclusion: XmnI polymorphism in homozygous/compound heterozygous BT group is 13%. The most common genotype associated with XmnI polymorphism was IVSI-5/IVSI-5

Awareness, knowledge and practice of evidence-based dentistry amongest dentists in Karachi

The purpose of this study was to determine the understanding, awareness and practice of Evidence Based Dentistry [EBD] amongst dentists working at dental colleges in Karachi. Total participants in this study were 200 who were randomly selected from different dental colleges in Karachi. Participants completed a pre-tested self administered questionnaire. 87% of the participants were graduates and were either trainees or had completed post-graduation. Data analysis was done by SPSS version 16. One-way ANOVA was applied. P- value < 0.05 were considered statistically significant. Only 23% of the participants reported that they always practiced Evidence based dentistry. Lack of training on EBD was considered as a barrier to Evidence Based Dentistry and the second most common cause reported was lack of access to resources. Majority of the participants 69% were not taught or trained earlier to practice Evidence Based Dentistry. Interestingly 87% of the participants showed their willingness to be trained for Evidence-Based Dentistry. With respect to barriers in EBD Education level [0.018] and field of specialty of dentist [0.014] were found to be statistically significant. Therefore more emphasis should be given in training students as well as faculty members in Evidence Based Dentistry. It should also be ensured that all possible resources for accessing current dental research should be provided in Dental colleges

Comparing the effects of manual therapy versus electrophysical agents in the management of knee osteoarthritis

To evaluate the effectiveness of Manual Therapy in comparison to Electrophysical agents in Knee Osteoarthritis

Total 50 patients with knee osteoarthritis were recruited from OPD of orthopedics civil hospital and Institute Of Physical Medicine and Rehabilitation, Dow University of Health Sciences Karachi. All those patients who fulfilled inclusion criteria were selected on voluntary basis. Selected patients were equally divided and randomly assigned into two groups with age and gender matching. The Manual therapy group received program of Maitland joint mobilization whereas Electrophysical Agent group received a program of TENS and cold pack

Both group received a program of exercise therapy as well. Patients received 3 treatment sessions per week for 4 successive weeks. Clinical assessment was performed using WOMAC index at baseline and on 12th treatment session. Both study groups showed clinically and statistically considerable improvements in WOMAC index. However, Related 2 sample t-test showed better clinical results in Manual Therapy group [p = 0.000] than Electrophysical Agents group [p = 0.008]

The mean improvement in total WOMAC index was relatively higher in Manual Therapy group [22.36 +/- 13.91] than Electrophysical Agent group [9.72 +/- 6.10]

This study concluded that manual therapy is clinically more effective in decreasing pain, stiffness and improving physical function in knee osteoarthritis

Natural antiemetics: An overview

Emesis encompasses the forceful expulsion of the contents of stomach via the mouth or sometimes the nose

The adverse effects of currently available anti-emetic agents potentiate the natural product researchers to explore the natural anti-emetics with fewer side effects

The presented communication constitutes a review on anti-emetic effect of two hundred and forty five plants belonging to seventy-eight families found in different parts of the world

It also outlined the anti-emetic effect of plant extracts and isolated secondary metabolites studied through a variety of animal models of emesis

The reported anti-emetic plants in different countries and cultures and the scientific studies on extracts may help in the identification of promising single chemical compound[s] that may be used as a potential leads for developing safe anti-emetic agents in future. Moreover the reported secondary metabolites having the same effect may open the door for the search of same secondary metabolites from other natural sources

This review will provide useful information for the discovery of natural anti-emetic compounds and fill the gaps in knowledge