Medical Trichology : Trigeminal trophic syndrome simulating pityriasis amiantacea,Nerve sheath myxoma of scalp,Woolly hair nevus type 2,Trichodynia silenced effectively with propranolol,Serum interleukin-15 is a marker of alopecia areata severity,Tubular hair casts in trichoscopy of hair and scalp disorders,Research on the balance of thiol-disulfide in blood serum in women with telogen effluvium,Light microscopic morphology of hair from scalp, eyebrow, axilla, and pubic regions

COMMENTARY
	Autistic-undisciplined thinking in the practice of medical trichology	p. 1
	Ralph Michel Trueb, Hudson Dutra, Maria Fernanda Reis Gavazzoni Dias DOI:10.4103/ijt.ijt_79_18   Medical trichology is the branch of dermatology that deals with the scientific study of the hair and scalp in health and disease. As any discipline, the practice of medical trichology is not immune to malpractice, either deliberately or carelessly. In his publication "Autistic Undisciplined Thinking in Medicine and How to Overcome It," Swiss psychiatrist Eugen Bleuler describes yet another form of malpractice in medicine reflecting autistic-undisciplined thinking. Autism is not limited to psychopathology, but inherent to the thinking of man throughout history in his drive for knowledge, with thousands of theories lacking any basis in reality. Bleuler recognized the drive character of autistic thinking and how it leads to conclusions that are unshakable because they are determined by, and fulfill, emotional needs, rather than rational argumentation. Even with correct questions, the complexity and incalculability of some problems are often so great that it cannot do justice to realistic thinking and the boundaries between inadequately substantiated hypothesis and autistic sham explanation disappear. Statistics, careful research design, and the attempt to impose stringent methods on our thinking are to be commended. The habituation of the public to useless medicine, to misconceptions, is not hygiene, but negligent endangerment. It has created an industry that largely lives on the autistic thinking of patients and doctors and because it is prosperous, makes propaganda among lay people as well as among doctors that necessarily leads to abuses. This article aims at exposing the most prevalent among abuses in trichological practice due to autistic-undisciplined thinking, specifically: iron supplementation, antiandrogenic treatment, and individualized cell-based therapy in female androgenetic alopecia, treatment of folliculitis decalvans with retinoids, and the value of nutritional therapies.
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ORIGINAL ARTICLES
	Light microscopic morphology of indigenous Ghanaian African hair from scalp, eyebrow, axilla, and pubic regions	p. 8
	Yusra Kalmoni, Frederick Kwaku Addai, Saviour Kweku Adjenti, Kevin Kofi Adutwum-Ofosu, John Ahenkorah, Bismarck Afedo Hottor, Richard Michael Blay DOI:10.4103/ijt.ijt_70_18   Context: Relatively scanty literature on autochthonic African Negroid hair morphology provokes research interest for anthropological, forensic, and cosmetic purposes. Aims: This study aimed to contribute basic morphological information on Ghanaian African hairs. Settings and Design: The study was done in selected second-cycle schools in Accra, Ghana, using convenient sampling. Subjects and Methods: Hairs were obtained by pluck method, from 30 males and 30 females aged 15–20 years. Ghanaian African autochthony was established if individuals had two generations of indigenous Ghanaian parentage. Scalp, eyebrow, axilla, and pubic hairs were image captured using a digital light microscope eyepiece connected to a computer. Diameters of hair strands were measured; types of the medulla and the form and shape of the hair roots were studied. Statistical Analysis Used: ANOVA test (SPSS Version 17.0) was used to compare the means of quantitative hair features among the sexes and the four regions of the body studied. Results: Pubic hair shaft was thickest (respective male and female diameters were 100.21 μm, 88.40 μm) and eyebrow hair was thinnest (53.97 and 46.69-μm diameters in males and females, respectively). Axillary and scalp hairs were the closest in diameters with 76.21 and 72.02 μm, respectively, in males and 73.07 and 71.15 μm, respectively, in females. Continuous type medulla was predominant in all hairs, with a trend of percentage occurrence in descending order from the pubic, axilla, eyebrow, and scalp in both sexes. Conclusions: Bodily regional differences in diameter of hair shaft and medullary presence were affirmed.
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	Tubular hair casts in trichoscopy of hair and scalp disorders	p. 14
	Mahesh Mathur, Prakash Acharya, Alina Karki, Jyoti Shah, Nisha Kc DOI:10.4103/ijt.ijt_77_18   Introduction: Hair casts have been reported in a variety of hair and scalp disorders. Trichoscopy allows a quick and noninvasive method for the evaluation of hair and scalp disorders in high magnification. However, the study of hair casts seen in trichoscopy is lacking. Objective: The main objective is to study the occurrence and patterns of tubular hair cast (THC) in different hair and scalp disorders. Patients and Methods: The patients with hair and scalp disorders presenting at the dermatology department of our hospital were evaluated using trichoscopy. Cases of primary parakeratotic disorders and behavioral disorders were excluded. After a detailed history and evaluation of the hair and scalp, histopathology, light microscopic examination, potassium hydroxide examination, and fungal culture were done when necessary. Results: THC was seen in total 21 cases of seven different hair and scalp disorders. Of these, the majority of cases were of discoid lupus erythematosus (DLE) (5/21) and maximum frequency of THCs within a disorder was seen in cases of pemphigus foliaceus (PF) (50%). Proximal casts occurred in 90.47% of cases. Single cast involving two shafts was seen in a case of PF, and two casts within a single shaft were seen in two cases of DLE and one case of alopecia areata. Conclusions: THCs in trichoscopy can be seen in various hair and scalp disorders and their study may help during the diagnosis of those disorders when combined with other trichoscopic features.
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	Research on the balance of thiol-disulfide in blood serum in women with telogen effluvium	p. 20
	Ayşe Akbas, Fadime Kılınç, Sertaç Sener, Akta Akınş, Cemile Bıçer, Orhan Şen DOI:10.4103/ijt.ijt_78_17   Backgrounds: Telogen effluvium (TE) is the most common reason for hair loss in humans. Although the exact etiopathogenesis of TE has not been revealed clearly and completely, multifactorial etiologies are to be blamed. In recent years, since oxidative stress (OS) has been shown to play an important role in the etiopathogenesis of so many diseases, the effects of OS on several skin diseases are researched and analyzed. Thiols are antioxidant components that include sulfur group, and the balance of thiol-disulfide has an important role in the formation and prevention of OS. This balance is destroyed in many diseases and its effect on TE is not clearly understood yet. Objectives: In this study, we aimed to search the thiol–disulfide balance that could reveal OS in patients with TE. Materials and Methods: Fifty-two patients with TE and control group of 46 persons were included in the study. Native thiol, disulfide, and total thiol levels were evaluated by a new, automatic spectrophotometric method. Disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol rates were calculated. Results: There was no statistical difference between TE patients and control group in terms of native thiol, disulfide, and total thiol levels. Thiol–disulfide balance was fixed and not affected in TE patients.
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	Serum interleukin-15 is a marker of alopecia areata severity	p. 26
	Adel Ali Ebrahim, Rehab Mohammed Salem, Asmaa Adel El Fallah, Esraa Taha Younis DOI:10.4103/ijt.ijt_80_18   Background: Interleukin-15 (IL-15) is a cytokine that is involved in many inflammatory and autoimmune diseases. Although alopecia areata (AA) is an autoimmune disease, serum levels of IL-15 have not been studied well in AA patients. Aim of the Work: We aims at evaluating the serum levels of IL-15 in active AA. Subject and Methods:This case-control study included 40 AA patients and 40 apparently healthy matched controls. Written informed consents were obtained from all the participants. The scalp was examined to assess sites, number, and size of alopecia patches, and the severity of AA lesions was assessed using the Severity of Alopecia Tool score (SALT score) which determine the percentage of hair loss in the scalp. The body was carefully examined to detect any alopecia patches in any hairy area. Nail examination was carried out to detect any nail involvement. Serum IL-15 levels were measured using an ELISA kits. Results: Serum levels of IL-15 in patients were significantly higher than those in the control group (P < 0.001). Serum levels in alopecia totalis were significantly higher than those with one or two patches, and serum levels in patients with both scalp and body involvement were significantly elevated than the levels of patients with either scalp or body involvement. There was a statistically significant positive correlation between SALT score and serum levels of IL-15 (P < 0.001). Conclusion: Serum IL-15 may be a marker of AA severity.
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CASE REPORTS
	Trigeminal trophic syndrome simulating pityriasis amiantacea	p. 31
	Luisa Groba Bandeira, Maria Cláudia Alves Luce, Bruno De Castro E Souza, Priscila Kakizaki, Neusa Yuriko Sakai Valente DOI:10.4103/ijt.ijt_16_18   We report a case of trigeminal trophic syndrome (TTS) on the scalp of a 69-year-old woman. Initially, the diagnosis of pityriasis amiantacea was considered. The review of pathological antecedents and knowledge of TTS were fundamental for the diagnosis of this illness. We performed a brief review on TTS and differential diagnoses.
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	Nerve sheath myxoma of scalp: A rare site of presentation	p. 34
	Shakti Kumar Yadav, Sompal Singh, Namrata Sarin, Roshina Naeem, Sonam Kumar Pruthi DOI:10.4103/ijt.ijt_45_18   Nerve sheath myxoma, a superficial myxoid tumor, was first described in 1969 by Harkin and Reed. Tumor has cytological and histological resemblance with neurothekeoma, another cutaneous myxoid lesion. Nerve sheath myxoma affects individuals of all age groups and equal predilection for both genders with most favored sites being the fingers and knee. Here, we present a case report of nerve sheath myxoma of the scalp, diagnosed and confirmed with histopathology and immunohistochemistry.
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	Woolly hair nevus type 2: Rare entity	p. 38
	Farhana Tahseen Taj, Shraddha Kologi DOI:10.4103/ijt.ijt_28_18   Woolly hair nevus is a rare non hereditary disorder of scalp characterized by curling and kinking of hair. It can present in childhood or adolescent age. Dermoscopy is a useful noninvasive technique to help in the diagnosis of wolly hair nevus. We report a case of woolly hair nevus associated with linear epidermal nevus.
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LETTER TO EDITOR
	Trichodynia silenced effectively with propranolol	p. 41
	Piotr Brzezinski, Vijay Zawar, Anca Chiriac DOI:10.4103/ijt.ijt_8_19
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Neural Regeneration Research

The hypothalamic-spinal dopaminergic system: a target for pain modulation Michelino Puopolo Neural Regeneration Research 2019 14(6):925-930 Nociceptive signals conveyed to the dorsal horn of the spinal cord by primary nociceptors are subject to extensive modulation by local neurons and by supraspinal descending pathways to the spinal cord before being relayed to higher brain centers. Descending modulatory pathways to the spinal cord comprise, among others, noradrenergic, serotonergic, γ-aminobutyric acid (GABA)ergic, and dopaminergic fibers. The contributions of noradrenaline, serotonin, and GABA to pain modulation have been extensively investigated. In contrast, the contributions of dopamine to pain modulation remain poorly understood. The focus of this review is to summarize the current knowledge of the contributions of dopamine to pain modulation. Hypothalamic A11 dopaminergic neurons project to all levels of the spinal cord and provide the main source of spinal dopamine. Dopamine receptors are expressed in primary nociceptors as well as in spinal neurons located in different laminae in the dorsal horn of the spinal cord, suggesting that dopamine can modulate pain signals by acting at both presynaptic and postsynaptic targets. Here, I will review the literature on the effects of dopamine and dopamine receptor agonists/antagonists on the excitability of primary nociceptors, the effects of dopamine on the synaptic transmission between primary nociceptors and dorsal horn neurons, and the effects of dopamine on pain in rodents. Published data support both anti-nociceptive effects of dopamine mediated by D2-like receptors and pro-nociceptive effects mediated by D1-like receptors.

Characteristics and advantages of adeno-associated virus vector-mediated gene therapy for neurodegenerative diseases Yuan Qu, Yi Liu, Ahmed Fayyaz Noor, Johnathan Tran, Rui Li Neural Regeneration Research 2019 14(6):931-938 Common neurodegenerative diseases of the central nervous system are characterized by progressive damage to the function of neurons, even leading to the permanent loss of function. Gene therapy via gene replacement or gene correction provides the potential for transformative therapies to delay or possibly stop further progression of the neurodegenerative disease in affected patients. Adeno-associated virus has been the vector of choice in recent clinical trials of therapies for neurodegenerative diseases due to its safety and efficiency in mediating gene transfer to the central nervous system. This review aims to discuss and summarize the progress and clinical applications of adeno-associated virus in neurodegenerative disease in central nervous system. Results from some clinical trials and successful cases of central neurodegenerative diseases deserve further study and exploration.

Gene expression changes in dorsal root ganglia following peripheral nerve injury: roles in inflammation, cell death and nociception Sarah L Martin, Adam J Reid, Alexei Verkhratsky, Valerio Magnaghi, Alessandro Faroni Neural Regeneration Research 2019 14(6):939-947 Subsequent to a peripheral nerve injury, there are changes in gene expression within the dorsal root ganglia in response to the damage. This review selects factors which are well-known to be vital for inflammation, cell death and nociception, and highlights how alterations in their gene expression within the dorsal root ganglia can affect functional recovery. The majority of studies used polymerase chain reaction within animal models to analyse the dynamic changes following peripheral nerve injuries. This review aims to highlight the factors at the gene expression level that impede functional recovery and are hence are potential targets for therapeutic approaches. Where possible the experimental model, specific time-points and cellular location of expression levels are reported.

Nicotinamide adenine dinucleotide phosphate oxidase activation and neuronal death after ischemic stroke Jiamei Shen, Radhika Rastogi, Xiaokun Geng, Yuchuan Ding Neural Regeneration Research 2019 14(6):948-953 Nicotinamide adenine dinucleotide phosphate oxidase (NOX) is a multisubunit enzyme complex that utilizes nicotinamide adenine dinucleotide phosphate to produce superoxide anions and other reactive oxygen species. Under normal circumstances, reactive oxygen species mediate a number of important cellular functions, including the facilitation of adaptive immunity. In pathogenic circumstances, however, excess reactive oxygen species generated by NOX promotes apoptotic cell death. In ischemic stroke, in particular, it has been shown that both NOX activation and derangements in glucose metabolism result in increased apoptosis. Moreover, recent studies have established that glucose, as a NOX substrate, plays a vital role in the pathogenesis of reperfusion injury. Thus, NOX inhibition has the potential to mitigate the deleterious impact of hyperglycemia on stroke. In this paper, we provide an overview of this research, coupled with a discussion of its implications for the development of NOX inhibition as a strategy for the treatment of ischemic stroke. Both inhibition using apocynin, as well as the prospect of developing more specific inhibitors based on what is now understood of the biology of NOX assembly and activation, will be highlighted in the course of our discussion.

Autophagy: novel insights into therapeutic target of electroacupuncture against cerebral ischemia/ reperfusion injury Ya-Guang Huang, Wei Tao, Song-Bai Yang, Jin-Feng Wang, Zhi-Gang Mei, Zhi-Tao Feng Neural Regeneration Research 2019 14(6):954-961 Electroacupuncture is known as an effective adjuvant therapy in ischemic cerebrovascular disease. However, its underlying mechanisms remain unclear. Studies suggest that autophagy, which is essential for cell survival and cell death, is involved in cerebral ischemia reperfusion injury and might be modulate by electroacupuncture therapy in key ways. This paper aims to provide novel insights into a therapeutic target of electroacupuncture against cerebral ischemia/reperfusion injury from the perspective of autophagy. Here we review recent studies on electroacupuncture regulation of autophagy-related markers such as UNC-51-like kinase-1 complex, Beclin1, microtubule-associated protein-1 light chain 3, p62, and autophagosomes for treating cerebral ischemia/reperfusion injury. The results of these studies show that electroacupuncture may affect the initiation of autophagy, vesicle nucleation, expansion and maturation of autophagosomes, as well as fusion and degradation of autophagolysosomes. Moreover, studies indicate that electroacupuncture probably modulates autophagy by activating the mammalian target of the rapamycin signaling pathway. This review thus indicates that autophagy is a therapeutic target of electroacupuncture treatment against ischemic cerebrovascular diseases.

Lessons from glaucoma: rethinking the fluid-brain barriers in common neurodegenerative disorders Francisco Javier Carreras Neural Regeneration Research 2019 14(6):962-966 Glaucoma has been recently characterized as a member of the group of anoikis-related diseases. Anoikis, a form of apoptosis, can be triggered by the unfastening of adherent junctions present in astrocytes. In those areas of the central nervous system in which the soma of the neurons or their axons and dendrites are metabolically dependent on the activity of astrocytes, a derangement of the lactate shuttle caused by a separation between the plasma membranes of neurons and astrocytes would result in metabolic impairment of the neurons themselves. In glaucoma, the triggering event has been attributed to the posterior deviation of aqueous humor towards the astrocyte-rich prelaminar tissue of the optic nerve head. The mean calcium content in the aqueous is able to interfere with calcium-dependent adherent junctions and induce anoikis of the astrocytes. As the cerebrospinal fluid has a similar base calcium concentration, a shunt of cerebrospinal fluid through the cerebral parenchyma would be able to interfere in the astrocytic architecture with dire consequences to the metabolically dependent neurons. Here the similitude between glaucoma, amyotrophic lateral sclerosis and Alzheimer’s disease are discussed and the concept of the break in the fluid-brain barrier, as an event separated from the blood-brain barrier, is stressed.

Busting the myth: more good than harm in transgenic cells Gonzalo Piñero, Patricia Setton-Avruj Neural Regeneration Research 2019 14(6):967-968

Muscle secretion of toxic factors, regulated by miR126-5p, facilitates motor neuron degeneration in amyotrophic lateral sclerosis Roy Maimon, Eran Perlson Neural Regeneration Research 2019 14(6):969-970

Preliminary in vitro evaluation of neuroprotective and monoamine oxidase type B inhibitory effects of newly synthesized 8-aminocaffeines Magdalena Kondeva-Burdina, Maya Georgieva, Alexandra Kasabova-Angelova, Virginia Tzankova, Alexander Zlatkov Neural Regeneration Research 2019 14(6):971-972

Therapeutic exploitation of the S-nitrosoglutathione/S-nitrosylation mechanism for the treatment of contusion spinal cord injury Mushfiquddin Khan, Inderjit Singh Neural Regeneration Research 2019 14(6):973-974

Hematology

Clinicohematological profile of patients with peripheral blood cytopenias in clinical practice Rajneesh Thakur, Navjyot Kaur, Malhotra Arjun, Sharma Sanjeevan, Puri Pankaj, Nair Velu Iraqi Journal of Hematology 2019 8(1):1-6 BACKGROUND: In clinical practice, the cytopenias may result from relatively benign causes such as viral infections and Vitamin B12/folic acid deficiency to more sinister causes such as bone marrow failure. In this study, we looked into the clinicohematological profile and etiological factors of bicytopenia and pancytopenia. OBJECTIVES: To study the etiology and clinicohematological profile in patients of peripheral blood cytopenias. MATERIALS AND METHODS: This was a cross-sectional study conducted at a tertiary care hospital over a period of 1 year. Cytopenias were defined as pancytopenia when there was simultaneous presence of hemoglobin <10 g/dL, total leukocyte count <4000/dL, and platelets < 100000/dL or as bicytopenia when two of the three blood cell lines were depressed. All patients who presented with pancytopenia and bicytopenia were included, and their clinicohematological profile was recorded. RESULTS: A total of 204 patients (103 males and 101 females) were diagnosed to have cytopenias. Pancytopenia was observed in 69/204 and bicytopenia was seen in 135/204 cases. The various causes of cytopenias included infections (n = 126 [61.76%]), megaloblastic anemia (MA) (n = 48 [23.52%]), drugs (n = 12 [5.8%]), hypersplenism (n = 8 [3.9%]), bone marrow failure syndromes such as aplastic anemia and myelodysplastic syndrome (n = 7 [3.4%]) and leukemias (n = 3 [1.4%]). We found a significant association between MA and pancytopenia (odds ratio [OR] = 2.47, P < 0.05) and also between infections and bicytopenia (OR = 5.8, P < 0.05). CONCLUSION: The present study concluded that infections and MA are the most common cause of bicytopenia and pancytopenia, respectively. The more serious disorders affecting the bone marrow constitute only <5% of all cases of cytopenias.

Acute promyelocytic leukemia: Epidemiology, clinical presentation, and outcome over a 10-year period of follow-up at Nanakali Hospital of Erbil city "Single-center study" Araz Taha Ahmed, Ahmed Khudair Yassin, Nawsherwan Sadiq Mohammed, Kawa Muhamedamin Hasan Iraqi Journal of Hematology 2019 8(1):7-13 BACKGROUND: Among the subtypes of acute myeloid leukemia, acute promyelocytic leukemia (APL) is a distinctive one. There are no published data regarding APL in Kurdistan, Iraq, so the data on this disease is limited. OBJECTIVES: The aims of this study was to recognize the epidemiology, clinical presentation, and to find out the outcome among APL patients at Nanakali hospital in Erbil city. PATIENTS AND METHODS: This was a retrospective study performed at Nanakali Hospital for blood diseases and cancer, Erbil, Iraq. Patients older than 18 years diagnosed with APL from January 2007 to December 2016 were involved in the study. Chi-square test, Kaplan–Meier survival curves, and the Log-Rank (Mantel–Cox) test were used for data analysis. RESULTS: During the period of the study, APL was diagnosed in 90 patients. The mean age (± standard deviations) was 37.5 ± 15.5 years, and the median was 35.5 years, the male: female ratio was 1.3:1. Around 70% were living in urban areas. Regarding clinical presentations: 71.4% of the patients presented with generalized weakness, 64.44% with bleeding, 48.9% with fever, and 2.2% presented with thrombosis. The mean hemoglobin was 8.31 ± 2.69 g/dL, mean white blood cell count of 22.3 ± 29.4 × 109/L, and mean platelet count was 33.37 ± 27.5 × 109/L. The complete remission rate was 68.2%. Early death rate was 46.4% and the 5-year survival rate was 37.8%. CONCLUSION: The clinical and epidemiological features were compared with previously published studies. High-risk patients predominate in our study population. There was a significant association between the overall survival and risk score.

Clinicopathological, immunohistochemical charachtaristic and the outcome of Hodghkin lymphoma patients in Erbil city, Iraq Lilan Bahzad Mohammedzaki, Kawa Muhammedamin Hasan, Ranan Kardagh Polus, Ahmed Khudair Yassin Iraqi Journal of Hematology 2019 8(1):14-20 BACKGROUND: Hodgkin lymphoma (HL) has unique epidemiological features with diversified pathologies and exhibits considerable clinicopathological variations in different parts of the world. OBJECTIVES: We aimed in this study to assess clinic-pathological features, immunohistochemistry and outcome of HL patients treated in Erbil, northren Iraq. PATIENTS AND METHODS: This was a retrospective study conducted in Nanakaly Hospital for blood diseases and oncology in Erbil, North Iraq; a total of 125 patients diagnosed between January 2012 and December 2016 were involved; they were assessed for their clinical characteristics and histopathology and immunophenotyping findings and their outcome was evaluated as well. RESULTS: The median age was 28 years (range: 18–71 years); 55% were male and 41% had Stage II disease; common histological type is nodular sclerosis (51.2%) followed by mixed cellularity (43.2%); CD30 was positive in nearly all cases of classical HL, and CD15 was positive in 98.7% and CD20 was positive in 75% in nodular lymphocyte predominant subtype. Most of the patients received adriamycin, bleomycin, vinblastine, and dacarbazine chemotherapy, and the 5-year overall survival in our study is 70%. Advanced stage (IV), high lactate dehydrogenase level, low hemoglobin, and splenomegaly are significant predictors for poor survival. CONCLUSION: Our patient exhibited outcomes that were lower to those reported in developed countries.

Prevalence of gestational thrombocytopenia and its effect on maternal and fetal outcome Vijay Zutshi, Nidhi Gupta, Renu Arora, Supriya Dhanker Iraqi Journal of Hematology 2019 8(1):21-24 BACKGROUND: Gestational thrombocytopenia (GT) is considered as the most common cause of thrombocytopenia in pregnancy and accounts for about 75% of cases. OBJECTIVES: The objectives of the study are (1) to estimate the prevalence of GT among antenatal patients at Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital in New Delhi, India, and (2) to study the fetomaternal outcome in mild, moderate, and severe GT. MATERIALS AND METHODS: This is a prospective observational study done in the Department of Obstetrics and Gynaecology, VMMC and Safdarjung hospital in New Delhi, India, for a period of 6 months. All antenatal women underwent complete hemogram with manual platelet count in the third trimester. Those with platelet count 150 × 109/L were included and divided into three groups on the basis of platelet count. Maternal and fetal outcome was observed. Cord blood was sent for neonatal platelet count. Follow-up was done in these cases till 6 weeks postpartum. RESULTS: The prevalence of GT was 12.82%. Fetomaternal outcome was favorable. A total of five (2.5%) patients suffered from abruption. Postpartum hemorrhage was present in about 7 cases (3.5%). Blood transfusion including platelet transfusion was needed in around 13 cases (6.5%). There was no maternal mortality. Only 6 (3%) neonates were having thrombocytopenia (platelet count < 150 × 109/L) regardless of degree of maternal thrombocytopenia. Twenty-six (13%) neonates were admitted in nursery for monitoring; among these, 11 (5.5%) neonates' ventilation was needed. There was no neonatal death. CONCLUSION: Better fetomaternal outcome is seen in GT, so a vigilant and careful monitoring can prevent any adverse event.

A one year anticipated blood transfusion requirements among patients with acute leukemia undergoing chemotherapy in the National Center of Hematology in Baghdad Alaa Fadhil Alwan, Nidal Kareem Alrahal, Maha Abdul-Jabbar Alnuaimi Iraqi Journal of Hematology 2019 8(1):25-28 BACKGROUND: Acute leukemia is considered one of the most diseases that required frequent blood transfusion. Despite that blood transfusion is one of the main parts in the supportive management of acute leukemia patients, still, there are few data showing the exact requirements in regard to blood components for those patients. OBJECTIVES: The aims of this study were to review the predicted amount of blood transfusions needed for a patient with acute leukemia under a regimen of chemotherapy and to verify the transfusion frequency practices, according to the types of acute leukemia, levels of treatment, prognosis, and other demographic factors. MATERIALS AND METHODS: A prospective cohort study conducted at the National Center of Hematology/Mustansiriyah University from January 2013 to January 2015. Thirty newly diagnosed patients were enrolled in this study. The inclusion criteria included newly diagnosed acute leukemia whether lymphoid or myeloid except acute promyelocytic leukemia (M3) patients who were excluded. All patients subjected to detailed history and routine hematological investigations. They were followed up and assessed during induction and consolidation phases for both disease entities. RESULTS: Thirty patients were included in this study; 20 were male and 10 were female. The mean age was 31.4 years, ranging from 15 to 66 years. There were 15 cases of AML and 15 cases for ALL. The number of transfused units was found to be higher and statistically significant in those below 40 years of age, male patients and in patients with complete remission, while it was not significant for type of disease. CONCLUSION: This study provides information to estimate the anticipated requirements for blood transfusion for those patients in regard to different factors which can be considered as guideline for these tertiary centers for accurate assessment of transfusion requirements and to direct resources for better outcome.

School performance of children with sickle cell disease in Basra, Iraq Falah Hassan Abid, Mea'ad Kadhum Hassan, Bahaa Abd Al Hussein Ahmed Iraqi Journal of Hematology 2019 8(1):29-37 BACKGROUND: Children with sickle cell disease (SCD) have a greater likelihood of demonstrating many medical complications that may put them at risk for a variety of difficulties, including poor school performance and cognitive impairment. OBJECTIVES: This study was designed to assess the school performance of primary school-aged patients with SCD compared to age- and gender-matched healthy students and to evaluate the factors that influence school performance in these patients. MATERIALS AND METHODS: A total of 68 patients with SCD from 48 primary schools and 68 healthy student classmates (control group), aged 7–12 years, were recruited. The average school examination scores were used as a school performance measure, while cognitive functioning was assessed by using the Draw-A-Person test. RESULTS: The average school examination scores and cognitive function scores of patients with SCD (82.46 ± 15.48 and 24.72 ± 7.48, respectively) were significantly lower than the corresponding scores of their classmate control group (93.42 ± 10.02 and 27.84 ± 7.46, respectively), P < 0.05. Students with SCD missed significantly more school days (12.37 ± 10.57) than healthy students (3.18 ± 3.62), P < 0.001, and high school absence was significantly associated with low school performance among SCD patients, P = 0.027. Among patients with SCD, Pearson correlation revealed a negative association between school performance and age and school absence days (r = −0.346 and r = −0.390, respectively, P < 0.01) and a positive association between school performance and maternal education (r = −0.388, P < 0.001). CONCLUSIONS: School performance and cognitive function were significantly lower among patients with SCD than among their classmates, and school absence and the age of patients had a negative impact on school performance.

Molecular detection of Toxoplasma gondii in a sample of Iraqi patients with acute leukemia and stem cell transplantation Hussein Ali Al-Toban, Huda Dhaher Al-Marsomy, Waseem F Al-Tameemi, Asmaa Baqer Al-Obaidi, Mazen Abbas Mohammed, Raghad Majid Al-Saeed, Ibrahim Khalil Al-Shemary Iraqi Journal of Hematology 2019 8(1):38-44 BACKGROUND: Acute leukemia and allogenic bone marrow transplantation BMT are immunocompromised conditions which may be susceptible for many opportunistic infections or reactivation of latent infections like Toxoplasma gondii (T.gondii). OBJECTIVES: The aims of study were to detect T.gondii in both acute leukemia patients and allogenic BMT recipients and to determine copy number of T.gondii in these groups in comparison to healthy individual as control group. METHODS: Sixty one acute leukemia patients enrolled in a prospective study from 1st December 2016 to 1st June 2017. Forty eight of them evaluated while induction chemotherapy (group I), while the other 13 within 1 year post bone marrow transplantation-BMT-(group II). In addition to 30 apparently healthy individuals as (control group), blood samples were collected from all groups. T.gondii DNA was extracted and then measured by Taqman quantitative real-time PCR. Measurement IgG and IgM antibody specific to T. gondii was investigated also in the control group by an enzyme-linked immune assay (ELISA). RESULTS: T.gondii parasitemia was detected in (8.3%) 4 out of 48 group I patient. While negative in group II and control group. The range of T.gondii load was (6.285×103-17.915×103) copy/ml, the mean of the copy numbers 11458.75± 5120.85. CONCLUSION: T.gondii should be looked for Leukemic patients at least by routine serological test for early diagnosis and early treatment if indicated. Quantitative PCR is used to monitor post BMT patients at risk for T.gondii disease and for a timely start of preemptive therapy.

Lenalidomide-related malar rash-like lesion in patient with 5q-syndrome Gokhan Sargin, Irfan Yavasoglu Iraqi Journal of Hematology 2019 8(1):45-47 It has become important to be careful in terms of side effects with the increased lenalidomide use. The most commonly reported adverse events with the use of lenalidomide were hematologic toxicities and less frequently peripheral edema, infections, gastrointestinal disorders, fatigue, and muscle cramps. In particular, the nonserious rash is the most common cause of permanent discontinuation of lenalidomide. Although morbilliform, urticarial, or acneiform rashes have been observed with lenalidomide, malar rash-like lesions have not been described previously. Our aim is to present here 71-year-old female myelodysplastic syndrome patient with deletion of 5q abnormality who should be discontinued lenalidomide due to recurrent skin reaction like a malar rash.

Extramedullary hematopoiesis in case of hemoglobin E Beta-thalassemia: An unusual cause of paraplegia Prita Pradhan, Narendra Kumar Das, Kanakalata Dash, Nageswar Sahu, Urmila Senapati Iraqi Journal of Hematology 2019 8(1):48-51 Hemoglobin E (HbE) beta-thalassemia is common in Asian countries. Extramedullary hematopoiesis (EMH) is a chronic complication of this condition, which is a rare cause of paraplegia. Here, we discuss an uncommon presentation of HbE beta-thalassemia with EMH. A 32-year-old male patient presented with spastic paraplegia at C7 level. Contrast magnetic resonance imaging showed epidural extramedullary soft-tissue clumps at D2–D7 vertebra. Histology section showed numerous pleomorphic large cells admixed with colonies of small cells having rounded contour. A relook at the history revealed a history of hemolytic anemia diagnosed at the age of 12 years, for which he was on 1–2 transfusions/year. HbE beta-thalassemia had been diagnosed 20 years before. Hence, a final diagnosis of EMH was made. Although such case reports have been documented, the amount of available data is limited. A high index of suspicion for EMH should be held in patients with hematological disease who present with neurological disorders.

Bronchology

Role of bronchoscopy in diagnosis of smear-negative pulmonary tuberculosis Rajendra Prasad, Abhijeet Singh Egyptian Journal of Bronchology 2019 13(1):1-5 Tuberculosis (TB) remains an important cause of morbidity and mortality in many developing countries including India. Prompt and accurate establishment of diagnosis is one of the essential basic principles of care for persons with TB. Sputum smear microscopy and culture remain the cornerstone of diagnosis but can be negative in a substantial proportion of pulmonary TB patients (multiple smear-negative status or scanty sputum). Bronchoscopy has been proven to be a safe and effective method for those patients with varying diagnostic yields ranging from 30 to 90%. Various specimens are obtained from a fiber-optic bronchoscope such as smear and culture for mycobacteria from the bronchial aspirate or wash, bronchoalveolar lavage fluid, bronchial brushing, postbronchoscopy sputum, transbronchial needle aspiration, and transbronchial biopsy. The diagnostic yield is significantly enhanced when nucleic acid amplification testing is applied to bronchoscopic specimens. The role of bronchoscopy in TB diagnosis is likely to be limited because of availability, cost, and logistical challenges. Future studies are needed to better define the role of the newer diagnostic modalities to improve early TB diagnosis.

Study of cardiopulmonary rehabilitation versus cardiac rehabilitation in patients suffering from coronary artery diseases and chronic obstructive pulmonary disease Yasser M Mohamed, Hala M Salem, Hazem M Khorshid, Karim H Abdel Fattah Egyptian Journal of Bronchology 2019 13(1):6-11 Introduction Chronic obstructive pulmonary disease (COPD) and coronary artery disease are common treatable and preventable chronic diseases. Rehabilitation is now considered an important part of the long-term management in both diseases and includes exercise, education, and smoking cessation. Patients and methods This study included 40 patients with COPD and coronary artery disease referred to the cardiac rehabilitation unit at Ain Shams University hospitals. Patients were assessed by clinical assessment, ECG, ECHO, modified Bruce protocol, spirometry, and St George’s Respiratory Questionnaire (SGRQ). Then, patients were divided into two groups: a cardiac rehabilitation group and a cardiopulmonary rehabilitation group. All patients received 8–12 weeks of rehabilitation and were reassessed by spirometry, the modified Bruce protocol, and SGRQ. Results Both groups improved in terms of spirometric parameters (forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity), SGRQ, and metabolic equivalents of tasks, but there was a statistically significant in resting heart rate in the cardiopulmonary rehabilitation group. Conclusion The inclusion of upper limb exercise and inspiratory muscles training in pulmonary rehabilitation improves exercise tolerance in patients suffering from both COPD and coronary artery disease compared with cardiac rehabilitation alone.

Cardiac evaluation of patients with chronic obstructive pulmonary disease using echocardiography Yasser Moustfa Mohammed, Ghada Samir ElShahid, Nehad Mohammed Osman, Nehal Qadry Abd ElHameed Egyptian Journal of Bronchology 2019 13(1):12-16 Background Chronic obstructive pulmonary disease (COPD) is a significant cause of death. Cardiovascular disease is a significant cause of morbidity and mortality in COPD. Aim We used echocardiography to evaluate cardiac function in patients with COPD and correlated echocardiographic findings with COPD severity. Patients and methods We performed a prospective cross-sectional study on 60 patients with stable COPD who presented to the Abbasia Chest Hospital during the period from November 2016 till August 2017. Spirometry was performed for all participants using American and European Thoracic Society (2005) recommendations. They were classified according to GOLD guidelines (2017) and evaluated by two-dimensional Doppler echocardiography according to American and European Association of Echocardiography ASE recommendations. Results Echocardiographic examination of left ventricular functions revealed no cases of left ventricular systolic dysfunction, but left ventricular diastolic dysfunction was found in ∼25%. Right ventricle dilatation was found in ∼18% of the patients. Tricuspid regurge was seen in ∼75%, with variable grades from mild to severe. Pulmonary hypertension (PH) was found in ∼40% of the patients. It was more prevalent in patients with severe and very severe disease. Correlation between echocardiographic findings and severity of COPD revealed significant positive correlation only with right ventricle size, tricuspid regurgitation, and PH. Conclusion Left ventricular diastolic dysfunction appears to be frequent in patients with COPD, but it is not related to the disease severity. Abnormal right heart changes could be expected. Presence of PH has a linear relationship with COPD severity.

Detection of chronic obstructive pulmonary disease among shisha smokers in the Fayoum Governorate Assem F El Essawy, Radwa A Elhefny, Randa I Ahmed, Samar A Fouad Egyptian Journal of Bronchology 2019 13(1):17-28 Background Shisha smoking is a common practice among the population in Arabic countries. Shisha smoking has a negative effect on lung function; it is probably one of the causes for chronic obstructive pulmonary disease (COPD). Objective Detection of COPD among Shisha Smokers in the Fayoum Governorate. Design Prospective study. Setting Fayoum University Hospital in Egypt between 2016 and 2017. Patients and methods Of the 300 participants, 200 were shisha smokers for more than 20 years or their age above 40 years and 100 of them were nonsmoker volunteers. History of smoking was taken from the patients with recording of the COPD assessment score and then general and local examination was done followed by flow volume loop and finally by a chest radiography (posteroanterior view). Statistical analysis: case–control study Coding of the data was done and then entered with SPSS (statistical package for the social sciences) version number 24. After that data was summarized using mean, SD, median, minimum and maximum in the quantitative data with using frequency (count) and relative frequency (percentage) for categorization of data. Results Out of the 300 male patients included in this study 51% has obstructive airway disease and 19% had restrictive airway disease. The mean age was 56.20±10.98 years. Number of hagars smoked by the COPD patients were 10.82±9.88 hagars per day with a duration of smoking of 24.87±12.36 years. Conclusion Shisha smoking increases the risk of COPD and this risk increases with the increase in the duration of smoking and number of hagar smoked was the conclusion of the study.

Forced vital capacity as a primary clinical outcome measure of bronchodilator reversibility in chronic obstructive pulmonary disease Magdy Mohamed Khalil, Eman Badawy AbdelFattah, Yasmin Yousif Mostafa Egyptian Journal of Bronchology 2019 13(1):29-34 Background Spirometry is the most reproducible and objective measurement of airflow limitation. The effectiveness of inhaled bronchodilator in individual patients with chronic obstructive pulmonary disease (COPD) is assessed by comparing measurements from pulmonary function tests made before and after administration. Generally forced expiratory volume in one second (FEV1) is the marker used with the global initiative for COPD (Global Initiative for Chronic Obstructive Lung Disease) guidelines. An increase in FEV1 that is both greater than 0.2 l and 12% above the prebronchodilator FEV1 value is considered significant. The aim of this study is to assess forced vital capacity (FVC) as a clinical outcome measure of bronchodilator reversibility in patients with COPD. Patients and methods This was a prospective study conducted on 163 patients with COPD at Suez Chest Hospital during the period from first of October 2016 till the end of March 2017. Patients were diagnosed based on clinical and spirometric criteria, and then reversibility test was done using inhaled short-acting B2-agonist. All patients were subjected to COPD Assessment Test questionnaire. Results Overall, 14.11% of patients had significant increase in FEV1, whereas 54.6% of patients had significant increase in FVC after bronchodilator inhalation. There was a highly significant positive correlation in FEV1 and FVC value before and after bronchodilator inhalation, and there was a highly significant direct correlation between ΔFEV1 and ΔFVC. There was a statistically significant relation between age and COPD Assessment Test score and ΔFVC. Conclusion ΔFEV1 underestimates the true effect of bronchodilator as airway obstruction increases. The addition of ΔFVC to the evaluation will help physicians to better interpret airways reversibility tests, particularly in more severe patients, without adding spirometric maneuvers or measurements. Patients with COPD, even if nonresponders in terms of FEV1, may benefit from bronchodilators because they can breathe at a lower lung volume owing to reduced air-trapping, notwithstanding the fact that they are still flow limited. ΔFVC correlates better than ΔFEV1with the degree of airway obstruction and the clinical status of the patients.

Psychological assessment of patients with bronchial asthma: focus on some predictors of abnormalities Hend M Esmaeel, Hanan Y Aly Egyptian Journal of Bronchology 2019 13(1):35-42 Background Bronchial asthma is a common chronic respiratory illness. Psychiatric comorbidity is a neglected zone in the care and management of such important physical disorders as bronchial asthma. Objective The present study targeted a population sample of out-patient asthmatics, aiming at detailed psychocognitive evaluation. Predictors of depression, anxiety, and cognitive impairment were searched for by detailed assessment of patient sociodemographic and disease-related criteria. Patients and methods A total of 50 patients with confirmed asthma diagnosis were recruited and subjected to detailed respiratory and psychiatric evaluation using Mini-Mental State Examination, Beck Depression Inventory-II, and Taylor manifest anxiety scale tests. Results Mild, moderate, and severe depression were diagnosed in 26, 28, and 14% of patients, respectively, whereas mild, moderate, and severe anxiety were revealed in 32, 34, and 20%, respectively. Overall, 54% of the patients showed cognitive impairment. Asthmatic female patients were more common to have depression (P=0.022). The present analysis showed that predictors of cognitive impairment were older age, increasing frequency of hospital admission for asthma in the past year, improper adherence to treatment, and uncontrolled asthma. Meanwhile better education level proved to be protective from abnormal cognitive function. Conclusion There was high prevalence of depression, anxiety, and cognitive dysfunction among asthmatic patients in Sohag University. Improving patient education, patient adherence to treatment, and asthma level control may lessen the chance of cognitive abnormality.

Assessment of lung functions using impulse oscillometry before and after bronchoscopic lung volume reduction with histoacryl gel Adel M Khattab, Nevine Abd Elfattah, Ayman Farghaly, Alsayyed Hassan Egyptian Journal of Bronchology 2019 13(1):43-48 Background Many forms of bronchoscopic lung volume reduction were introduced as a treatment for patients with emphysema surpassing the surgical management and its fatality. Biological bronchoscopic lung volume reduction (BBLVR) proved to be a safe and competent solution inducing collapse of the emphysematous segment(s). Impulse oscillometry (IOS) constitutes an effortless but underused surrogate to spirometry in assessment of pulmonary function. Therefore, the aim of this study was to evaluate the use of IOS before and after BBLVR with histoacryl gel in comparison with spirometry among patients with emphysema. Patients and methods A prospective comparative follow-up study was performed at Kobry El-Kobba Military Hospital. A total of 30 patients with radiological evidence of heterogenous emphysema or emphysematous bullae were enrolled during the period from July 2014 to April 2015. BBLVR was accomplished by the instillation of the histoacryl gel into the affected segment(s) using standard technique. Clinical, radiological, and functional assessments were done before and 4 weeks after the procedure. Results After BBLVR, the following outcome was measured: 6-min walk test, partial pressure of O2 in arterial blood, forced expiratory volume in the first second, resistance at 5 Hz, resistance at 20 Hz, and reactance at 5 Hz. They improved with statistical significance among all the patients. There was a negative correlation between forced vital capacity and resistance at 5 Hz in the heterogenous emphysema group (ρ=0.47 and P<0.025); however, the forced expiratory volume at first second showed positive correlation with reactance at 5 Hz in emphysematous bullae group (ρ=0.82 and P<0.023). Conclusion BBLVR with histoacryl gel is associated with improvement in exercise capacity and lung functions. IOS provided comprehensive assessment of the pulmonary functions, which was in good correlation with spirometry.

Evaluation of lung cancer patterns and bronchoscopic presentations in patients admitted to Abbasia Chest Hospital Farrag A Muhammad, Diab S Haytham, Khalaf A Mostafa Egyptian Journal of Bronchology 2019 13(1):49-54 Background Lung cancer is the most common cause of cancer-related death worldwide, accounting for more cancer-related deaths compared with colon, breast, and prostate combined. Aim The aim of this work is to detect the predominant bronchoscopic presentations and anatomical sites for all histopathological types of lung cancer. Patients and methods This study was conducted prospectively in the bronchoscopy units in Abbasia Chest Hospital. It included 132 patients suspected clinically and radiologically to have lung cancer and admitted to the hospital during the period from July 2016 to March 2017. Of them, 81 patients were pathologically diagnosed as having primary lung cancer. Statistical analysis χ2 test was used to examine the relationship between the two qualitative variables. Student’s t test was used to assess the statistical significance of the difference between the two study group means. McNamara test was used assess the statistical significance of the difference between a qualitative variable measured twice for the same study group. Results A total of 81 patients (73 males and eight females) with primary lung cancer were included in the study; most of them were in the sixth decade of life. The main anatomical sites of bronchogenic carcinoma were main bronchi and lower lobe bronchi equally (24% each), followed by lower lobe bronchi (20%). Most common macroscopic bronchoscopic presentations of bronchogenic carcinoma were end bronchial lesion (46.91%) followed by external compression (12.35%) and then mucosal infiltration and external compression (9.88%). Conclusion Persistent pulmonary complaints like productive cough, dyspnea, chest pain, and hemoptysis should be investigated immediately. Proper screening and early diagnostic methods should be applied on a large scale to find out suspected patients who at risk to develop lung cancer.

The role of medical thoracoscopy in the management of empyema Ahmad G El Gazzar, Mohammad A.E El-Mahdy, Gehan F Al Mehy, Asmaa El Desoukey Mohammad Egyptian Journal of Bronchology 2019 13(1):55-62 Background Empyema thoracis is defined as accumulation of pus in the pleural space. Despite advanced medical diagnostic and therapeutic methods, thoracic empyema remains a common clinical entity and a serious problem all over the world with significant associated morbidity and mortality. Aim The aim of this work was to study the efficacy and safety of medical thoracoscopy (MT) in the management of empyema. Patients and methods This study included 30 inpatients with empyema. Included patients had frank pus on aspiration (turbid purulent fetid fluid) with or without positive Gram stain smear and microbiological culture findings or pH less than 7.20, with signs of sepsis. Patients were managed by MT. MT using rigid thoracoscopy was performed with evacuation of the purulent fluid, visualization of the pleural space, assessment of adhesions and purulent material, forceps adhesiolysis, and irrigation by normal saline with partial debridement of accessible parietal pleural surface. Results The present study included 30 patients with empyema (17 men, 13 women with a mean age of 47.4±14.5 years; range, 18–70 years); 19 (63.3%) patients had free-flowing empyema (by computed tomography/ultrasonography) and 11 (36.7%) patients had multiloculated empyema. The etiology of empyema included pneumonia (parapneumonic effusion) (33.3%), malignancy (23.3%), tuberculosis (6.7%), lung abscess (6.7%), and no cause was identified in nine patients (spontaneous pleural infection) (30%). MT was considered successful without subsequent interventional procedures in 26 of 30 (86.7%) patients, including all patients with free-flowing empyema (19 patients), 63.6% of patients with multiloculated empyema (seven patients), and four (13.3%) patients required surgical intervention (surgical decortication). No procedure-related mortality or chronic morbidity occurred in this study. Conclusion MT is a simple, safe, minimally invasive, and effective modality in the management of empyema.

Evaluation of safety and diagnostic yield of pleural cryobiopsies during thoracoscopy Mona M Ahmed, Samar H AlSharkawy, Amr M Shoukri, Yousra T AbouBakr Egyptian Journal of Bronchology 2019 13(1):63-66 Background Biopsies using cryoprobe are now widely used in interventional pulmonology. There are only few data available on the use of cryotechnique through rigid thoracoscopy. Aim The aim of this work was to evaluate the diagnostic yield and safety of pleural cryobiopsies using rigid thoracoscopy. Patients and methods A total of 30 patients with undiagnosed exudative pleural effusion who underwent rigid thoracoscopy were included in our study. Biopsies were obtained from suspicious areas by rigid forceps and cryoprobe. Results A total of 30 patients with undiagnosed exudative pleural effusion have been analyzed. Histopathological results of thoracoscopic pleural biopsies revealed that the most common diagnosis was malignancy (50%), followed by tuberculosis (26.7%). Cryobiopsy specimens were larger than forceps biopsy specimens, with no difference in diagnostic yield (76.7%). Cryotechnique proved to be beneficial in cases of thin highly vascular pleura, allowing easier biopsies with lesser risk of bleeding. In cases of thickened fibrous pleura, there was no difference between both the techniques. Conclusion Pleural cryobiopsies through rigid thoracoscopy is a simple and safe procedure. It has a high diagnostic yield similar to rigid forceps biopsy, and it showed better performance in thin highly vascular pleura where biopsies can be performed with minimal risk of bleeding.

Advanced Pharmaceutical Technology & Research

Nanomedicine in prosthetic dentistry Upendra Nagaich Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):1-1

Quercetin prevent proteoglycan destruction by inhibits matrix metalloproteinase-9, matrix metalloproteinase-13, a disintegrin and metalloproteinase with thrombospondin motifs-5 expressions on osteoarthritis model rats Dian Agustina Permatasari, Deantari Karliana, Iskandarsyah Iskandarsyah, Ade Arsianti, Anton Bahtiar Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):2-8 Prior study has shown that Ageratum conyzoides L. extract that containing quercetin has been proved to prevent inflammation and proteoglycan degradation by inhibiting tumor necrosis factor-alpha and matrix metalloproteinase (MMP-9) expression. Target of osteoarthritis (OA) treatment was in the synovial joint that requiring a drug delivery system. The aim of this study was to prove the efficacy of quercetin-loaded lecithin-chitosan nanoparticles on the OA model rats by observed its effect on interleukin (IL-1) β, MMP-9, MMP-13, and a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS-5) expressions. In this study, 70 white male Sprague Dawley rats were divided into 14 groups, 7 groups each for destabilization of medial meniscus (DMM) and monoiodoacetate (MIA)-induced OA. After 28 days from induction, SHAM and negative group received gel base topically; positive group received sodium diclofenac gel; three-dose group received each 0.84, 1.68, 3.36 mg/g quercetin-loaded nanoparticles gel; and A. conyzoides L. group received A. conyzoides L. extract gel. Each group gets treatment until day 70, and then, blood sample was collected for serum analysis; knee joint was isolated and subjected to histology samples treatment. Quercetin-loaded nanoparticle gel dose 1 (0.84 mg/g gel), dose 2 (1.68 mg/g gel), dose 3 (3.36 mg/g), and A. conyzoides L. extract gel could decreased the level of IL-1 β, MMP-9, MMP-13, ADAMTS-5, and increasing color intensity significantly on histopathological observations on DMM and MIA-induced OA.

High mannoronic acid containing alginate affects the differentiation of Wharton's jelly-derived stem cells to hepatocyte-like cell Saeed Azandeh, Darioush Bijan Nejad, Vahid Bayati, Foroug Shakoor, Negar Varaa, Bahman Cheraghian Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):9-15 For transplantation of cell into injured tissues, cells should be transferred to the damaged site through an adequate carrier. Nevertheless, the nutrient-limited and hypoxic condition in the carrier can bring about broad cell death. This study set to assess the impact of alginate concentrations on the differentiation and the proliferation of cells encapsulated in alginate hydrogels. Human Wharton's Jelly-derived Mesenchymal Stem Cells (HWJ-MSCs) were encapsulated in two concentrations of alginate hydrogel. Then, the proliferation and the hepatic differentiation were evaluated with an MTT assay and the enzyme-linked immunosorbent assay software and urea production. The results demonstrated that the proliferation of cell and urea production in 1.5% alginate concentration was higher than in 2.5% alginate concentration in the hydrogels of alginate. We deduce that the optimized alginate hydrogel concentration is necessary for achieving comparable cell activities in three-dimensional culture.

The effect of venous caffeine on the prevention of apnea of prematurity in the very preterm infants in the neonatal intensive care unit of Shahid Motahhari Hospital, Urmia, during a year Zahra Fakoor, Ali Aghayar Makooie, Zahra Joudi, Rasool Gharaaghaji Asl Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):16-19 Due to the importance of prevention of apnea of prematurity in the very preterm infants and the side effects of using methylxanthines in preterm infants, the present study was conducted and aimed at investigating the effects of prophylactic caffeine on the incident of apnea (short-term consequence). This is a clinical–experimental trial, in which the infants were included after receiving written consent from their parents. The infants were randomly divided into two groups, namely, Group A (receive caffeine) and Group B (did not receive caffeine). After sampling of the collected data, the two groups were analyzed using statistical tests using SPSS software 23. Among the 50 infants in the caffeine group and 50 infants in the control group, 1 (2%) and 2 (4%) infants required long-term oxygen, respectively. Three (6%) infants from the caffeine group and 2 (4%) infants from the control group had an intraventricular hemorrhage. Two (4%) infants from the caffeine group and 1 (2%) infant from the control group had a positive patent ductus arteriosus and needed treatment. Among the 50 infants in the caffeine group and 50 infants in the control group, 7 (14%) and 9 (18%) infants had apnea, respectively. According to the Fisher's exact test, there was no significant difference between the incident of apnea in the two groups (P = 0.58). Ten (20%) infants from the caffeine group and 7 (14%) infants from the control group died. The prescription of prophylactic caffeine had no effect on the incident of apnea in the infants. Hence, the use of that should be limited to the preterm infants lower than 1250 g in the prophylactic form.

Proniosomal gel-mediated topical delivery of fluconazole: Development, in vitro characterization, and microbiological evaluation Amal Saber Mohammed Abu El-Enin, Maha Khalifa Ahmed Khalifa, Aya Mohammed Dawaba, Hamdy Mohammed Dawaba Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):20-26 The aim of this study was to explore the potential of proniosomal gel for topical delivery of fluconazole, an antifungal drug used in fungal infections caused by pathogenic fungi. Fluconazole-loaded proniosomal gels were prepared by the coacervation phase separation method using different nonionic surfactants (spans and tweens). The prepared fluconazole proniosomal gels were evaluated for various parameters such as particle size (PS), drug entrapment efficiency percentage (EE%), and in vitro drug release. The experimental results showed that the EE% for the prepared formulae are acceptable (85.14%–97.66%) and they are nanosized (19.8–50.1 nm) and the diffusion from the gels gave the desired sustaining effect. F4, which was prepared from span 60, tween 80 (1:1), and cholesterol showed highest EE% and gave slow release (40.50% ± 1.50% after 6 h), was subjected to zeta potential (ZP) test, transmission electron microscopy as well as microbiological study. The results showed a well-defined spherical vesicle with sharp boundaries with good physical stability of fluconazole within the prepared gel. Moreover, F4 showed an excellent microbiological activity represented by a greater zone of inhibition (5.3 cm) compared to control gel (fluconazole in 2% hydroxy propyl methyl cellulose (HPMC) gel formula) (4.2 cm) and plain gel with no drug (0 cm) against Candida albicans. This study showed the suitability of the proniosomal gel in attaining the desired sustainment effect for topical delivery of fluconazole for the management of fungal infection. The physical stability study showed that there was no significant change in EE%, PS, and ZP of fluconazole proniosomal gel after storage for 6 months.

The potency of chitosan-Pinus merkusii extract nanoparticle as the antioxidant and anti-caspase 3 on lead acetate-induced nephrotoxicity in rat Sri Agus Sudjarwo, Koerniasari Eraiko, Giftania Wardani Sudjarwo, Koerniasari  Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):27-32 The current study was carried out to evaluate the antioxidant and anti-caspase 3 activity of chitosan-Pinus merkusii nanoparticle in against lead acetate-induced nephrotoxicity in rats. chitosan-P. merkusii nanoparticle was characterized by dynamic light scattering (DLS) and scanning electron microscope (SEM). The male rats were divided into control group (rats were given with distilled water), lead acetate group (rats were injected with lead acetate 15 mg/kg BW i. p), and the treatment group (rats were given the chitosan-P. merkusii nanoparticle 150 mg, 300 mg, 600 mg/kg BW orally and were injected with lead acetate 15 mg/kg BW). The rats blood samples were measured levels of blood urea nitrogen (BUN) and creatinine. The kidney tissues were collected to evaluate the malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx). Histological to evaluate renal damage, and immunohistochemical to analyze the expression of caspase 3. The results showed that DLS showed the size of chitosan-P. merkusii nanoparticle was 165.9 ± 24.18 nm. SEM images of the chitosan-P. merkusii nanoparticles showed an irregular shape and its the rough surface. Administration of lead acetate resulted in a significant increase in levels of the BUN, creatinine, MDA level, caspase 3 expression, and a decrease in SOD and GPx were compared with the control group. Treatment with the chitosan-P. merkusii nanoparticle 600 mg/kg BW significantly decreased the elevated BUN, creatinine, MDA levels, caspase 3 expression and also increase in SOD and GPx as compared to lead acetate group. The lead acetate induced loss of the normal structure of renal cells and necrosis, whereas treated with chitosan-P. merkusii nanoparticle improved renal cell necrosis. This study indicates that chitosan-P. merkusii nanoparticles appeared to be a promising agent for protection against lead-induced nephrotoxicity through increasing antioxidant and inhibiting caspase 3 expression.

Effects of rosuvastatin on metabolic profile: Versatility of dose-dependent effect Hayder M Al-Kuraishy, Ali I Al-Gareeb Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):33-38 Obesity refers to an excess of body fat content causing metabolic and inflammatory disorders. Therefore, the aim of the present study was to investigate dose-dependent effect of rosuvastatin on the metabolic profile of diet-induced obesity in mice model study. A total number of 40 male Albino Swiss mice were used which divided into Group I: Control group, fed normal diet for 8 weeks (n = 10); Group II: High-fat diet (HFD) group, fed on HFD for 8 weeks (n = 10); Group III: HFD + 20 mg/kg rosuvastatin for 8 weeks (n = 10); and Group IV: HFD +40 mg/kg rosuvastatin for 8 weeks (n = 10). Anthropometric and biochemical parameters were estimated, including fasting blood glucose, lipid profile, fasting insulin, and glucose tolerance test (GTT). Mice on HFD fed showed a significant increase in the insulin resistance, body weight, deterioration of lipid profile and significant reduction in the β-cell function, and insulin sensitivity compared to the control P < 0.05. GTT and blood glucose level were significantly high in HFD fed group compared to the control group P < 0.05. Rosuvastatin in a dose of 40 mg/kg illustrated better effect than 20 mg/kg on the glucometabolic profile P < 0.05. Rosuvastatin may has a potential effect on reduction of glucometabolic changes induced by HFD with significant amelioration of pancreatic β-cell function in dose-dependent manner.

Assessment of the fitness of Cox and parametric regression models of survival distribution for Iranian breast cancer patients' data Maryam Mohseny, Reza Shekarriz-Foumani, Parastoo Amiri, Marjan Vejdani, Pezhman Farshidmehr, Hossein Zabihi Mahmoudabadi, Farzaneh Amanpour, Pegah Mohaghegh, Farzad Tajdini, Azadeh Sayarifard, Esmat Davoudi-Monfared Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):39-44 Factors affecting the time of survival after breast cancer (BC) diagnosis remain unknown. However, some of the prognostic factors have been identified. The aim of this study was to investigate the effects of biologic and socioeconomic factors on long-term survival of BC patients. This was a descriptive chart review and survey of all women with a confirmed diagnosis of BC registered in Shohada-e-Tajrish Cancer Research Center database from March 2004 to March 2015. The checklist of study consisted of biologic, demographic, reproductive, genetic, medical, and therapeutic information of patients. The minimum time of follow-up was 3 years and the maximum was 10 years. We then evaluated possible associations of these variables with BC survival using Cox and parametric regression models of survival analysis. The study population was 1276 BC patients. Their mean survival was 23 (range 1–120) months. Between the parametric models, Weibull regression model demonstrated the lowest Akaike information criterion and thus the best fit, and tumor size, number of lymph nodes, BC stage, educational level, and high-fat diet were significant in this model. Based on our findings, educational level, consumption of fat, and characteristics of tumor at the time of diagnosis (disease stage, tumor size, number of involved lymph nodes) are the most important prognostic factors affecting long-term survival of BC patients. We suggest that future studies assess the efficacy of possible interventions for these factors.

Pharmacy And Bioallied Sciences

Date palm (Phoenix dactylifera L.) fruit as potential antioxidant and antimicrobial agents Hussah A Al-Shwyeh Journal of Pharmacy And Bioallied Sciences 2019 11(1):1-11 Date palm (Phoenix dactylifera L.) is the most popular fruit in the Middle East and North Africa. It is consumed widely and has been used for traditional medicine purposes for a long time. The fruits are nutrient rich, containing dietary fibers, sugar, protein, vitamins, minerals, flavonoid, and phenolic compounds. Due to the presence of the phenolic compounds, date palm fruits are antioxidant rich with potent bioactivities against several bacterial pathogens. Therefore, on the basis of the available evidence as reviewed in this paper, it was found that date fruits are a good source of natural antioxidants, which can be used for the management of oxidative stress–related and infectious diseases.

Biosimilars in India; current status and future perspectives Bikash R Meher, Sakthi Balan, Rashmi R Mohanty, Monalisa Jena, Smita Das Journal of Pharmacy And Bioallied Sciences 2019 11(1):12-15 Many key biologics are scheduled to lose their patent by the year 2020, which will provide the opportunity to other biopharmaceutical companies to develop the similar biologics. Biosimilar or similar biologic used has increased in the recent year following the approval of the first biosimilar in early 2000. India is one of the leading manufacturers of similar biologics. India has developed a new guideline in 2012 for the pre- and post-marketing approval of similar biologics.

High-performance liquid chromatographic analysis explores the potential antioxidative agents of Argyreia argentea ARN. EX CHOISY extract Md. Nazim Uddin, Md. Atiar Rahman, Hemayet Hossain, Tanzir Ahmed Khan, Rehana Akter Journal of Pharmacy And Bioallied Sciences 2019 11(1):16-22 Background: Antioxidative properties of medicinal plants play the key role in plant defense mechanism. Argyreia argentea is an evergreen shrub which is used in the treatment of boils, gastric ulcers, tumor, marasmus, paralysis and spermatorrhea, rheumatoid arthritis, cold, painful sensation, and fever. Aims: This research investigates the phytochemical contents and antioxidative effects of optimized crude methanol extract of A. argentea. Materials and Methods: Crude methanol extract of A. argentea prepared in an optimized procedure has been analyzed by high-performance liquid chromatography to quantitatively determine the phytochemical contents. Tannin content of the extract was determined by established method. The extract was also analyzed for in vitro antioxidative actions by spectrophotometric analysis using 2,2’-azino-bis(3-ethylbenzo-thiazoline-6-sulfonic acid) diammonium salt (ABTS) method, N, N-dimethyl-1,4-diaminobenzene (DMPD) free radical scavenging method, superoxide radical scavenging method, and nitric oxide scavenging method. Results: The experimental results showed a high amount of catechin hydrate (348.62mg/100g of dry extract) and moderate amount of gallic acid, p-coumaric acid, and rutin hydrate in the methanol extract of A. argentea. Tannin content was found to be 29.66mg/g tannic acid equivalent. Scavenging effects expressed as inhibition concentrations (IC50) for ABTS assay, DMPD assay, superoxide assay, and NO assay were 1148.3 µg/mL ± 7.32 µmol ascorbic acid/g, 1017.68 µg/mL, 1116.89 µg/mL, 1835.23 µg/mL, respectively. All the values were compared with their respective standards. No β-carotene was detected in the extract. Conclusions: Use of A. argentea extract as a source of functional food as well as an antioxidative agent could be considered with further confirmation.

Cysteine supplementation mitigates the toxicity associated with antitumor therapy of Ehrlich's ascites fluid adsorbed over protein a containing Staphylococcus aureus cowan I† Ashish S Verma, Anchal Singh, Priyadarshini Mallick, Premendra D Dwivedi Journal of Pharmacy And Bioallied Sciences 2019 11(1):23-32 Introduction: Previously, we have reported the amelioration of ad-AF induced hepatotoxicity with the exogenous supplementation of glutathione (GSH) without compromising the anti-tumor effect of ad-AF in ascites tumor model of mice with transplantable Ehrlich’s Ascites Tumor cells. Cellular uptake of glutathione (GSH) has its own limitations, therefore exogenous supplementation of L-cysteine (Cys) was tried to reduce the toxicity of ad-AF by providing –SH contents without compromising the anti-tumor property of adsorbed ascites fluid (ad-AF). Results: A significant increase in mean survival time (MST) of tumor bearing mice from 18.1 days to 32.9 days with exogenous supplementation of Cys was observed. Cys supplementation did not alter decline in body-weight gain, tumor cell counts as well as decrease in the viability of tumor cells in ascites tumor bearing animals. Similarly, Cys has been helpful to restore the hepatic –SH contents upto the levels of –SH content in tumor control group. The exogenous supplementation of Cys along with ad-AF has been helpful to restore the decline in the activities of phase-I and enhanced levels of glutathione-S-transferase (GST). The changes in the activities of different enzymes of phase-I and phase-II indicate the reduction in toxic insult induced by the therapeutic material (ad-AF). However, ad-AF treatment could not prevent tumor bearers from natural death due to tumor progression but significantly reduced the rate of tumor progression. Conclusions: Our study suggests that exogenous supplementation of Cys alongwith ad-AF could have a potential to be developed as a modality for the treatment of ascites tumor at least at experimental level.

Effect of Azadirachta indica crude bark extracts concentrations against gram-positive and gram-negative bacterial pathogens Shreelakshmidevi Singaravelu, Jaikumar Sankarapillai, Abilash Sasidharn Chandrakumari, Pammy Sinha Journal of Pharmacy And Bioallied Sciences 2019 11(1):33-37 Background: Today’s pharmaceutical markets are crowded with antibacterial agents, yet their toxicities and resistance are always contentious. Azadirachta indica is used in India as an age-old treatment for diverse medical conditions. This study was put forth to analyze the antibacterial action of A. indica bark extract on different bacterial pathogens. Materials and Methods: A. indica bark extract was prepared using Soxhlet extraction method. The bark extract of A. indica was screened for antibacterial activity by agar well diffusion assay technique against Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, and Proteus mirabilis. Ciprofloxacin (5 µg per disc) was used as positive control. All assays were carried out under strict aseptic precautions. All the concentrations included were duplicated, and the results obtained were the average of two independent experiments. Broth microdilution method was used to study the minimum inhibitory concentration of the bark extract of A. indica. Results: A. indica bark extract has shown antibacterial activity against all concentrations of bark extract, whereas antibacterial activity against S. aureus was observed at higher concentration of >500 µg/mL. The bark extract of A. indica showed zone of clearance against E. faecalis, P. aeruginosa, and P. mirabilis at all concentrations. Zone of inhibition was observed in higher concentrations against S. aureus. Conclusion: This study has shown that A. indica bark extract has a potent antibacterial property against S. aureus, E. faecalis, P. aeruginosa, and P. mirabilis. Further isolation of bioactive compounds may lead to a new scope in the treatment of bacterial infections.

Apoptosis-mediated cytotoxic effect of Caralluma adscendens var. attenuata on colon (HT29) and Hepatic (HepG2) cancer cell lines Mallela Vijaya Jyothi, Eranti Bhargav, Chilamakuru Naresh Babu, Kanala Somasekhar Reddy, Bhupalam Pradeep Kumar, Ravi Prasad Rao Journal of Pharmacy And Bioallied Sciences 2019 11(1):38-42 Introduction: Caralluma adscendens var. attenuata (Wight) Grav. and Mayur., a member of Apocynaceae, is a perennial stem succulent plant with wide distribution in tropics and subtropics of the world. This plant is reported for the presence of steroids, flavonoids, saponins, triterpenes, and pregnane glycosides, and is known to have antidiabetic and antiulcerogenic properties. Materials and Methods: In this study, an attempt was made to identify antioxidant capacity and cytotoxic potential of n-hexane and aqueous methanolic extracts of total stem part of C. adscendens var. attenuata. Antioxidant activity was evaluated by total phenolic content assay, total flavonoid content assay, free radical scavenging activity, and reducing ability methods. Cytotoxic activity was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide (MTT) assay and nuclear staining methods for colorectal cancer cell lines HT29 and liver cancer cell lines HepG2. Results: MTT assay method has proven that the IC50 value was 10 μg/mL for both extracts, whereas for cisplatin standard, it was 2 μg/mL. By nuclear staining, the apoptotic cells were identified as oval masses with dark cytoplasm and dense green nuclear chromatin fragments indicating the programmed cell death for both n-hexane and aqueous methanolic extracts at the same concentration (10μg/mL). Conclusion: However, aqueous methanolic extract showed prominent cytotoxic potential against both cancer cell lines.

Comparison and evaluation of different seed extracts of Trachyspermum ammi for immunomodulatory effect on cell-mediated immunity through delayed-type hypersensitivity assay skin thickness method Mohammad Jamshed Siddiqui, Adeel Aslam, Tanveer Khan Journal of Pharmacy And Bioallied Sciences 2019 11(1):43-48 Objective: The aim and objective of this study was to find the immunostimulant and immunomodulatory effect of T. ammi seed extracts. Methods: Seeds of T. ammi were extracted using three different solvents n-hexane, chloroform, and methanol by using soxhlet apparatus. To assess the immunomodulatory effect, delayed-type hypersensitivity (DTH) assay method was used and by the DTH assay, the effect of T. ammi on the skin thickness of rats was estimated. To find the exact dose for administration, acute toxicity test was performed using crude methanolic extract at a dose of 400, 800, 1600, and 3200mg/kg. After acute toxicity test, 500mg/kg dose was determined as safe for therapeutic effect and immunomodulatory effect was evaluated at this dose. Dose of 500mg/kg was administered to Wistar rats daily for 14 days and skin thickness of rats was measured at 24, 48, and 72h. Results: Results were obtained from six groups of rats, which were positive control group, negative control group, and the groups receiving the test drugs. Standard drug was the combination of sodium selenite, vitamin E, and sodium chloride and it showed more positive results as compared to that of test drug. Furthermore, among the three extracts, methanol extract showed more effectiveness on skin thickness. Conclusion: There was a meaningful difference was observed between the skin thickness of rats which shows that T. ammi have good immunomodulatory as well as immunostimulant activity.

Development and validation of liquid chromatography method for determination of glimepiride in presence of (Vimto®) soft drinks in rats: application to pharmacokinetics studies Mohammed Hamad, Areej Rahhal, Wael Abu Dayyih, Eyad Mallah, Alice Abu Dayyih, Zainab Zakaria, Tawfiq Arafat Journal of Pharmacy And Bioallied Sciences 2019 11(1):49-59 Context: Diet and beverages are thought to have notable effects on drugs. Recently, this relationship has received significant consideration. Aims: To develop and validate a simple, rapid, and sensitive method for the determination of glimepiride in rat serum. This will be performed using high-performance liquid chromatography–mass spectrometry (HPLC-MS/MS). Potential pharmacokinetic interactions between glimepiride and the soft drink, Vimto, will also be investigated in the serum of experimental rats. Materials and Methods: HPLC-MS/MS was constructed and clarithromycin was used as an internal standard. Results: The method was validated in terms of linearity, precision, accuracy, stability, and system suitability parameters. The method was found to be satisfactory and suitable for the determination of glimepiride. The precision of glimepiride was high (coefficient of variation, CV% <15%), the accuracy over all 3 days of validation was within the accepted criteria. Glimepiride peak serum concentration (Cmax) was 126.01ng/mL and was reached within 1h (Tmax) of administration. Mean area under curve (AUC) was 964.70ng/mL and was reached within 24h of administration. The Vimto soft drink significantly (P < 0.050) reduced glimepiride peak serum concentration to 57.87ng/mL and was reached within 2h of administration. AUC was significantly reduced to 335.04 ng*h/mL (P < 0.050). Conclusion: Glimepiride pharmacokinetic parameters such as Cmax and AUC were significantly affected by the Vimto soft drink. Therefore, this study developed a simple, rapid, and sensitive method for validation and determination of the effects of soft drinks on drugs using the LC-MS/MS method.

Antioxidant potential of Solanum nigrum aqueous leaves extract in modulating restraint stress-induced changes in rat's liver Syed K Zaidi, Shakeel A Ansari, Shams Tabrez, Muhammad I Naseer, Moyad J Shahwan, Naheed Banu, Muhammad H Al-Qahtani Journal of Pharmacy And Bioallied Sciences 2019 11(1):60-68 Introduction: This study was carried out to evaluate the antioxidant potential of crude extract of Solanum nigrum leaves and its active constituents as treatment against restraint stress in rat’s liver. Methods: For this purpose, male albino Wistar rats were treated with crude extract of leaves and its alkaloid and flavonoid fractions both before and after 6 h of acute restraint stress. Prooxidant status of rat liver was assessed by determining the levels of thiobarbituric acid reactive substances, reduced glutathione, alkaline phosphatase, alanine transaminase, aspartate aminotransferase, and the activities of antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione S-transferase (GST). Results: Six hours of restraint stress generated oxidative stress in rat’s liver resulted in a significant rise in the level of the aforementioned liver enzymes. On the other hand, SOD, CAT, and GST enzymatic activities showed a significant decline in their level. The administration of crude leaves extract, both before and after stress exposure, significantly prevented the rise in the level of liver enzymes and reverted the activities of studied biochemical parameters toward their normal control values. However, the reversion was found to be more prominent in after-stress group. Conclusion: The aforementioned results highlight the significant antioxidant potential of S. nigrum extracts. On the basis of our study, we suggest the possible use of S. nigrum leaves extract as a nutritional supplement for combating oxidative stress induced damage.

Impact of pharmacist-directed counseling and message reminder services on medication adherence and clinical outcomes in type 2 diabetes mellitus Narayana Goruntla, Vijayajyothi Mallela, Devanna Nayakanti Journal of Pharmacy And Bioallied Sciences 2019 11(1):69-76 Introduction: Medication nonadherence is the most common issue observed in the management of diabetes because of complex and lifelong therapy. The study aimed to assess the effect of pharmacist-directed counseling and daily text message reminder on medication adherence and clinical profile of patients with type II diabetes. Materials and Methods: This prospective, open-labeled, randomized control trial was carried out in outpatient medical department of a secondary care referral hospital. A total of 330 patients who met study criteria were enrolled and randomized into an intervention group (n = 165), received counseling and daily messages about medication intake and control group (n = 165), and usual care by physician. Medication adherence and clinical outcomes such as glycosylated hemoglobin (HbA1C), systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol, triglyceride (TG) levels, and body mass index (BMI) were recorded at baseline and follow-up visits. Two-sample Wilcoxon rank sum test was used to compare the mean difference of medication adherence and paired t-test was used to compare clinical outcomes. Results and Discussion: The mean age of intervention and control groups were 57.1±8.55 and 58.5±8.53 years, respectively. The mean difference of medication adherence from baseline to second follow-up visit was significantly more in intervention group (12.2±7.1%) compared to that in control group (0.75±10.2%) with a P < 0.001. From baseline to second follow-up visit, HbA1C (7.79±0.67 to 6.91±0.83%), SBP (136.75±20.09 to 126.23±18.22mm Hg), and LDL cholesterol (104.14±26.23 to 98.29±20.87mg/dL) levels were significantly reduced in intervention group compared to that in control group with a P < 0.01. No significant improvement was observed in TG (169±33.71 to 168 65±33.90mg/dL) and BMI (27.9±4.21 to 27.1±3.12Kg/m2) levels from baseline to second follow-up visit. Conclusion: Pharmacist-directed patient counseling combined with message reminder showed a greater effect on the improvement of medication adherence and control of glycemia, blood pressure, and lipid profile in diabetes.

Hepatotoxicity induced by immune checkpoint inhibitors, Drug–drug interactions of a two-drug regimen of dolutegravir and lamivudine for HIV treatment,Enhancement of lung levels of antibiotics by ambroxol and bromhexine,Pharmacokinetic considerations for anti-epileptic drugs in children

New for Expert Opinion on Drug Metabolism & Toxicology and online now 
   on Taylor & Francis Online 


   Pharmacokinetic considerations for anti-epileptic drugs in children 
   Alberto Verrotti, Giulia Iapadre, Giulia Di Donato, Ludovica Di 
   Francesco, Luca Zagaroli, Sara Matricardi, Vincenzo Belcastro & Maria 
   Laura Iezzi 
   Pages: 1-13 
   DOI: 10.1080/17425255.2019.1575361 
   https://www.tandfonline.com/action/doSecureKeyLogin?uuid=d8594a82-ce8d-4e6c-8a1f-0da062c12f34&dateTime=201902121215&key=VDPNBUIz5a0xwGlHxXUPEU%2BIEkmdS3eDJoUSKBla%2BAE%3D&uri=https%3A%2F%2Fwww.tandfonline.com%2Fdoi%2Ffull%2F10.1080%2F17425255.2019.1575361%3Fai%3D1ws9i%26ui%3D843fx%26af%3DT 

   Enhancement of lung levels of antibiotics by ambroxol and bromhexine 
   Vojo Deretic & Graham S. Timmins 
   Pages: 1-6 
   DOI: 10.1080/17425255.2019.1578748 
   https://www.tandfonline.com/action/doSecureKeyLogin?uuid=d8594a82-ce8d-4e6c-8a1f-0da062c12f34&dateTime=201902121215&key=VDPNBUIz5a0xwGlHxXUPEU%2BIEkmdS3eDJoUSKBla%2BAE%3D&uri=https%3A%2F%2Fwww.tandfonline.com%2Fdoi%2Ffull%2F10.1080%2F17425255.2019.1578748%3Fai%3D1ws9i%26ui%3D843fx%26af%3DT 

   Drug–drug interactions of a two-drug regimen of dolutegravir and 
   lamivudine for HIV treatment 
   Dario Cattaneo, Amedeo Capetti & Giuliano Rizzardini 
   Pages: 1-8 
   DOI: 10.1080/17425255.2019.1577821 
   https://www.tandfonline.com/action/doSecureKeyLogin?uuid=d8594a82-ce8d-4e6c-8a1f-0da062c12f34&dateTime=201902121215&key=VDPNBUIz5a0xwGlHxXUPEU%2BIEkmdS3eDJoUSKBla%2BAE%3D&uri=https%3A%2F%2Fwww.tandfonline.com%2Fdoi%2Ffull%2F10.1080%2F17425255.2019.1577821%3Fai%3D1ws9i%26ui%3D843fx%26af%3DT 

   Hepatotoxicity induced by immune checkpoint inhibitors: a 
   comprehensive review including current and alternative management 
   strategies 
   Joseph J. Jennings, Rohan Mandaliya, Ahmad Nakshabandi & James H. 
   Lewis 
   Pages: 1-14 
   DOI: 10.1080/17425255.2019.1574744 
   https://www.tandfonline.com/action/doSecureKeyLogin?uuid=d8594a82-ce8d-4e6c-8a1f-0da062c12f34&dateTime=201902121215&key=VDPNBUIz5a0xwGlHxXUPEU%2BIEkmdS3eDJoUSKBla%2BAE%3D&uri=https%3A%2F%2Fwww.tandfonline.com%2Fdoi%2Ffull%2F10.1080%2F17425255.2019.1574744%3Fai%3D1ws9i%26ui%3D843fx%26af%3DT