Hepatoprotective Effect of Rheum emodi Roots (Revand chini) and Akseer-e-Jigar Against Paracetamol-induced Hepatotoxicity in Rats

Hepatoprotective effects of Rheum emodi roots and their aqueous and methanolic extracts were studied against liver damage induced by paracetamol in albino rats. In addition, the effects of herbal preparation, Akseer-e- Jigar and a control drug, silymarin were also studied. Pretreatment and post-treatment hepatoprotective effects of all these drugs were determined. The prevention of liver damage and curative effects of the drugs were judged by changes in serum ALT, AST, ALP, albumin and bilirubin (total and direct) levels. Powdered Rheum emodi roots (1 and 1.5 g/kg) and their aqueous extract did not significantly affect serum enzymes, albumin and bilirubin levels. However, treatment with powder (2 g/kg), methanolic extract (0.6 g/kg), Akseer-e-Jigar (1 g/kg) and silymarin (50 mg/kg) in both pre and post-treatment studies significantly prevented the paracetamol-induced rise of serum enzymes and bilirubin levels whereas serum albumin was raised after treatment with these drugs. It is conceivable, therefore, that Rheum emodi roots and Akseer-e-Jigar possess hepatoprotective principles that can prevent and/or treat liver damage due to paracetamol. The study has supported empirical use of the plant and its compound preparation used in traditional medicine

Determinants of Increasing Trend of Self-Medication in a Pakistani Community

Purpose: To determine the major reasons, sources, diseases and drugs responsible for increasing trend of self-medication.Method: A community-based cross-sectional survey was carried out in the district of Faisalabad in Pakistan. Respondents (1488) were classified on the basis of age, sex, education, lifestyle and their economical level. A questionnaire was distributed among the sample population to collect data.Results: Majority of respondents involved in self-medication were aged between 15 and 20 years. Family members (N = 717, 48 %) were considered the major source of information for self-medicated drugs. Lack of time (N = 504, 37 %) while economic issues (N = 485, 33 %) were the major reasons for self-medication. Medical stores were the source of drug purchase by 1087 (73 %) respondents. Headache (N = 772, 52 %) and fever (N = 600, 40 %) were the main indications for self-medication while 694 respondents reported that they engage in single-dose self-medication. Paracetamol (N = 689, 46 %), other analgesics (N = 488, 33 %),  non-steroidal anti-inflammatory (N = 680, 46 %) were reported to be used frequently for self-medication.Conclusion: Self-medication is prevalent in the Pakistani community due to easy access to over the counter (OTC) and prescription-only medicines  (POM). This may lead to untoward effects in consumers of the products. Special interventions by relevant regulatory agencies regarding the sale of the drugs are therefore required.Keywords: Self-medication, OTC drugs, Pharmacist

Antihypertensive Activity of Aqueous-Methanol Extract of Berberis Orthobotrys Bien Ex Aitch in Rats

Purpose: To investigate the hypotensive potential of Berberis orthobotrys Bien Ex Aitch (Family: Berberidaceae) in both normotensive and hypertensive rats.Methods: Aqueous-methanol (70:30) extract of Berberis orthobotrys at doses of 25, 50, 75 and 100 mg/kg was evaluated for its effect on blood pressure and heart rate using non-invasive blood pressure measuring apparatus. After initial screening, 100 mg/kg dose that produced a maximum effect was selected for the antihypertensive study. Median lethal dose (LD50) and sub-chronic toxicity of the extract were also determined. Various biochemical parameters and organ weight were measured usingstandard procedures.Results: The extract produced a significant (p < 0.01) decrease in systolic blood pressure (SBP), mean blood pressure (MBP), diastolic blood pressure (DBP) and heart rate of normotensive rats at all test doses with maximum effect at 100 mg/kg. Similarly, a significant antihypertensive and negative chronotropic effect was observed in both hypertensive models. LD50 of the extract was 200 mg/kg in mice. The extract also exhibited a reduction (p < 0.05) in serum alanine transaminase (ALT), aspartate aminotransaminase (AST), alkaline phosphatase (ALP), triglycerides and low density lipoprotein (LDL) levels while a significant (p < 0.05) increase in high density lipoproteins (HDL) level was observed.Conclusion: It seems that the aqueous-methanol extract of Berberis orthobotrys possesses active compounds which may be responsible for the antihypertensive and negative chronotropic effects in rats.Keywords: Berberis orthobotrys, Antihypertensive, Egg feed diet, Blood lipid

Investigation of the cardiac depressant effect of Caralluma tuberculate N.E.Br on isolated rabbit heart

Purpose: To investigate the histopathological and cardiac depressant effect of the aqueous methanol extract of Caralluma tuberculata N.E. Br (AMECT) (family: Asclepiadaceae)’ and to determine if there is a scientific basis for its cardiovascular diseases-related folkloric use. Methods: The effect of AMECT in different concentrations ranging from 0.00001 to 1.0 mg/mL were evaluated in isolated perfused rabbit heart to assess their effect on the force of contraction and heart rate using Langendorff’s apparatus. Atropine and adrenaline were used to identify the underlying mechanism of response produced by AMECT. The extract was studied for its possible mechanism in the absence and presence of atropine and adrenaline. In addition, sub-chronic toxicity and histopathological study of heart tissues in rats were assessed by administering 500 mg/kg of extract. Results: At all concentrations, AMECT produced significant (p < 0.001) negative ionotropic and negative chronotropic effects. The most significant effect was observed at 0.001 mg/mL and higher concentrations hence 0.001 mg/mL was selected for further studies. Pre-incubation with atropine did not significantly inhibit the effects of AMECT. However, AMECT significantly (p < 0.01) blocked the cardiac stimulant effect of adrenaline. In the histopathological studies, AMECT did not produce any significant cellular changes or signs of toxicity in the sub-chronic toxicity study. Conclusion: The cardiac-depressant responses of AMECT may involve the β-adrenergic receptors in the myocardium of isolated rabbit heart thus confirming the rationale for its use in ethnomedicine for cardiac diseases

Prevalence and Impact of Psychological Disorders on Pharmacotherapy of Diabetic Patients in Low Resource Settings: A Prospective Assessment in Primary Healthcare Settings

Kiran Shahbaz,1 Alamgeer,1 Vibhu Paudyal,2 Maryam Zubair,3 Maryam Zahra Safdar,4 Momina Tahir,4 Laraib Akram,4 Salamat Ali4 1Department of Pharmacology, University College of Pharmacy, University of the Punjab Lahore, Pakistan; 2Institute of Clinical Sciences, University of Birmingham, Edgbaston Birmingham, UK; 3Faculty of Experimental Medicine Orebro University, Sweden; 4Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, GC University Faisalabad, Faisalabad, PakistanCorrespondence: Salamat Ali, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, GC University Faisalabad, Faisalabad, Pakistan, Tel +00-92-3004189052; +00-92-041-9201036, Email [email protected]: Prevalence of psychological disorders among individuals with diabetes is significantly higher as compared to the general population.Aim: This study aimed to assess the prevalence and impact of psychological disorders on pharmacotherapy of diabetes patients.Methodology: This cross-sectional study was conducted at two primary care hospitals in Pakistan from April to June 2023. The nine-item Patient Health Care Questionnaire (PHQ-9) scale was used to assess depression in the study’s population, and its effects on pharmacotherapy of diabetes. Chi-square test was used to evaluate relationship between ordinal variables/categorical variables and depression whereas; Student’s t-test was used to assess the relationship between numerical variables with depression.Results: A total of 320 patients were assessed, comprising 120 (37.5%) males and 200 (62.5%) females, with a mean age of 52.5 (SD± 11.8) years. The average duration of diabetes is 7.0 (SD± 5.4). The average PHQ-9 score was 8.3 (SD± 5.5). Depression was found to be prevalent in 43.7% of the study population. Gender (female) (p-value 0.002), advanced age (p-value 0.002), lower income (p-value 0.001), education levels (p-value 0.001), longer duration of diabetes (p-value 0.001), poor diabetes control according to BSR value (p-value 0.001), usage of injectable insulin (p-value 0.005), and concomitant diseases (p-value 0.001) were found to be independently linked with depression. Significant association was observed between depression and treatment adherence (p-value 0.0025), number of missed doses (p-value 0.045), and difficulty in diabetes management (p-value 0.0015).Conclusion: Our study highlights significant prevalence of depression in study population and the prevalent depression negatively impacts on treatment adherence. It also revealed that depression complicates diabetes management resulting in poor medication adherence, poor diabetes control and diabetes related complications, making diabetes control more challenging and difficult.Keywords: psychological disorders, diabetes, pharmacotherapy, PHQ-

Immune checkpoint inhibitor therapy for advanced cutaneous squamous cell carcinoma in Australia: A retrospective real world cohort study

Objectives: To review the outcomes of immune checkpoint inhibitor (ICI) treatment of advanced cutaneous squamous cell carcinoma (CSCC) outside clinical trials. Study design: Retrospective observational study; review of patient records in fifteen Australian institutions. Setting, participants: All Australian adults with locally advanced or metastatic CSCC not amenable to curative surgery or radiotherapy treated with ICIs, 5 May 2017 – 23 May 2022, through a cemiplimab compassionate access scheme (Therapeutic Goods Administration Special Access Scheme) or who personally covered the cost of pembrolizumab prior to the start of the access scheme. Main outcome measures: Best overall response rate (ORR) according to standardised assessment criteria using the hierarchy: Response Evaluation Criteria in Solid Tumors (RECIST 1.1), the modified World Health Organization clinical response criteria, and the Positron Emission Tomography Response Criteria (PERCIST 1.0); overall and progression-free survival. Results: A total of 286 people with advanced CSCC received ICI therapy during May 2017 – May 2022 (cemiplimab, 270; pembrolizumab, 16). Their median age was 75.2 years (range, 39.3–97.5 years) and 232 were men (81%); median follow-up time was 12.2 months (interquartile range, 5.5–20.5 months). Eighty-eight people (31%) were immunocompromised, 27 had autoimmune disease, and 59 of 277 (21%) had ECOG performance scores of 2 or 3. The ORR was 60% (166 of 278 evaluable patients): complete responses were recorded for 74 (27%) and partial responses for 92 patients (33%). Twelve-month overall survival was 78% (95% confidence interval [CI], 72–83%); progression-free survival was 65% (95% CI, 58–70%). Poorer ECOG performance status was associated with poorer overall survival (per unit: adjusted hazard ratio [aHR], 3.0; 95% CI, 2.0–4.3) and progression-free survival (aHR, 2.4; 95% CI, 1.8–3.3), as was being immunocompromised (overall: aHR, 1.8; 95% CI, 1.1–3.0; progression-free: aHR, 1.8; 95% CI, 1.2–2.7). Fifty-five people (19%) reported immune-related adverse events of grade 2 or higher; there were no treatment-related deaths. Conclusion: In our retrospective study, the effectiveness and toxicity of ICI therapy were similar to those determined in clinical trials. Our findings suggest that ICIs could be effective and well tolerated by people with advanced CSCC who are ineligible for clinical trials