Evaluation of Susceptibility and Resistance of Human Infectious Bacteria and Identification of Bioactive Compounds in Pistacia atlantica, Cassia absus, and Quercus persica

Background: The antimicrobial activity of plants has long been considered an effective mechanism for controlling pathogenic microorganisms. Objectives: This study aimed to identify phytochemical compounds of the seed extracts from ethnomedicinal plants of Pistacia atlantica, Cassia absus, and Quercus persica with Gas Chromatography-Mass Spectrometry (GC-MS) and investigation of their antibacterial and antioxidant activities. Methods: The seeds were collected from Lorestan Province, Iran. Their antibacterial and antiradical activities were analyzed by disk-diffusion and 2,2-diphenyl-1-picrylhydrazyl assays, respectively. Ethanol (96%), methanol (80%), and distilled water extracts were obtained by the maceration method. The methanol extract was used for the analysis of chemical compositions. Results: About 40, 31, and 8 compounds were identified by GC-MS in the seeds of C. absus, P. atlantica, and Q. persica, respectively. Results indicated that 2,4-di-tert-butylphenol (36.043%) and tetradecanoic acid (4.92%) were dominated in the seed extracts of C. absus. However, germacyclopetene (38.119%) and 1,2,3-benzenetriol (8.115%) were dominated in the seed extracts of P. atlantica. Furthermore, 5H-tetrazole-5-thione, 1,4-dihydro-1,4-dimethy (38.505%), and tetradecanoic acid (30.546%) were dominated in the seed extracts of Q. persica. The highest inhibitory activity against Micrococcus luteus was observed on the methanol extract of C. absus with ascorbic acid. A significant difference was observed between the Inhibitory Concentration (IC50) values of methanol extract of C. absus with ascorbic acid. Conclusion: Because of the presence of antimicrobial compounds in the tested ethnomedicinal plants, they can be used to synthesize new antimicrobial drugs in medicinal and pharmaceutical sciences.

Doctors Perception of the Use of Hydroxychloroquine as Prophylaxis for COVID-19 Infection

Background: The National Task force constituted by the Indian Council of Medical Research (ICMR) and various International agencies has recommended the use of Hydroxychloroquine (HCQ) as prophylaxis for Coronavirus Disease 2019 (COVID-19). This measure was taken because of the urgent need to protect high-risk individuals like Health Care Workers (HCW) from contracting COVID-19. Objectives: This study aimed to assess the awareness, attitudes, and practices on using HCQ as prophylaxis to prevent COVID-19 infection. Methods: A cross-sectional study was conducted among the doctors working in Dr RML Hospital, New Delhi, India, a tertiary care public hospital involved in the care of COVID-19 patients. The invitation to participate was electronically circulated, and the consenting participants were allowed to access an online survey. The survey had a total of 23 questions that were designed to understand the awareness, perception, and practices of doctors regarding the use of HCQ as prophylaxis in COVID-19. Results: About 147 doctors participated in this survey. The major source of knowledge regarding HCQ prophylaxis was quoted as regulatory agencies (44%), particularly ICMR, and the main indication was reported as being a healthcare worker (60%). Most of the participants (91%) believed that the HCQ effect is not clear and felt more scientific data regarding the use of HCQ as prophylaxis for COVID-19. But many doctors (51%) still recommend using HCQ to their colleagues. Conclusion: In this study, we observed that most doctors were aware of the recommendations regarding the HCQ prophylaxis in COVID-19 and had good adherence to therapy but felt the need for more concrete scientific evidence for using HCQ.

COVID‐19 Pandemic: Management and Challenges

Background: Coronavirus Disease 2019 (COVID-19) is an ongoing pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‑CoV‑2). The outbreak was first identified in Wuhan, China, in December 2019. Objectives: This review gives a bird’s-eye view of the COVID-19 pandemic and its various effects on human society. Since knowledge about this virus is rapidly evolving, readers are urged to update themselves regularly. Methods: In this review, our searching was performed on international databases of Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) from October 2019 to June 2020. Results: Most patients infected with COVID‑19 have mild symptoms. Approximately 15% of patients have severe pneumonia, and about 5% acute distress syndrome or organ failure. In the absence of definitive treatment and vaccines, the most effective measure is to prevent infection, particularly in those at high risk of taking the severe form of the disease with adverse outcomes. Pharmacotherapy is essentially supportive; the role of antiviral agents is yet to be established. The commonest drugs used in treating this viral disease are tocilizumab, remdesivir, favipiravir, and camostat mesilate. Also, drugs related to malaria, AIDS, and Ebola, such as hydroxychloroquine, are widely used. Based on physical examinations alone, it is impossible to comment with certainty in mild cases of the disease. Accordingly, a wide range of methods is used for diagnosing and treating the disease. Various variables in reducing the severity of the epidemic and the effects of the virus require special management at the national, regional, and global levels. Conclusion: This review summarizes the latest findings in safety, management, and public services related to the COVID-19 virus epidemic.

Poisoning and its Management in Healthcare Facilities in Lagos State, Nigeria

Background: Poisons are chemical substances that produce harmful effects on the body. About 0.3 million people die annually from poisoning. Poisons are produced by animals, plants, microorganisms, and food contamination. Poisoning is a global public health problem, especially in children and teenagers and healthcare providers ought to provide protocols for its management. Objectives: The main aim of this study was to document the mode, knowledge of antidotes, and management of poisoning by healthcare providers in selected community pharmacies and hospitals in Lagos state. Methods: This study was a descriptive cross-sectional study. The study data were collected using questionnaires administered to 112 providers in selected community pharmacies and hospitals in Lagos state. The obtained data were collated and analyzed using SPSS version 20.0. Results were presented as frequency tables and charts. Results: A response rate of 85.7% was achieved. The most common mode of poisoning was accidental (89% and 68% among pharmacists and physicians, respectively) and the highest incidence was among children 0-5 years old (41.5% and 48.3% among pharmacists and physicians, respectively). Management was mainly via gastric decontamination with activated charcoal in pharmacies and supportive care in the hospitals. Knowledge and availability of antidotes and management of poisoning were poor. Conclusion: Management of poisoning was generally inadequate and the prominence of a poison control center was recognized. The establishment of poison control centers in healthcare facilities and the organization of updated lectures for healthcare providers will go a long way to improving poisoning management in the state.

Clinical Case Series of Gastrointestinal Symptoms in Patients With Novel Coronavirus 2019 Infection

Background: Various digestive symptoms have been frequently reported in a significant portion of patients infected with the virus since the outbreak of Coronavirus Disease 2019 (COVID-19). Most patients with COVID-19 have a fever accompanied by respiratory signs and symptoms, such as cough and dyspnea. We present 36 cases with a chief complaint of Gastrointestinal (GI) symptoms along with respiratory symptoms. In this study, we aimed at investigating the prevalence and outcomes of COVID-19 patients with digestive symptoms. Methods: A variety of observed GI symptoms included nausea and vomiting (72.2%), diarrhea (25%), abdominal pain (19.4%), loss of appetite (14%), and anosmia (14%). The most nonGI symptoms were dyspnea (66.7%), fever (66.7%), dry cough (58.3%), myalgia (52.4%), and others. Six patients (16.6%) were critically ill, 7 (19.4%) were in stable condition, and 23 patients (64%) showed moderate symptoms. Among the patients, 7 (19.5%) needed critical care and were admitted to ICU. Leucopenia, lymphopenia, and elevated acute-phase proteins were other features observed in these patients. The most common antiviral regimen was hydroxychloroquine and oseltamivir. Finally, 32 patients (89%) were discharged, and 4 (11%) died. Conclusion: This case series study highlights that patients with COVID-19 are prone to GI symptoms along with fever and respiratory symptoms. Patients may even present with digestive symptoms and without any respiratory symptoms. Hence, clinicians should pay more attention to these patients and help diagnose COVID-19 earlier to start prompt treatment before the occurrence of severe disease.

Safety Assessment of a New Strain of Lactobacillus pentosus (IBRC=11143) As a Candidate Probiotic

Background: It is believed that the consumption of an adequate amount of live lactic acid bacteria (as probiotic) may improve the health of the host. Many strains of lactic acid bacteria are generally considered to be safe. However, some strains have shown some adverse effects. Objectives: This study aimed to investigate the safety of a new strain of Lactobacillus pentosus (IBRC=11143) in Wistar rats Methods:In this experimental study, male and female Wistar rats (n=6) were used. A subacute toxicity study (for 28 days) was conducted by oral administration of Lactobacillus pentosus to the animals. In each sex, one group received saline, and the other two groups received the bacteria at doses of 1×108 and 1×109 Colony-Forming Units (CFU)/rat. Results: No significant alteration in the liver and kidney tissues was seen. However, in both sexes, there were significant differences in urea and creatinine levels between the control and the experimental groups. Some blood parameters (Lymphocyte, red blood cell, hematocrit, and hemoglobin) also showed significant changes in the groups that received the bacteria. Moreover, a significant increase in alkaline phosphatase level was observed in male rats. Conclusion: The results indicate that Lactobacillus pentosus (11143) is not entirely safe like other Lactobacillus strains. Therefore, the Lactobacillus pentosus (11143) strain may not be the right choice as a probiotic for human consumption.

Hemorrhagic Events in Patients Receiving Heparin or Enoxaparin in Combination With Oral Antithrombotics, NSAIDs, and Antiplatelet Medications: A Multi-Center Case-Series Study

Background: Hemorrhagic events are amongst the significant adverse effects of injectable anticoagulants such as heparin and enoxaparin. This undesirable effect needs close monitoring of their use for clinically relevant drug-drug interactions. Objectives: To study the rate of hemorrhagic events, the anatomical site, and the severity of the bleeding in patients receiving heparin or enoxaparin in combination with clopidogrel, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), and warfarin. Methods: We designed a prospective, multi-center, case-series study. Patients admitted to two teaching hospitals who received either an NSAID, or warfarin, or clopidogrel were evaluated. Any hemorrhagic event was recorded by Yellow Card Scheme. Also, the Naranjo scale was utilized for causality assessment.Results: A total of 123 patients were eligible for inclusion. They were admitted between November 2014 and April 2015. Sixty-five patients (52.5%) received heparin and 58 patients (47.2%) received enoxaparin. Of 123 patients, 115 patients (93.5%) received aspirin, 69 (56.1%) warfarin, 34 (27.6%) an antiplatelet medication, and 121 (98.4%) NSAIDs in combination with heparin or enoxaparin. Overall, 26 cases (21.1%) of the hemorrhagic incident were reported, of whom six cases (4.9%) were categorized as major bleeding. Patients receiving heparin constituted the largest proportion among all 26 hemorrhagic incidents (57.7%). All patients with the hemorrhagic incident had aspirin in their medication regimen, while 19 patients (73.0%) were concomitantly receiving warfarin as well. Hematuria (46.2%), hematoma in the injection site (38.5%), and hematoma (34.6%) were the top three types of hemorrhagic events. In Naranjo scale analysis, 19 patients scored more than 9 points, indicating a definite Adverse Drug Reaction (ADR) causality. Moreover, seven patients scored 5 to 8, affirming a possible association with ADR. Conclusion: The risk of hemorrhagic can be influenced by undesirable drug-drug interactions. Close monitoring of high-risk patients is advised to prevent adverse hemorrhagic reactions. Further studies to detect the explanatory factors associated with the hemorrhagic events are recommended.

Assessment of Anticonvulsant Activities of Petroleum Ether Extract of Anacyclus pyrethrum Roots on Experimental Rats

Background: Epilepsy is one of the most common neurological conditions and a significant cause of morbidity and mortality. Objectives: The present study aimed to evaluate the anticonvulsant activity of the petroleum ether extract of the root of Anacyclus pyrethrum on Pentylenetetrazole (PTZ)-induced seizure model in Wistar rats. Methods: The composition of the petroleum ether extract of A. pyrethrum was first analyzed using Gas Chromatography-Mass Spectrometry (GC-MS). Subsequently, the anticonvulsant activities of these extracts (70 and 140 mg/kg, intraperitoneal injection) were evaluated on PTZ-induced seizures in rats. The protection rate against induced seizures, latency, and duration of seizures, as well as neurological symptoms, were assessed and compared to those protected by phenobarbital. Results: GC/MS analysis of the petroleum ether extract showed that the main components were octadecadienoic acid, hexadecanoic acid, diheptylcyclopropene, naphthalene, and methyl stearate. The extract (70 and 140 mg/kg) was found to provide significant protection against PTZ-induced seizures. Moreover, compared to the negative control, the extracts increased the latency of induced-convulsion and reduced the duration of epilepsy. Interestingly, the extracts showed a reduction in neurological symptoms and the severity of seizures compared to the negative control. All of these outcomes manifested in a dose-dependent manner. Conclusion: The petroleum ether extract of A. pyrethrum may produce anticonvulsant effects by reducing the duration of seizures and delaying the latency of seizures induced by PTZ.

Synthesis of Pyrazolo[1,2-b]phthalazine-5,10- dione Derivatives: A New Class of α –Glucosidase Inhibitors

Background: Hyperglycemia is a metabolic disorder that refers to an increase in blood sugar in diabetic patients. α-Glucosidase has been introduced as a membrane-bound enzyme, and it is the main enzyme for carbohydrate digestion in some parts of the intestine. Inhibition of α -glucosidase enzyme activity is a reliable approach to control post-prandial hyperglycemia condition. Objectives: In this study, a series of Pyrazolo[1,2-b]phthalazine-5,10-dione derivatives 5a–t were synthesized via a multicomponent reaction and evaluated as new inhibitors for α-glucosidase. Methods: The biological activity of the synthesized compounds was studied using a source of the α-glucosidase enzyme (EC3.2.1.20, Saccharomyces cerevisiae) at 20 U/mg concentration. Results: Four compounds showed higher α-glucosidase inhibitory activity in comparison to a standard, i.e., Acarbose. Compound 5q displays the most potent α-glucosidase inhibitory activity (IC50 = 155.4 ± 6.0 μM). Conclusion: In conclusion, some of the synthesized compounds, including heterocyclic core molecules, have shown remarkable activity that could be considered as subjects for the development of new, more efficient inhibitors of the α-glucosidase enzyme.

A Case of Erythema Multiforme Caused by Sildenafil Plus Tramadol

In this report, we present a 29-year-old man who experienced EM five days after using sildenafil and tramadol. Based on clinical examination and history, the diagnosis of EM was made confirmed via skin biopsy, which found intra-epidermal bulla filled by fibrinous exudate, some mononuclear cells, and a few eosinophils. The spongiotic epidermis showed lichenoid interface dermatitis, eosinophilic spongiosis, and necrolysis, consistent with EM diagnosis. Fluocinolone, 0.025% ointment, was prescribed for the patient, and the lesions healed after two weeks of treatment.