Natural mouthwash of sarang banua leaves (Clerodendrum fragrans Vent Willd) extractas a healthy solution during the covid-19 pandemic

The spread of the COVID-19 virus has shaken the world. The application of Clean and Healthy Living Behavior (CHLB) is the best effort to prevent the transmission of the Covid-19 virus. Maintaining oral and dental hygiene can improve health, especially during the COVID-19 pandemic. Sarang Banua (Clerodendrum fragrans Vent Willd) is a local plant of North Sumatra, containing secondary metabolites of alkaloids, steroids, flavonoids, triterpenoids, saponins, tannins, and quinones that have bioactivity such as antibacterial and antioxidant. The preparation of Sarang Banua mouthwash (SABANA) made from the extract of the sarang banua leaves with a concentration of 0.5 grams in 100 ml of preparation (0.5%) has been formulated, evaluated by organoleptic, pH and antibacterial test. The results of organoleptic and pH tests showed that SABANA mouthwash preparations were brown and slightly cloudy, tasted very distinctive, fresh, and eliminated bad breath with a pH of 7 in accordance with quality standards. About 70% of the panelists stated that they really liked the color, aroma, taste and appearance of SABANA mouthwash preparations. The results of antibacterial test against the oral bacteria Streptococcus mutans ATCC (25175) showed that 0.5% and 0.75% of the oral antibacterial mouthwash was found to be effective as oral antibacterial with an average inhibition zone diameter of 16.55 and 16.9 mm. Through the activities of the Student Creativity-Entrepreneurship Program, SABANA mouthwash have been produced and marketed in the local as well as outside the city by online and offline-shop and have the opportunity to develop into a new entrepreneur.

Analysis of price variation of some commonly used antibacterial agents

Background: Antimicrobial resistance is a serious problem. Resistance may develop due to irrational use including poor patient compliance due to prescription of expensive drugs. In present study, the variation in the price of commonly used antibacterial was analysed.Methods: The price of commonly used antibacterial agents listed in recent issues of CIMS and MIMS was analysed in respect of number of brands available, price range (10 tablets or capsules) and 1 ampoule or vial (parenteral preparation) i.e. minimum, maximum and average price and price ratio (maximum/minimum). FDCs and formulation with only 1-2 brands were excluded.Results: The number of brands of oral antibacterial agents varied from 3 (faropenem 200 mg) to 90 (azithromycin 500 mg). The maximum price variation amongst different brands was 21.64 for levofloxacin 500 mg followed by 14.28 and 11.26 for linezolid 600 mg and moxifloxacin 400 mg respectively. For parenteral preparations, the number of brands varied from 2 (gentamicin 80 mg) to 57 (ceftriaxone 1 g). The maximum price variation was 5.05 for meropenem 1 g followed by 3.69 and 2.63 for meropenem 500 mg and ceftriaxone 1 g respectively.Conclusions: A very wide price variation was observed amongst different brands of both oral and parenteral formulations of antibacterial agents. Prescribing expensive brands may lead to resistance due to poor patient compliance.

Activity of Mecillinam and Clavulanic Acid on ESBL Producing and Non- ESBL Producing Escherichia Coli Isolated From UTI Cases

Mecillinam is one of the very few oral antibacterial agents used against extended spectrum ?- lactamase (ESBL) producing Escherichia coli (E. coli) causing urinary tract infection (UTI)). It is reported that, resistance to mecillinam can be reversed to some extent by adding beta lactamase inhibitor like clavulanic acid. The present study was aimed to determine in-vitro activity of mecillinam and mecillinam-clavulanic acid combination on the susceptibility of ESBL producing and non-ESBL producing E. coli. Total 124 E. coli (78 ESBL positive and 46 ESBL negative) isolates from urine samples of patients with UTI were included in the study. Organisms were isolated from patients attending BIRDEM General Hospital from July 2012 to December 2012. ESBL production was tested by double disc synergy test. Minimum inhibitory concentration (MIC) of mecillinam and clavulanic acid against E. coli was determined by agar dilution method. Of the total E. coli isolates, 62.9% was ESBL positive and 37.1% was negative for ESBL. Out of ESBL positive isolates, 75.6% was sensitive to mecillinam while ESBL negative isolates showed the sensitivity as 67.4%. The sensitivity to mecillinam of ESBL positive and negative isolates increased to 85.9% and 86.9% respectively by addition of clavulanic acid with mecillinam. The MIC values of intermediate and resistant isolates converted to sensitive MIC range after addition of clavulanic acid with mecillinam. Conversion of resistance of ESBL producing isolates by adding clavulanic acid was also evident by the reduction of MIC50 and MIC90 from 4?g/ml to ?1 ?g/ml and from 128 ?g/ ml to 64 ?g/ml respectively. Similar trend of reduction of MICs was also observed in non-ESBLs. In conclusion, both ESBL positive and negative E. coli demonstrated considerable sensitivity to mecillinam and the sensitivity increased significantly (p<0.05) by adding clavulanic acid with mecillinam.Ibrahim Med. Coll. J. 2014; 8(2): 56-60

Conservative Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw in Multiple Myeloma Patients

The use of intravenous bisphosphonates (pamidronate or zoledronic acid) is the cornerstone for the management of multiple myeloma-(MM-) related bone disease. However, osteonecrosis of the jaw (ONJ) is a rare, but sometimes difficult to manage, adverse effect of bisphosphonates therapy. A retrospective review of all MM patients who were treated with bisphosphonates in our department, from 2003 to 2013, and developed ONJ was performed. According to inclusion criteria, 38 patients were studied. All these patients were treated as conservatively as possible according to the American Association of Oral and Maxillofacial Surgeons criteria. Patients were managed with observation, oral antibacterial mouth rinse with chlorhexidine, oral antibiotics, pain control with analgesics, nonsurgical sequestrectomy with or without simultaneous administration of antibiotics, or major surgery with or without antibiotics. Healing of the lesions was achieved in 23 (60%) patients who were treated with conservative measures; the median time to healing was 12 months (95% CI: 4–21). The number of bisphosphonates infusions influenced the time to healing: the median time to healing for patients who received <16 infusions was 7 months and for those with >16 infusions was it 14 monthsP=0.017. We conclude that a primarily nonsurgical approach appears to be a successful management strategy for bisphosphonate-related ONJ.