Drug use evaluation of cefepime at Khartoum North Teaching Hospital in Sudan.

BACKGROUND: Cefepime is essentially used for life-threatening infections. Although overutilisation of antibiotics is strongly discouraged around the world, they are still overused in developing countries including Sudan. OBJECTIVES: This study aims to evaluate the rational use of cefepime at Khartoum North Teaching Hospital-Sudan. METHODS: A retrospective cross-sectional, hospital-based study was conducted in the internal medicine ward at Khartoum North Teaching Hospital from August/2018 to April/2019. The study covered medical records of adult patients receiving cefepime during the study period. Patient's data were analysed using simple descriptive statistics (frequency and percentage) and inferential statistics (logistic regression) to describe the relationship between dependent and independent variables. P ≤ .05 was considered statistically significant. RESULTS: Out of 90 patients, only 16.7% of patients were tested for antibiotic sensitivity. Cefepime was prescribed to 50% and 23.3% of patients for the treatment of UTIs/post-dialysis and sepsis, respectively. Although the majority of patients (72.2%) received cefepime with appropriate indication, only 21.1% and 15.6% received the drug with appropriate dose and duration, respectively. Cefepime had been prescribed appropriately in a correct dose, duration, and indications for only 7.8% of patients. The vast majority of patients tested for kidney functions had elevated creatinine levels (96.1%); however, cefepime dose had been adjusted for only 4.1% of them. CONCLUSION: This study highlighted the irrational use of cefepime regarding inappropriate dose, duration, and inadequate antibiotic sensitivity tests. A lack of attention to dosage adjustment in patients with renal impairment had been observed. Positive clinical outcome was significantly associated with antibiotic sensitivity test.

Protective Role of Loranthus regularis against Liver Dysfunction, Inflammation, and Oxidative Stress in Streptozotocin Diabetic Rat Model.

Earlier studies revealed the potential therapeutic values of Loranthus regularis (L. regularis). This study evaluated Loranthus regularis (L. regularis) extract systemic antidiabetic effects and benefits against diabetic hepatocellular injuries through antioxidant and anti-inflammatory pathways using the streptozotocin (STZ) model in Wistar albino rats. After diabetes induction, animals were orally treated with L. regularis extract for 4 weeks. Serum levels of glucose, insulin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), total triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were estimated. Furthermore, tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1ß), interleukin-6 (IL-6), caspase-3, nitric oxide (NO), and prostaglandin E-2 (PGE-2) were estimated in serum. In liver, thiobarbituric acid reactive substances (TBARSs) and reduced glutathione (GSH) as well as the proinflammatory cytokines and enzymatic activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reeducates (GR), and glutathione-S-transferase (GST) were assayed. Finally, the degree of hepatic tissue damage was evaluated histologically. Treatment of the diabetic rats with L. regularis extract markedly reduced the elevated serum levels of glucose, ALT, AST, TC, TG, LDL, TNF-α, IL-1ß, IL-6, caspase-3, NO, and PGE-2. L. regularis extract also improved serum levels of insulin and HDL. The elevated TBARS, TNF-α, IL-1ß, and IL-6 levels in hepatic tissue of diabetic animals were reduced by L. regularis. Moreover, L. regularis extract significantly restored the diminished hepatic GSH level and enzymatic activities of SOD, CAT, GPx, GR, and GST in diabetic animals. The biochemical protective effects of L. regularis were associated with improved histological hepatocellular integrity and architecture. Taken together, L. regularis has therapeutic effects against diabetic-induced hepatic complications. The restored liver functions and cellular damage might be mediated through free radicals scavenging and proinflammatory cytokine inhibition.

Species and tissue-specificity of prokinetic, laxative and spasmodic effects of Fumaria parviflora.

BACKGROUND: Fumaria parviflora Linn. (Fumariaceae), is a small branched annual herb found in many parts of the world including Saudi Arabia and Pakistan. This study was designed to provide pharmacological basis for the medicinal use of Fumaria parviflora in gut motility disorders. METHODS: The in-vivo prokinetic and laxative assays were conducted in mice. Isolated intestinal preparations (ileum and jejunum) from different animal species (mouse, guinea-pig and rabbit) were separately suspended in tissue baths containing Tyrode's solution bubbled with carbogen and maintained at 37°C. The spasmogenic responses were recorded using isotonic transducers coupled with PowerLab data acquisition system. RESULTS: The aqueous-methanol extract of Fumaria parviflora (Fp.Cr), which tested positive for the presence of alkaloids, saponins, tannins and anthraquinones showed partially atropine-sensitive prokinetic and laxative activities in the in-vivo in mice at 30 and 100 mg/kg. In the in-vitro studies, Fp.Cr (0.01-1 mg/ml) caused a concentration-dependent atropine-sensitive stimulatory effect both in mouse tissues (jejunum and ileum), and rabbit jejunum but had no effect in rabbit ileum. In guinea-pig tissues (ileum and jejunum), the crude extract showed a concentration-dependent stimulatory effect with higher efficacy in ileum and the effect was partially blocked by atropine, indicating the involvement of more than one types of gut-stimulant components (atropine-sensitive and insensitive). This could be a plausible reason for the greater efficacy of Fp.Cr in gut preparations of guinea-pig than in rabbit or mouse. CONCLUSIONS: This study shows the prokinetic, laxative and spasmodic effects of the plant extract partially mediated through cholinergic pathways with species and tissue-selectivity, and provides a sound rationale for the medicinal use of Fumaria parviflora in gut motility disorders such as, indigestion and constipation. This study also suggests using different species to know better picture of pharmacological profile of the test material.

Anti-inflammatory, antinociceptive and antioxidant activities of the endemic Soqotraen Boswellia elongata Balf. f. and Jatropha unicostata Balf. f. in different experimental models.

In the present study, the two endemic Soqotraen plants Boswellia elongata and Jatropha unicostata were investigated for their anti-inflammatory, antinociceptive and antioxidant potential. To assess the anti-inflammatory and antinociceptive activities, two concentrations of each extract (200 and 400mg/kg, p.o.) were tested in carrageenan-induced rat paw edema, cotton pellet granuloma in rats, acetic acid-induced abdominal writhing and hot-plate test model in mice. Moreover, the antioxidant activity was determined in vitro, using scavenging activity of DPPH radical and ß-carotene-linoleic acid assays. Both plants produced significant (P<0.05-0.01) anti-inflammatory and antinociceptive effects; however the results suggest that B. elongata possesses the highest activities. B. elongata and J. unicostata at (400mg/kg) reduced the paw edema considerably (82% and 53%) and the weight of cotton pellet granuloma (51% and 32%), respectively. Furthermore, they diminished the abdominal constriction induced by acetic acid with a 67% and 41% inhibition respectively, and prolonged significantly the reaction time of animal with relatively extended duration of stimulation. In addition, both plants showed considerable antioxidant activity in both assays. These results clearly confirmed the traditional anti-inflammatory indication of B. elongata and suggest that B. elongata could be a potential source for anti-inflammatory, antinociceptive and antioxidant agents.

Assessment of selected Yemeni medicinal plants for their in vitro antimicrobial, anticancer, and antioxidant activities.

CONTEXT: The role of natural products as a source for remedies has been recognized since the beginning of mankind. Nevertheless, a minority of folkloricly used medicinal plants have been evaluated for their pharmacological activities. OBJECTIVES: The purpose of this study is to evaluate 33 selected Yemeni plants for their in vitro anticancer, antimicrobial, and antioxidant activities. MATERIALS AND METHODS: The plants were extracted with methanol and hot water. The obtained 66 extracts were tested for their in vitro cytotoxic activity using the neutral red uptake assay against two cancer cell lines (5637 and MCF-7). The antimicrobial activity was determined using the agar diffusion method and MIC-determination. The DPPH radical method was used for the determination of antioxidant activity. RESULTS: Interesting cytotoxic activity was observed for Hypoestes forskalei (Vahl) R. Br. (Acanthaceae), Lycium shawii Roem. & Schult. (Solanaceae), Pergularia tomentosa L. (Asclepiadaceae), Psiadia punctulata (DC.) Vatke (Compositae), Pulicaria petiolaris Jaub. & Spach (Compositae) and Rosmarinus officinalis L. (Labiatae) (IC(50) values < 50 µg/mL). Antimicrobial activity with MIC values ≤ 125 µg/mL was exhibited against Gram-positive bacteria by Chrozophora oblongifolia (Del.) A.Juss. ex Spreng. (Euphorbiaceae), Myrtus communis L. (Myrtaceae), Phragmanthera regularis (Steud. ex Sprague) M.G. Gilbert (Loranthaceae) and R. officinalis. Antioxidant activity was observed for C. oblongifolia, M. communis, and P. regularis. CONCLUSION: The results justified the use of some investigated plants in the Yemeni ethnomedicine. These findings demonstrated that some of the investigated plants could be a source of new cytotoxic and antibiotic compounds; however, further work is needed.

Antimicrobial, antioxidant and cytotoxic activities and phytochemical screening of some yemeni medicinal plants.

The traditional medicine still plays an important role in the primary health care in Yemen. The current study represents the investigation of 16 selected plants, which were collected from different localities of Yemen. The plants were dried and extracted with two different solvents (methanol and hot water) to yield 34 crude extracts. The obtained extracts were tested for their antimicrobial activity against three Gram-positive bacteria, two Gram-negative bacteria, one yeast species and three multiresistant Staphylococcus strains using agar diffusion method, for their antioxidant activity using scavenging activity of DPPH radical method and for their cytotoxic activity using the neutral red uptake assay. In addition, a phytochemical screening of the methanolic extracts was done. Antibacterial activity was shown only against Gram-positive bacteria, among them multiresistant bacteria. The highest antimicrobial activity was exhibited by the methanolic extracts of Acalypha fruticosa, Centaurea pseudosinaica, Dodonaea viscosa, Jatropha variegata, Lippia citriodora, Plectranthus hadiensis, Tragia pungens and Verbascum bottae. Six methanolic extracts especially those of A. fruticosa, Actiniopteris semiflabellata, D. viscosa, P. hadiensis, T. pungens and V. bottae showed high free radical scavenging activity. Moreover, remarkable cytotoxic activity against FL-cells was found for the methanolic extracts of A. fruticosa, Iris albicans, L. citriodora and T. pungens. The phytochemical screening demonstrated the presence of different types of compounds like flavonoids, terpenoids and others, which could be responsible for the obtained activities.

Phytochemical screening and antiviral activity of some medicinal plants from the island Soqotra.

Methanol and hot-aqueous extracts of 25 different plant species, used in Yemeni traditional medicine and growing, partly as endemic plants, on the island Soqotra have been investigated for their antiviral activity. In addition, the phytochemical identification of the main chemical constituents was performed. The extracts were assayed in two in vitro viral systems, which used influenza virus type A/MDCK cells and herpes simplex virus type 1/Vero cells, at non-cytotoxic concentrations. The herpes simplex virus type 1 showed more sensitivity than the influenza virus type A against the extracts investigated. The methanol extracts of Boswellia ameero, Boswellia elongata, Buxus hildebrandtii, Cissus hamaderohensis, Cleome socotrana, Dracaena cinnabari, Exacum affine, Jatropha unicostata and Kalanchoe farinacea showed anti-influenza virus type A activity with 50% inhibition (IC50) concentrations ranging from 0.7 to 12.5 microg/mL. In addition, 17 plants of the 25 investigated exhibited anti-HSV-1 activity. The antiviral activity of some active extracts was also observed on a molecular level.

Antimicrobial activity of some medicinal plants of the island Soqotra.

Twenty-five selected plants belonging to 19 families were collected from different localities of the island Soqotra, dried and extracted with the solvents chloroform, methanol and hot water to yield 80 extracts. The extracts were tested for their antimicrobial activity against several Gram-positive and Gram-negative bacteria and against one yeast species using agar diffusion method. Antibacterial activity was demonstrated especially against Gram-positive bacteria including multiresistant Staphylococcus strains. The greatest activity was exhibited by the methanolic extracts of Boswellia elongata, Boswellia ameero, Buxus hildebrandtii, Commiphora parvifolia, Jatropha unicostata, Kalanchoe farinacea, Pulicaria stephanocarpa, Punica protopunica, Withania adunensis and Withania riebeckii. Only the methanolic extract of Buxus hildebrandtii displayed significant antifungal activity.