Efficiency of proteolytic enzymes in treating lumbar spine osteoarthritis (low back pain) patients and its effects on liver and kidney enzymes.

Lumbar spine osteoarthritis with 40-85% prevalence, degeneration of spine with remarkable narrowing of disc space and osteophytes formation trigger pain in lower back. Pain in lower portion of back is now considered to be the second most commonly treated health issue in primary health care setups. This pain causes disability, functional loss and job absentees. Commonly pain is managed pharmacologically by NSAIDS but resulted in severe gastric side effects. The purpose of this trial was to appraise the properties of bromelain and papain, the vegetal proteolytic enzymes, in comparison with standard drug on LBP patients. Forty men and women with lumbar spine osteoarthritis were recruited and divided into group 1, received aceclofenac 100mg tablet b.i.d as standard treatment, group 2, patients treated with aceclofenac 100 mg tablet b.i.d and enzyme supplements 250 mg b.i.d for 6 weeks. All the participants were evaluated for their body mass index, vital signs and liver/kidney enzymes before and after treatment. Moreover intensity of pain were also measured through visual analogue scale (VAS) and oswestry low back pain questionnaire (ODI) before treatment (0 week), 3rd week and 6th week of treatment. The enzyme group patients showed significantly diminished pain scores VAS from 7.10±1.29 to 5.85±1.531*** (P=0.001), ODI score from 56.2±8.70 to 51.6±8.125*** (P=0.000), significantly diminished enzymes; ALP from 210.00±55.24 to 196.90±51.02 (P=0.054*) and serum creatinine from 0.97±0.153 to 0.87±0.139 (P=0.035*) and improved quality of life. Hence, this study suggested that the enzyme supplements for 6 weeks have prolonged beneficial carry-over effects in comparison to standard treatment without producing any change in BMI (P>0.05) and vital signs (P> 0.05).

In vitro antibacterial susceptibility of different brands of oral levofloxacin 250 mg tablet against Staphylococcus aureus and Escherichia coli.

Antibiotics are not only used in morbidity but also help in prevention of infection. The irrational use of broad spectrum antibiotics is now increasing the resistance against pathogens. This present study has been carried out to evaluate the in-vitro antibacterial effect of levofloxacin against clinical isolates. According to Clinical and Laboratory Standards Institute (CLSI) guidelines, minimum inhibitory concentrations 90% (MIC90) of the levofloxacin tested were evaluated by an agar dilution method. Total 63 clinical isolates Staphylococcus aureus (n=34) and Escherichia coli (n=29) were collected from different hospitals at Karachi and were evaluated MIC90 of eleven different brands of levofloxacin tablet (250 mg). Levofloxacin (Reference) was tested against E.coli standard (American Type Culture Collection) (ATCC=25922) with (MIC90; 0.03µg/ml) and compared with different eleven brands of levofloxacin tablets 250mg (MIC90; 0.5µg/ml -16.0µg/ml). Levofloxacin (Reference) sensitivity against S. aureus standard (ATCC=25923) is (MIC90; 0.12µg/ml) and similarly when it was compared with same levofloxacin tablets (MIC90; 0.5-16.0µg/ml). It has been concluded by the present study, a large number of strains of bacteria have shown better bactericidal action of different brands of levofloxacin and nearly all commercialized drugs were appropriate for therapeutic use.

Evaluation of five discriminating indexes to distinguish Beta-Thalassemia Trait from Iron Deficiency Anaemia.

OBJECTIVE: To assess the reliability of different red blood cell indices-based formulae in the indexes formula in differential diagnosis of beta thalassemia trait and iron deficiency anaemia. METHODS: This cross-sectional study was conducted between January and October 2015 in Dera Ismail Khan in the Khyber Pakhtunkhwa province of Pakistan. Patients of beta thalassemia trait and iron deficiency anaemia were registered irrespective of age and gender. About 5 mL of blood was taken from each patient to analyse different red cell parameters like red blood cell count, haemoglobin, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, and red cell distribution width. Five formulae were used to discriminate between the two conditions. These were red cell distribution width index, Shine and Lal index, Mentzer index, Srivastava index, and the Green and King index. Sensitivity, specificity, positive and negative predictive values and Youden's index of all the indices were calculated. RESULTS: Of the 800 patients, 230(29%) had beta thalassemia trait and 570(71%) had iron deficiency anaemia. The red cell distribution width index appeared be a reliable index in discriminating between beta thalassemia trait and iron deficiency anaemia with sensitivity and specificity of 100% and 93% respectively. CONCLUSIONS: The red cell distribution width index was the most consistent index for differentiating between beta thalassemia trait and iron deficiency anaemia. IIt could be used as a screening index for beta thalassemia trait in areas where haemoglobin electrophoresis facility is unavailable.

Solvent Effect on the Photolysis of Riboflavin.

The kinetics of photolysis of riboflavin (RF) in water (pH 7.0) and in organic solvents (acetonitrile, methanol, ethanol, 1-propanol, 1-butanol, ethyl acetate) has been studied using a multicomponent spectrometric method for the assay of RF and its major photoproducts, formylmethylflavin and lumichrome. The apparent first-order rate constants (k obs) for the reaction range from 3.19 (ethyl acetate) to 4.61 × 10(-3) min(-1) (water). The values of k obs have been found to be a linear function of solvent dielectric constant implying the participation of a dipolar intermediate along the reaction pathway. The degradation of this intermediate is promoted by the polarity of the medium. This indicates a greater stabilization of the excited-triplet states of RF with an increase in solvent polarity to facilitate its reduction. The rate constants for the reaction show a linear relation with the solvent acceptor number indicating the degree of solute-solvent interaction in different solvents. It would depend on the electron-donating capacity of RF molecule in organic solvents. The values of k obs are inversely proportional to the viscosity of the medium as a result of diffusion-controlled processes.

Photodegradation of moxifloxacin in aqueous and organic solvents: a kinetic study.

The kinetics of photodegradation of moxifloxacin (MF) in aqueous solution (pH 2.0-12.0), and organic solvents has been studied. MF photodegradation is a specific acid-base catalyzed reaction and follows first-order kinetics. The apparent first-order rate constants (kobs) for the photodegradation of MF range from 0.69 × 10(-4) (pH 7.5) to 19.50 × 10(-4) min(-1) (pH 12.0), and in organic solvents from 1.24 × 10(-4) (1-butanol) to 2.04 × 10(-4) min(-1) (acetonitrile). The second-order rate constant (k2) for the [H(+)]-catalyzed and [OH(-)]-catalyzed reactions are 6.61 × 10(-2) and 19.20 × 10(-2) M(-1) min(-1), respectively. This indicates that the specific base-catalyzed reaction is about three-fold faster than that of the specific acid-catalyzed reaction probably as a result of the rapid cleavage of diazabicyclononane side chain in the molecule. The kobs-pH profile for the degradation reactions is a V-shaped curve indicating specific acid-base catalysis. The minimum rate of photodegradation at pH 7-8 is due to the presence of zwitterionic species. There is a linear relation between kobs and the dielectric constant and an inverse relation between kobs and the viscosity of the solvent. Some photodegraded products of MF have been identified and pathways proposed for their formation in acid and alkaline solutions.

Photolysis of tolfenamic acid in aqueous and organic solvents: a kinetic study.

Tolfenamic acid (TA) is a non-steroidal anti-inflammatory drug that was studied for its photodegradation in aqueous (pH 2.0-12.0) and organic solvents (acetonitrile, methanol, ethanol, 1-propanol, 1-butanol). TA follows first-order kinetics for its photodegradation, and the apparent first-order rate constants (k obs) are in the range of 0.65 (pH 12.0) to 6.94 × 10-2 (pH 3.0) min-1 in aqueous solution and 3.28 (1-butanol) to 7.69 × 10-4 (acetonitrile) min-1 in organic solvents. The rate-pH profile for TA photodegradation is an inverted V (∧) or V-top shape, indicating that the cationic form is more susceptible to acid hydrolysis than the anionic form of TA, which is less susceptible to alkaline hydrolysis. The fluorescence behavior of TA also exhibits a V-top-shaped curve, indicating maximum fluorescence intensity at pH 3.0. TA is highly stable at a pH range of 5.0-7.0, making it suitable for formulation development. In organic solvents, the photodegradation rate of TA increases with the solvent's dielectric constant and solvent acceptor number, indicating solute-solvent interactions. The values of k obs decreased with increased viscosity of the solvents due to diffusion-controlled processes. The correlation between k obs versus ionization potential and solvent density has also been established. A total of 17 photoproducts have been identified through LC-MS, of which nine have been reported for the first time. It has been confirmed through electron spin resonance (ESR) spectrometry that the excited singlet state of TA is converted into an excited triplet state through intersystem crossing, which results in an increased rate of photodegradation in acetonitrile.

Analysis of Tolfenamic Acid using a Simple, Rapid, and Stabilityindicating Validated HPLC Method.

BACKGROUND: Tolfenamic acid (TA) belongs to the fenamates class of non-steroidal anti-inflammatory drugs. Insufficient information is available regarding the availa-bility of a reliable and validated stability-indicating method for the assay of TA. OBJECTIVE: A relatively simple, rapid, accurate, precise, economical, robust, and stability-indicating RP-HPLC method has been developed to determine TA in pure and tablet dosage forms. METHODS: The method was validated according to the ICH guideline, and parameters like linearity, range, selectivity, accuracy, precision, robustness, specificity, and solution stability were determined. TLC and FTIR spectrometry were used to ascertain the purity of TA. The specificity was determined with known impurities and after performing forced degradation, while the robustness was established by Plackett-Burman's experimental design. The mobile phase used for the analysis was acetonitrile and water (90:10, v/v) at pH 2.5. The detection of the active drug was made at 280 nm using a C18 column (tR = 4.3 min.). The method's ap-plicability was also checked for the yellow polymorphic form of TA. RESULTS: The results indicated that the method is highly accurate (99.39-100.80%), precise (<1.5% RSD), robust (<2% RSD), and statistically comparable to the British Pharmacopoeia method with better sensitivity and specificity. CONCLUSION: It was observed that the stress degradation studies do not affect the method's accuracy and specificity. Hence the proposed method can be used to assay TA and its tablet dosage form.

Microbial Profile and Antimicrobial Susceptibility Pattern in Diabetic Foot Ulcer Patients Attending a Tertiary Care Hospital.

Background This study aimed to assess the bacterial profile of diabetes patients with an infected foot and their antimicrobial susceptibility pattern in a tertiary care hospital. Methodology We conducted a six-month prospective study at a hospital in Peshawar, Pakistan. Demographics and clinical characteristics such as age, sex, type and duration of diabetes, glycemic control, presence of retinopathy, nephropathy, neuropathy, peripheral vascular disease, ulcer size, outcomes, and the number of admitted days at the facility were collected. Pus or discharges from the ulcer base and debrided necrotic tissue were obtained. Gram staining was performed on the samples which were isolated on chocolate agar and MacConkey agar. Incubation was done for 24 hours at a temperature of 37°C, and isolates were identified using standard bacteriological methods. The Kirby-Bauer testing method was used to assess antibiotic susceptibility. Results A total of 200 patients received a diagnosis of diabetic foot ulcer at the hospital during the study period. The age of the patients ranged from 24 to 92 years, with a mean age of 58.12 years (standard deviation (SD) = 12.494). The mean HbA1c level was 9.33% (SD = 2.050). The mean duration of diabetes mellitus was 12.3 years (SD = 6.181). In total, 96 (66.2%) isolates were gram-negative bacteria, while 49 (33.8%) were gram-positive bacteria. Among the gram-negative bacteria, Pseudomonas spp. was the most reported (15.9%), whereas methicillin-resistant Staphylococcus aureus was the most reported gram-positive bacteria (20.7%). Amikacin was found to be the most effective (45%) in treating diabetic foot ulcers, followed by tineam and meropenem being equally effective at a susceptibility of 44%. The highest resistance of the microbes was to the drug trimethoprim (44.5%). Conclusions The pathogens causing diabetic foot ulcers show sensitivity to many of the routinely used medications. However, resistance is being developed to some of the antibiotics such as trimethoprim. Therefore, the culture of the specimen to identify the causative agent and adequate knowledge of the susceptibility pattern are critical for the appropriate management of diabetic foot ulcers.

Formulation and stabilization of norfloxacin in liposomal preparations.

A number of liposomal preparations of norfloxacin (NF) containing variable concentrations of phosphatidylcholine (PC) (10.8-16.2mM) have been formulated and an entrapment of NF to the extent of 41.7-56.2% was achieved. The values of apparent first-order rate constants (kobs) for the photodegradation of NF in liposomes (pH7.4) lie in the range of 1.05-2.40×10(-3)min(-1) compared to a value of 8.13×10(-3)min(-1) for the photodegradation of NF in aqueous solution (pH7.4). The values of kobs are a linear function of PC concentration indicating an interaction of PC and NF during the reaction. The second-order rate constant for the photochemical interaction of PC and NF has been determined as 8.92×10(-2)M(-1)min(-1). Fluorescence measurements on NF in liposomes indicate a decrease in fluorescence with an increase in PC concentration as a result of formation of NF(-) species which exhibits poor fluorescence. Dynamic light scattering has shown an increase in the size of NF encapsulated liposomes with an increase in PC concentration. The stabilization of NF in liposomes is achieved by the formation of a charge-transfer complex between NF and PC.

Photodegradation of levofloxacin in aqueous and organic solvents: a kinetic study.

The kinetics of photodegradation of levofloxacin in solution on UV irradiation in the pH range 2.0-12.0 has been studied using a HPLC method. Levofloxacin undergoes first-order kinetics in the initial stages of the reaction and the apparent first-order rate constants are of the order of 0.167 to 1.807×10-3 min-1. The rate-pH profile is represented by a curve indicating the presence of cationic, dipolar and anionic species during the reaction. The singly ionized form of the molecule is non-fluorescent and is less susceptible to photodegradation. The increase in the degradation rate in the pH range 5.0-9.0 may be due to greater reactivity of the ionized species existing in that range. The rate appears to vary with a change in the degree of ionization of the species present in a particular pH range and their susceptibility to photodegradation. Above pH 9, the decrease in the rate of photodegradation may be a result of deprotonation of the piperazinyl group. The levofloxacin molecule is more stable in the pH range around 7, which is then suitable for formulation purposes. The photodegradation of levofloxacin was found to be affected by the dielectric constant and viscosity of the medium.