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Kannan O Ahmed,1 Imad Taj Eldin,2 Mirghani Yousif,1 Ahmed A Albarraq,3 Bashir A Yousef,4 Nasrein Ahmed,5 Anas Babiker6 1Department of Clinical Pharmacy, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan; 2Department of Pharmacology, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan; 3Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia; 4Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan; 5Department of Cardiology, Ahmed Gasim Cardiac Surgery and Renal Transplantation Centre, Khartoum, Sudan; 6Department of Cardiology, Royal Care International Hospital, Khartoum, SudanCorrespondence: Kannan O AhmedDepartment of Clinical Pharmacy, Faculty of Pharmacy, University of Gezira, Hospital Street No. 1, Wad Medani, 21112, SudanTel +249 121860001Fax +249 511861180Email omerkannan@gmail.comBackground: Medications known to improve outcomes in heart failure (HF) are either not prescribed or prescribed at sub-therapeutic doses. The addition of clinical pharmacists to the HF team positively impacts optimizing prognostic medications for a patient with HF with reduced ejection fraction (HFrEF).Objective: To assess the intervention of the clinical pharmacist as part of the multidisciplinary (MD) team in up-titration to achieve target doses of key therapeutic agents for HFrEF.Methods: This was a prospective one group pretest-posttest interventional study; a comparison of the target dose achievement of key therapeutic agents for HFrEF was performed before and after clinical pharmacist interventions.Results: Out of 110 HFrEF patients, 57.3% were males, and the mean age of patients was 55.8 years (SD 12.6). Cardiomyopathy was the leading cause of HF. At baseline, 86% were on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEIs/ARBs/ARNi) and 93.6% on beta blockers (BBs). At the end of study, the proportion of patients achieved the target dose was significantly increased (0 vs 77.4%, 6.8 vs 85.4%, and 0 vs 55.6%) for ACEIs, ARBs and ARNi, respectively, and (8.6% vs 66.1%; P = 0.001) for BBs. Moreover, the up-titration process was associated with significant improvement in most clinical as ejection fraction and New York Heart Association (NYHA) scale and laboratory characteristics.Conclusion: As a part of the MD team in the outpatient HF clinic, the clinical pharmacists increased the percentage of HFrEF patients achieving the target or maximal doses of key therapeutic agents and improving clinical and laboratory parameters.Keywords: clinical pharmacist, intervention, heart failure, medications titration, Sudan

Massive extraction of groundwater for boro rice is the main cause of declining groundwater tables, especially in Rangpur Division, which is now a burning issue at the national level. It is now scientifically proven that rice is not a water-loving plant, but rather a water-tolerant plant. AWD can save water and energy, where both farmers and pump-owners can save around 30% of their irrigation water requirements. In Bangladesh around 4.8 million hectares of land are brought under irrigated boro rice where AWD technology can be utilized. With introduction of AWD technology, a savings of electricity costs equivalent to 5 billion Tk. or fuel cost equivalent to 7 billion Tk. will be incurred at the national level. Hence, the implementation of AWD technology will have major impacts at the farm and national levels, which can reduce irrigation cost significantly, thus saving foreign currency, as well as reducing excessive use of ground water.J. Bangladesh Agril. Univ. 16(1): 1-4, April 2018

Objective: Psidium guajava (PG) belongs to the family Myrtaceae that is believed to have active components that help to treat conditions like malaria, gastroenteritis, vomiting, diarrhea, dysentery, wounds, ulcers, toothache, coughs, sore throat, inflamed gums, and a number of other condition. The objective of current study was phytochemical screening of chemical constituents of Psidium guajava extract.Methods: In this study methanolic and aqueous extracts of one plant namely Psidium guajava, were screened for the presence of phytochemical constituents and tested for their antimicrobial and antioxidant activity.Results: TLC tests conducted revealed Rf values in the leaves for alkaloids, Flavonoids, Tannins, Phenols and Saponins(0.96-0.97-0.99-0.97-0.99) respectively. The antimicrobial activity extracts against four bacterial isolates Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Klebsiella sp. and a single fungal isolate Candida albicans with concentrations (0.5 mg/ml, and 1,0 mg/ml) of the extract were added to the disc and respective solvent was used as negative control. The antioxidative activity of leaf was evaluated by using 1,1- diphenyl-2 picrylhydrazyl (DPPH), the results showed are 88.4%, highest from standard, ascorbic acid 87.5%.Conclusion: The qualitative phytochemical analysis revealed the results showed presence of alkaloids, terpenoids, glycosides, resins, saponins, tannins, flavonoids, phenols, and amino acid were present in the methanol extract, with absence of glycosides, and amino acids in the aqueous extracts in leaves plant. Peer Review History: Received 24 March 2019; Revised 10 April; Accepted 20 April, Available online 15 May 2019 Academic Editor: Dr. Iman Muhammad Higazy, National Research Center, Egypt, imane.higazy@hotmail.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.5/10 Reviewer(s) detail: Ahmad Najib, Universitas Muslim Indonesia, Makassar, Indonesia, ahmad.najib@umi.ac.id Dr. Md. Shahidul Islam, USTC, Chittagong, Bangladesh, S_i_liton@yahoo.com Similar Articles: PHYTOCHEMICAL ANALYSIS AND ANTIMICROBIAL ACTIVITY OF COLOCASIA ESCULENTA (TARO) MEDICINAL PLANT LEAVES USED IN FOLK MEDICINE FOR TREATMENT OF WOUNDS AND BURNS IN HUFASH DISTRICT AL MAHWEET GOVERNORATE–YEMEN

Background: The growth rate of elderly is the fastest in most of the developing countries including Bangladesh. Nutrition plays fundamental role in maintaining good health especially in old age. This study was an attempt to assess the nutritional status of elderly and to compare it with their location.Methods: A total of 400 elderly in urban and rural area of Sunamgonj district have been interviewed through a structured questionnaire during July to September, 2019. A person aged 60 and above is included in the sample. Body mass index (BMI), mini nutritional assessment (MNA) short form, descriptive statistics, and Chi square test for association have been used for data analysis.Results: The analysis revealed that 17 percent elderly were under-weight, 66 percent were normal nutrition, 13 percent were over-weight and 4 percent were obese. The prevalence of malnutrition was found to be 40 percent. The rural elderly were at more risk of being malnourished compared to urban elderly. The mean BMI and MNA score of urban elderly were significantly different from the rural elderly.Conclusions: The findings show that more proportion of urban elderly are over-weight and obese compared to rural elderly. Therefore, measures should be taken to improve the nutrition status of elderly especially in rural area.

Abstract. Background: The long term efficacy of endovascular recanalization for chronic iliocaval occlusion secondary to inferior vena cava (IVC) filters is unknown. The purpose of this study was to evaluate the effectiveness of endovascular recanalization and stent placement across the filter in patients with filter-associated chronic iliocaval occlusion. Patients and Methods: Seven patients (mean age 56 ± 15 yrs; seven males) with symptomatic chronic iliocaval occlusion and occluded IVC filter were included. Immediate technical success rate, long term clinical effectiveness of endovascular recanalization and patency rate of the stents were assessed. Results: In all patients, the endovascular treatment consisted of percutaneous venous access, recanalization of the occluded iliac veins and the IVC, transluminal angioplasty and stenting of the infrarenal inferior vena cava and iliac veins with self-expanding stents. The IVC filter was not removed, but rather the stents were extended across the filter. In four of seven patients (57 %), adjunctive pharmaco-mechanical thrombolysis was performed. All patients received anticoagulation post procedure. The mean clinical follow-up was 51.1 ± 27 months. Technical success rate was 100 %. Clinical success rate with symptomatic improvement was 85.7 %; one patient developed post-thrombotic syndrome on long term follow-up despite initial symptomatic improvement. Poststenting, the primary patency rate was 85.7 % (six of seven patients) and the secondary patency rate was 100 % (seven of seven patients). Conclusions: Endovascular recanalization with balloon angioplasty and placement of a self-expanding stent across a chronically occluded IVC filer can be performed safely and effectively for patients with symptomatic iliocaval thrombosis. An adjunctive pharmacologic-mechanical thrombolysis may be considered for selected patients.

The relative efficiency of farming under tenancy systems in Bangladesh was measured in this study. Thirty cash tenants and 30 share tenants were randomly selected for data collection through field survey method from Narayanpur and Bhabokhali villages under Sadar upazila of Mymensingh district. The functional analysis of the study was based on Boro rice. The land tenancy situation in rural Bangladesh was explored in this study with a reasonable high incidence of owners who cultivate their own land in comparison to owner-cum-tenants and tenants. A number of tenurial arrangements including sharing agreements were also revealed in the study villages. Share tenant farmers earned significantly lower net return (Tk. 19,252.18) than the cash tenant farmers (Tk. 22,815.89) from Boro rice production. However, Boro rice production was profitable from the viewpoint of both tenant operators. Finally, the study tested and confirmed that all the explanatory variables (key production inputs) included in the Cobb- Douglas revenue type production function model were important for explaining the variations in gross returns under both tenancy arrangements. DOI: http://dx.doi.org/10.3329/pa.v22i1-2.16479 Progress. Agric. 22(1 & 2): 181-192, 2011

Background: Medicinal plants contain physiologically active principles that over the years have been exploited in traditional medicine for the treatment of various ailments. Objectives and Methods: This study aimed to investigate the effects of the methanolic extract of Pausinystalia yohimbe bark (5 mg/ml) on isolated rabbit aortic strip and rat uterus. Results: methanolic extract of P. yohimbe bark (5 mg/ml) produced relaxation of the phenylephrine precontracted-rabbit aortic strip. This relaxation may be resulted through nitric oxide (NO), since the pretreatment of the isolated rabbit aortic strip with methylene blue inhibited the NO-mediated relaxation. Moreover, the extract exhibited relaxation of rat uterine muscles, which appeared to be not mediated by activation of β2-adrenoceptors and/or H2 receptors, since the relaxant effect continued even after the pretreatment of the tissue with propranolol and ranitidine respectively. Conclusion: The obtained results revealed that methanolic extract of P. yohimbe bark caused relaxation of both isolated rat uterus and rabbit aortic strip through facilitating the role of endogenous compounds such as NO.

We assessed response to immunisation with trivalent split virus influenza vaccine in children with non-leukaemic malignant disease. Children with solid tumours and lymphoma received one or two doses of influenza vaccine, according to current UK guidelines, in autumn 2001 and/or 2002. Children were currently receiving chemotherapy or were within 6 months of completing chemotherapy. Pre and post vaccination sera were assessed for antibodies to the prevalent influenza strains by haemagglutination inhibition (HI). Sixty six children were assessed prior to 69 episodes of vaccination. In 30% episodes, children were susceptible to all three circulating influenza viruses (65% to H1N1, 42% to H3N2 and 90% to B) and only one patient showed protective titres (HI ⩾ 32) against all three strains. Seroresponse rates (⩾4-fold rise in HI) for H1N1, H3N2 and B were 52%, 33% and 51% in 65 episodes. Following immunisation protective titres to all three viruses were seen in 25 episodes (38%) and protective responses to one or two viruses were seen in a further 12 (19%) episodes. There was no significant difference in response rates among children on treatment and off treatment and by intensity of chemotherapy. Children with solid tumours and lymphoma are highly susceptible to influenza infection. Influenza vaccine was well tolerated in this patient group and children showed a significant response to immunisation. These findings support the recommendation for annual influenza vaccination in these children.

Background Diabetes mellitus is a heterogeneous group of disorders characterized by abnormalities of carbohydrate, protein and lipid metabolism. Type 1 diabetes mellitus is an autoimmune disease caused by destruction of pancreatic beta cells and characterized by defect in insulin secretion while type 2 diabetes mellitus results from abnormalities in insulin secretion and/or insulin action or both. Objectives The present study was conducted to investigate the clinical hypoglycemic effects of Allium cepa in type 1 and type 2 diabetic patients. Results In assessment of hypoglycaemic activity of Allium cepa in type 1 and type 2 diabetic patients, ingestion of crude Allium cepa (100 g) caused a considerable reduction in fasting blood glucose levels by about 89 mg/dl in relation to insulin (145 mg/dl) in type 1 diabetic patients and it reduced fasting blood glucose levels by 40 mg/dl, compared to glibenclamide (81 mg/dl) in type 2 diabetic patients, 4 hours later. The same dose of crude Allium cepa produced a significant reduction in the induced hyperglycemia (GTT) by about 120 mg/dl compared to water (77 mg/dl) and insulin (153 mg/dl) in type 1 diabetic patients and considerably reduced GTT by 159 mg/dl in relation to water (55 mg/dl) and glibenclamide (114 mg/dl) in type 2 diabetic patients, after 4 hours. Conclusion It was evident that, crude Allium cepa produced hypoglycemic effects, thus it could be used as a dietary supplement in management of type 1 and/or type 2 diabetes mellitus.

Purpose Patients with febrile neutropaenia (FN) can be stratified according to their risk of significant complications, allowing reduced intensity therapy for low risk (LR) episodes. Serious events are very rare in low risk episodes making randomised trials difficult. Introduction of new evidence-based guidelines followed by re-auditing of the outcome is an alternative strategy. Methods New guidelines for the management of LR FN were implemented in 4 specialist paediatric oncology centres (POCs) and in their associated shared care units (POSCUs). All patients commenced empirical intravenous antibiotic therapy and after 48 h those with blood culture negative episodes designated LR were eligible for discharge on oral co-amoxiclav. Prospective data collection on FN episodes in all treatment centres was undertaken over a 1-year period. Results Seven hundred and sixty two eligible episodes of FN were recorded in 368 patients; 213 episodes were initiated in POCs and 549 episodes were initiated in POSCUs. In 40% of episodes no clinical or microbiological focus of infection was found. At 48 h, 212 (27%) episodes were classified as LR and 143 of these (19%) were managed on the LR protocol. There was a low hospital readmission rate (8/143 episodes; 5.6%), no intensive care admissions and no deaths in LR episodes. Almost all LR episodes (209/212) occurred in the shared care setting. Conclusions Rapid step-down to oral antibiotics was a feasible and safe management strategy for LR FN in the shared care setting in England.

The Moroccan National Railways (O.N.C.F.—Office National de Chemins des Fer du Maroc) network includes 28 tunnels totalling 18,842 km in length. These tunnels have been constructed in the past 65 years (the average tunnel is between 60 and 70 years old). With the exception of the Rabat-Ville and Orangers tunnels, which are double-track, all of the railway tunnels are single-track. The majority of the tunnels were driven in soft or loose ground. In the late 1970s, O.N.C.F. initiated a system of periodic inspections to better follow the condition of the works and to reveal any disorders that threatened the stability of the tunnels. The authors recount in detail the results of two such inspections, and the resulting prevention and repair measures taken.

Limited information is available on the use of positron emission tomography (PET) in paediatric oncology. The aim of this study was to review the impact of PET on the management of paediatric patients scanned over a 10-year period. One hundred and sixty-five consecutive oncology patients aged 11 months to 17 years were included. Two hundred and thirty-seven scans were performed. Diagnoses included lymphoma (60 patients), central nervous system (CNS) tumour (59), sarcoma (19), plexiform neurofibroma with suspected malignant change (13) and other tumours (14). A questionnaire was sent to the referring clinician to determine whether the PET scan had altered management and whether overall the PET scan was thought to be helpful. One hundred and eighty-nine (80%) questionnaires for 126 patients were returned (63 relating to lymphoma, 62 to CNS tumours, 30 to sarcoma, 16 to plexiform neurofibroma and 18 to other tumours). PET changed disease management in 46 (24%) cases and was helpful in 141 (75%) cases. PET findings were verified by histology, clinical follow-up or other investigations in 141 cases (75%). The returned questionnaires indicated that PET had led to a management change in 20 (32%) lymphoma cases, nine (15%) CNS tumours, four (13%) sarcomas, nine (56%) plexiform neurofibromas and four (22%) cases of other tumours. PET was thought to be helpful in 47 (75%) lymphoma cases, 48 (77%) CNS tumours, 24 (80%) sarcomas, 11 (69%) neurofibromas and 11 (61%) cases of other tumours. PET findings were verified in 44 (70%) lymphoma cases, 53 (85%) CNS tumours, 21 (70%) sarcomas, 12 (75%) neurofibromas and 11 (61%) other tumour cases. PET imaging of children with cancer is accurate and practical. PET alters management and is deemed helpful (with or without management change) in a significant number of patients, and the results are comparable with the figures published for the adult oncology population.

Background and Aims AML15 was the first major trial to compare anthracycline based consolidation to a Cytosine-Arabinoside based one. Following closure of the trial, standard therapy of cytosine - arabinoside consolidation therapy is currently recommended at this centre. A review of the cytogenetic, treatment and outcome profiles for patients diagnosed with Acute Myeloid Leukaemia was undertaken following concerns regarding relapse rates. Methods A retrospective study was conducted at the Royal Marsden Hospital on children (aged less than 18), diagnosed to have acute Myeloid Leukaemia between January 2004 and June 2011. Results A total of 72 patients were identified, of which 7 patients did not achieve remission following induction chemotherapy with ADE. 48 patients were appropriate for comparison, 22 patients received treatment with cytosine - arabinoside (ara-C) based consolidation and 26 patients received treatment with anthracycline based therapy (MACE/MIDAC). 9 patients (41%) in the araC group relapsed and 3 of these patients subsequently died. In only 1 patient this was secondary to resistant disease. Of the 9 patients who relapsed 6 had adverse cytogenetics. Within the group of patients treated with MACE/MIDAC consolidation, 14 relapsed (54%) and of these, 10 patients subsequently died. 6 of the 14 relapsed patients had adverse cytogenetic profiles. No patient within the MACE/MIDAC group had treatment changed due to cardiotoxicity. Chi-squared analysis of death rates identified a p value Conclusions The outcome analysis indicates that there is no significant difference between rates of relapse or death in the 2 groups of patients.

Background Bezoars result from the accumulation of ingested foreign material in the form of masses or concretions and consist of three major types depending on their composition: (1) phytobezoars (compressed vegetable matter), (2) trichobezoars (hair), (3) pharmacobezoars (compacted amounts of undigested medication). Symptoms may vary depending on the location of the bezoar. Gastric bezoars may present with abdominal pain, nausea, vomiting, early satiety, anorexia, and gastric outlet obstruction, whereas esophageal bezoars present with dysphagia, odynophagia, and regurgitation of food. Therapy for bezoars should be tailored to the composition of the concretion and to the underlying pathophysiologic process. Available treatment methods include chemical dissolution, endoscopy, or surgery. Case Report A 56-year-old African American, female, active smoker with a history of CNS toxoplasmosis, HIV on highly active antiretroviral therapy (HAART) treatment, and bronchial asthma presented with dysphagia, odynophagia, and regurgitation of solid food. Physical examination and laboratory analysis did not reveal any significant abnormalities. The patient underwent upper GI endoscopy and was found to have a large pill bezoar (2-3 cm) occluding the lumen above a Schatzki ring. The pills were broken using a polypectomy snare and flushed into the stomach and the Schatzki ring was dilated. The patient improved symptomatically and was advised to take crushed pills/liquid medication where possible with a semisolid diet. Teaching Point Pharmacobezoars (most commonly associated with nifedipine, ASA, sucralfate, etc) have become increasingly recognized and are typically found in the lower GI tract. Esophageal bezoars are very rare, and pharmacobezoars as a result of HAART are rarer. The potential for complications in untreated patients emphasizes the importance of early diagnosis and treatment along with prevention of recurrence.