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The goal of this study was two-fold. The first one was to conduct a literature review of five dietary supplements (L-arginine, coenzyme Q10, garlic, hawthorn, and pycnogenol) on their blood pressure lowering effects. The second goal was to survey first-year pharmacy students at Howard University College of Pharmacy on their knowledge of the various aspects of these DSs. The literature review showed that all the 5 DSs included in this study have beneficial effects in reducing high blood pressure, although their effects are mostly mild to moderate. However, their effects are more pronounced in patients with hypertension and have no or limited effects in normotensive patients. Despite these promising benefits, the survey from the students showed a lower-than-expected knowledge score. The average knowledge level was 57.5 % on all the questions related to the five selected dietary supplements. The knowledge levels ranged from 52.9% for L-arginine to 66.2% for garlic. When the knowledge scores were paired and further analyzed, no statistical differences were noted among the levels for each dietary supplement. Overall, the survey showed that there is a lack of adequate knowledge among the participants on the supplements included in this study. Thus, an additional effort must be made to incorporate key supplement topics in various therapeutics courses throughout the pharmacy education.

This survey was conducted at Howard University (HU) College of Pharmacy as part of a Drug Information course, in which First-Year Pharmacy students learn how to perform literature search on a pharmacy topic and run a survey. A total of 42 student respondents participated in the survey. Nearly 64% (n=27) wrongly thought that cimetidine reduces the risk of colon cancer, while 57.1% (n=24) gave a wrong response that, even though cimetidine is FDA-approved for other indications, it can be taken for the prevention of colorectal cancer. Twenty-seven (64.3%) correctly believed that cimetidine is used for other health problems than colorectal cancer. The majority gave the correct response (n=25; 59.5%) that prescription medications are more useful than dietary supplements for the prevention of colorectal cancer. The highest number of correct responses (n=28; 66.7%) was obtained for the question of cimetidine passing through breast milk. The opinions of survey respondents were evenly divided in recommending cimetidine for the prevention of colorectal cancer (50%, n=21), and knowing someone or oneself taken for other than colorectal cancer (50%, n=21). Opinions varied unevenly for the other three opinion-based questions.

A survey was conducted among 42 Howard University first year professional pharmacy students regarding their knowledge and opinions about the use of metformin in colorectal patients. Twenty-five (59.5%) respondents agreed that metformin reduces the risk of colorectal cancer in type 2 diabetes patients, and the majority (n=22, 52.4%) disagreed with the statement that metformin is a drug recommended for colorectal cancer. Twenty-five (59.5%) replied that colorectal cancer is a common illness regardless of age range. Twenty-four (57.1%) survey participants responded in favor of patients taking metformin to lower the risk of colon cancer. On the other hand, the majority (n=25, 59.5%) agreed that colorectal patients with diabetes mellitus taking metformin have the same outcome as those who do not have diabetes. In response to the opinion part of the questionnaire, the majority (n=23, 54.7%) admitted to feeling comfortable about recommending metformin to increase the chance of survival of colorectal patients, while only 18 (42.8%) were confident in explaining the benefits of metformin in preventing colorectal cancer. Twenty-three (54.7%) of respondents prefer natural and holistic methods, and 16 (28.1%) knew someone with type 2 diabetes who was taking metformin for the prevention of colorectal cancer. Most respondents (n=29, 69%) believe prescription medications should be used to prevent colorectal cancer rather than metformin which has inadequate supporting evidence. A sub-analysis appears to indicate that female participants, those with previous pharmacy-related jobs, and those with fewer years of work experience disagree with most of the opinion questions compared to their counterparts. They also had a wider range of opinions among themselves compared to their counterparts.

A survey was conducted among first-year pharmacy students at Howard University College of Pharmacy to measure their level of knowledge and gauge their opinion regarding the off-label uses of two non-steroidal anti-inflammatory drugs (NSAIDs), indomethacin and celecoxib. The average level of knowledge on indomethacin and celecoxib was 36.2% and 31.2%, respectively. Among the five knowledge-based questions on each of these drugs, the highest correct response rate was obtained on indomethacin dosing at 72.9%, and 64.7% on the class of drugs celecoxib belongs to. In the responses to questions on indomethacin, the highest correct response of 72.9% was significantly higher (pp=0.3257). In the same manner, the correct response rate of 64.7% for the class of drugs that celecoxib belongs to was significantly higher than the response rates for the other questions (pp=0.0883). The opinions of the students varied, with a majority (55.9%) agreeing that serious diseases should be treated with non-approved medications. In the case of indomethacin, 35.5% of the respondents believed that because of toxicity issues, it should not be used outside the approved indications, while 27.8% believed that the safety has been established and can be used outside the approved use. Most respondents (55.9%) on celecoxib thought colorectal cancer is a serious disease and can be treated with non-approved drugs.

The objective of the survey was to evaluate the knowledge and opinion of Howard University College of Pharmacy first-year professional pharmacy students regarding the use of the nutritional supplement flaxseed. The survey questionnaire comprising 5 knowledge-based and 5 opinion-based items was administered to 42 first year pharmacy students. Most of the respondents had adequate knowledge about flaxseed ranging from 52.4 to 90.5%. There was no statistical difference when responses were analyzed based on the gender, age and prior work experience categories of the survey participants. More than half of the respondents had good levels of knowledge and opinion about flaxseed, with the highest being 90.5% to a specific knowledge question on the use of flaxseed for hyperlipidemia, heart disease, cancer, stroke, and diabetes. The respondents were close to being evenly divided on whether flaxseed can increase appetite and feeling comfortable about recommending it for personal use to lower cholesterol before taking prescription medications (42.8 to 57.2 and 47.6 to 52.4%, respectively).

Previous studies have shown a correlation between acute kidney injury (AKI) and combination antimicrobial therapy comprising piperacillin-tazobactam and vancomycin. In this study, AKIs were compared in patients who received vancomycin plus piperacillin-tazobactam with those who received vancomycin plus cefepime. We found a statistically significant increase in AKI risk in the vancomycin plus piperacillin-tazobactam group when compared to the vancomycin plus cefepime group using both AKI criteria [KDIGO 18.9% vs. 4.5% (p = 0.0012); RIFLE 11.2% vs. 1.8% (p = 0.0029)]. Vancomycin in combination with piperacillin-tazobactam led to an increased risk of AKI in comparison to vancomycin and cefepime.

Background Per World Health Organization, carbapenems should be key targets for antibiotic stewardship programs. Methods A multifaceted antimicrobial stewardship program (ASP) was implemented in January 2018 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Carbapenem use during pre ASP intervention period (P1: 07/01/2016-12/31/2017) was compared with ASP intervention period (P2: 01/01/2018-06/30/2019). ASP interventions included: providing educational pearls in monthly physician newsletter; educational posters in high-traffic provider areas; suppression of carbapenem results on microbiology susceptibility reports; distributing monthly carbapenem use data to providers; provider counseling for appropriate ordering; creating carbapenem alternative alert in order-entry software; generating pharmacy decision-support software algorithms to aid in identifying intervention opportunities; removing carbapenems from order-sets where appropriate. Additional ASP pharmacist interventions: limiting double antibiotic coverage for pseudomonas/anaerobes; de-escalation recommendations. Results Carbapenem use declined significantly from a mean of 64.81 days of therapy (DOT) per 1000 patient days during P1 to 8.91 DOT per 1000 patient days in P2 (p< 0.001). All hospital units showed a significant decrease in carbapenem use, with intensive care step-down unit noting 85.7% reduction (p < 0.00001); floors (medicine, pediatric, surgery) with 61.6% reduction (p< 0.00001); and intensive care units with 52% reduction (p< 0.00001) during P2 compared to P1. Defined daily doses per 1000 patient days decreased from 314.9 in P1 to 93.4 in P2 (p< 0.00001). During P2, 58.3% (132/228) of carbapenem orders were found to be appropriate compared to 37.5% (190/506) in P1 (p< 0.00001). Sensitivity profile for Pseudomonas aeruginosa improved from 86% carbapenem sensitivity during P1 to 89% in P2. No Carbapenem Resistant Enterobacteriaceae isolates were identified. Cost savings of $643 per 1000 patient days were recognized in P2 as a result of reduced carbapenem use. Conclusion There was a significant decline in total carbapenem utilization, an increase in proportion of appropriate use and considerable cost savings as a result of ASP interventions. Disclosures All Authors: No reported disclosures

Introduction: Many patients use home remedies for various maladies. The effectiveness of these remedies is not always scientifically ascertainable. Some may be backed by limited sci- entific studies. Case Summary: A few years ago, a five-year old girl in Addis Ababa, Ethiopia sustained heavy burns from spillage of boiling water. The child was taken to a local Emergency Department (ED) of a hospital for evaluation and treatment. The patient was discharged after the burn was treated and the wound was appropriately dressed. The mother was instructed to take the child to a clinic for follow-up. After four days of treatment at the clinic, no arrangement was made for visits during the weekend. Upon the advice of her neighbor, the mother decided to apply coffee powder from freshly roasted coffee beans to the wound. In the few days that followed, she observed significant improvement in the healing of the wound. She continued this treatment daily, in lieu of visits to the clinic. In about three weeks, the wound was completely healed. The mother who now lives in the USA recently contacted the Drug Information Center at Howard University (HU) inquiring about the merits of coffee powder in the treatment of burn wounds. A literature review revealed various studies confirming the potential effectiveness of powder prepared from freshly roasted coffee beans in the treatment of wounds. Conclusion: A mother of a five-year old reported that treatment of a burn wound sustained by her child with powder from freshly roasted coffee resulted in healing. A literature review found some evidence to support the usefulness of this home remedy in wound treatment.

Objective: To determine sociodemographic factors that help to predict the use of complementary and alternative medicine (CAM) by Ethiopian immigrants in the USA. Methods: A multicomponent survey was administered to over 350 Ethiopian immigrants to elicit information regarding their demographic characteristics and use of CAM. The primary dependent variable was use of CAM within the past 5 years. Descriptive statistics were utilized to characterize the sample in regards to gender, age, education, income and length of residency in the USA. Bivariate logistic regression analysis was used to determine which factors were associated with use of CAM. Multivariate logistic regression was utilized to evaluate which characteristics predicted use of CAM after adjusting for other variables. Results: A bivariate logistic regression analysis of CAM use among Ethiopian immigrants in the USA showed that females were twice as likely as males to use herbs and supplements. Survey participants with some college or associate degree level education had 2.21 times greater odds for using herbs and supplements than those with only high school education. No association was discerned between herbs/supplements use and the categories of age and length of residency in the USA. In a multivariate logistic regression analysis, gender, some college level education and annual income greater than $100,000 showed significant association with the use of herbs and supplements. Conclusion: Certain demographic characteristics such as gender, education and income can be useful in helping to predict which Ethiopian immigrants are more likely to use CAM.

Intellectual Property Rights (IPRs) has been the subject of voluminous literature. Much has been written about its origin, implications and dispositions. Yet, the subject of IPRs is fraught with murky issues, especially as it applies to developing countries. This paper will examine IPRs within the context of developing countries, in particular those in Africa. It will cite examples in the field of traditional medicine/medicinal plants to show how IPRs have been applied in the past. This paper will also try to chart a few pointers for the future to turn the tide in favour of developing countries in Africa by focusing more on potential collaboration among developing countries.

This review discusses the most commonly used natural remedies by Ethiopian immigrants in the United States of America (USA). The data is extracted from a previous survey by the same authors who established that more than half of the respondents (57.5%) used supplements and herbs for a wide array of ailments in the preceding 5 years. Ginger, garlic and flaxseed were the most commonly used herbs by the survey participants.

An electronic questionnaire was utilized to conduct a survey on complementary and alternative medicine (CAM) use among first year Howard University pharmacy students. 36 out of 49 completed the questionnaire for a response rate of 73.5%. 21 (58.3%) reported having used herbs or other supplements in the past 5 years with cranberry, garlic, ginger and ginseng topping the list. Prayer (48%) and Yoga (32%) were the most commonly utilized non-herbal CAM modalities. Our finding is consistent with other studies, including one by the same authors, that CAM is a widely practiced modality in diverse segments of the US population.

Objective The Medicare Hospital Readmissions Reduction Program (MHRRP) which took effect on October 1st, 2012 holds providers accountable for quality of care delivered, placing a greater focus on care coordination. Innovative strategies in medication management in the acute care and outpatient primary care settings require vigilant pharmacist intervention. The objective of this study is to determine if pharmacist-provided medication reconciliation service in conjunction with hospital follow-up outpatient physician visits reduces hospital readmission rate. Methods This was a prospective study in which physician-initiated outpatient hospital follow-up appointment scheduling was used to identify patients at time of hospital discharge. All patients ≥50 years of age were eligible for outpatient pharmacist visits. Emergency room visits were excluded. Data collected included: patient demographics, characteristics of identified drug therapy problems, accuracy of outpatient medication histories and time required by pharmacist to perform the reviews. Patient adherence to early (24–72 hours) outpatient hospital follow-up visit was also evaluated. Previous year’s readmission data for high risk patients who received only physician visits were also collected for comparison with those who were jointly visited by pharmacists and physicians. Results A total of 98 patients were assigned to receive pharmacist intervention in conjunction with physician hospital follow-up visits. Nine of the 98 patients seen by pharmacists at hospital follow-up visits were readmitted (9.2%) to a hospital within 30 days of discharge. Out of the 236 patients seen during the same period the previous year (2011) for physician alone hospital follow-up visits 46 were readmitted (19.4%) within 30-days of hospital discharge. The difference between these groups was statistically significant ( p = 0.023), with patients in the pharmacist intervention group experiencing a reduction in 30-day readmission risk. Physician alone outpatient follow-up was associated with earlier mean time to readmission, 12.8 days vs. 18.3 days in the pharmacist intervention group ( p = 0.042). Conclusion Pharmacist involvement in hospital discharge follow-up visits reduced overall readmission rate in high risk patients and improved monitoring of drug therapy, and medication history accuracy when compared to physician-alone visits.

A new pterocarpan, (+)-3,4-dihydroxy-8,9-methylenedioxypterocarpan [1], was isolated from the flowers of Petalostemon purpureus by a DNA strand-scission assay-guided fractionation procedure. Compound 1 demonstrated activity in a standard in vitro DNA strand-scission assay, and cytotoxicity toward a KB tumor cell line. Two other related pterocarpans [2, 3] isolated from same plant were found to be moderately active for KB cells, but were inactive in the DNA strand-scission assay. (+)-4-Hydroxy-3-methoxy-8,9-methylenedioxypterocarpan [2] has not been reported previously as a natural product, while (+)-maackiain [3] has been isolated only as an optically inactive racemate along with its optical antipode, the (-)-isomer.

Pentacyclic triterpenoids based on the taraxer-14-ene skeleton with a C-28 attached carboxylic acid group have been isolated from the roots of Maprounea africana. These compounds were identified as 1 beta,2 alpha-dihydroxyaleuritolic acid 2,3-bis-p-hydroxybenzoate [1], 2 alpha-hydroxyaleuritolic acid 3-p-hydroxybenzoate [2], 2 alpha-hydroxyaleuritolic acid 2,3-bis-p-hydroxybenzoate [4], aleuritolic acid 3-p-hydroxybenzoate [5], aleuritolic acid [6], and aleuritolic acid 3-acetate [7]. Compounds 1 and 2 are new triterpene esters. Compound 3 was previously reported as 7 beta-hydroxymaprounic acid 3-p-hydroxybenzoate [13]. However, based on detailed nmr studies, its structure has been revised.

Ethyl acetate and aqueous extracts of tannin-containing topoisomerase inhibitory plant samples were subjected to one or more of seven tannin removal procedures, and the resulting products were subsequently evaluated for topoisomerase inhibitory activity. In most of the samples investigated, the initial activity was lost after tannin removal. It was concluded that the activity initially observed was primarily due to tannins. Procedures are presented for routinely obtaining tannin-free organic and aqueous fractions.

Three new biflavonoids to which we have accorded the trivial names caly- copterone (1), isocalycopterone (2), and 4-demethylcalycopterone (3) and the known flavone 4',5-dihydroxy-3,3',6,7-tetramethoxyflavone (4) were isolated as cytotoxic constituent from the flowers of Calycopteris floribunda Lamk. (Combretaceae). Compounds (1-3) showed a wide range of activity against a panel of solid tumor cell lines. Among the biflavo- noids, calycopterone (1) is the major constituent

Purpose Six extended-interval gentamicin dosing regimens were comparatively evaluated in premature and full-term neonates. Methods Data regarding six physician-ordered dosing regimens of gentamicin for neonates in a hospital neonatal intensive care unit were collected and analyzed. Neonates of gestational age (GA) 29 weeks or younger received 4.5 mg/kg every 48 hours. Neonates of GA 30–34 weeks received one of three dosing regimens: 3.5, 4, or 4.5 mg/kg every 36 hours. Neonates of GA 35 weeks or older received either 3.5 or 4 mg/kg every 24 hours. Blood samples were collected 30 minutes before and 30 minutes after the third dose was infused for binary trough and peak level determinations, respectively. Results Peak gentamicin concentrations in the target range were attained most often in neonates of GA 29 weeks or younger who received gentamicin 4.5 mg/kg every 48 hours, in neonates of GA 30–34 weeks treated with gentamicin 3.5 mg/kg every 36 hours, and in neonates of GA 35 weeks or older treated with gentamicin 3.5 mg/kg every 24 hours. Conclusion For neonates of GA 30–34 weeks, gentamicin 3.5 mg/kg every 36 hours resulted in the highest percentage of peaks in the target range compared with 4 and 4.5 mg/kg every 36 hours. For neonates of GA 35 weeks or older, gentamicin 3.5 mg/kg every 24 hours provided the highest percentage of peaks in the target range compared with 4 mg/kg every 24 hours. The differences between the percentages of trough values in the target range of 0.5–2 μg/mL were not significant among dosing subgroups within each age group.

A new potently sweet labdane diterpene arabinoside, gaudichaudioside A (1), was isolated from the aerial parts of Baccharis gaudichaudiana DC. (Compositae). Also isolated were four other novel labdane arabinosides, gaudichaudiosides B–E (2–5), which although closely related to 1 structurally, were not found to be highly sweet.

Description d'un protocole de separation d'un certain nombre de composes potentiellement edulcorants extraits de Stevia rebaudiana (glycosides), Polypodium glycyrrhiza (polypodosides) et Lippia dulcis (hernandulcine) et comparaison avec l'hernandulcine de synthese

An investigation of the combined leaf and stem of Lithospermum caroliniense afforded two new pentacyclic triterpenoids based on the olean-12-ene and taraxast-12-ene skeletal types. The structures of these compounds were elucidated on the basis of spectral analysis as 1 alpha,3 beta,23-trihydroxyolean-12-ene-28-oic acid and 3 alpha,19 beta,21 alpha,23-tetrahydroxytaraxast-12-ene-28-oic acid.

A new prenylated flavonol, petalopurpurenol (1), and a known dihydroflavonol, petalostemumol (2), have been isolated by DNA scission-guided fractionation of the organic portion of a 20% MeOH/CHCl 3 /H 2 O partition of a 50% MeOH/CHCl 3 extract of the roots of Petalostemon purpureus. Compound 2 displayed moderate activity in DNA-scission assay. Both compounds 1 and 2 were evaluated for cytotoxicity in a panel of human cancer cell lines. The structures of petalopurpurenol (1) and petalostemumol (2) were determined by spectroscopic analysis.

Investigation of the aerial parts of Baccharis gaudichaudiana has afforded a new labdane arabinoside with a novel 23-carbon aglycone skeleton. The structure of this compound, to which we have accorded the trivial name, gaudichaudioside F, was established by analysis of its spectroscopic parameters.

The rootwood of Aeschynomene mimosifolia Vatke (Leguminosae) has yielded a new neoflavonoid, mimosifoliol (1), and an unusual C16-styrylcycloheptenone derivative, mimosifolenone (2). The structures of these compounds were determined on the basis of spectral analysis. Compound 1 demonstrated weak activity in DNA-strand scission assay, while compound 2 was found to be inactive. Mimosifoliol (1) was inactive toward several human cell lines, while 2 was moderately active against the KB cell line.

A new polyacetylenic diepoxide compound, gummiferol [1] was isolated from the leaves of Adenia gummifera by KB cytotoxicity-guided fractionation. Compound 1 exhibited significant activity against the KB human cell line and a broad cytotoxic spectrum against other human cancer cell lines. The structure of 1 was established primarily on the basis of its spectral data.

Publisher Summary This chapter focuses on the structure-activity relationship of highly sweet natural products. It may be seen that ongoing research activities on the isolation and characterization of naturally occurring sweet principles have continued to afford many novel molecules in several structural classes. These compounds occur in species representing a taxonomically wide range of plant families. Methodology has been developed in terms of candidate plant selection, dereplication of sugars, polyols and sweet phenylpropanoids, and in other phytochemical procedures, such that significant progress can be made in the elucidation of further highly sweet-tasting molecules with only a modest investment of capital. To being used in an unmodified form as sweeteners, plant-derived sweet-tasting molecules can serve as useful lead molecules for synthetic optimization. Therefore, knowledge of structure-sweetness relationships of plant sweeteners, and their naturally occurring congeners and semi-synthetic analogs is of use in assisting with the rational design of new sweeteners based on natural product leads.

Three new labdane diterpenes, gaudichaudols A-C [1-3], a new clerodane diterpenoid, gaudichaudone [4], and the known clerodane, articulin acetate [5] have been isolated from the aerial parts of Baccharis gaudichaudiana, together with the known compounds, apigenin, hispidulin, spathulenol, and ursolic acid. Through the application of 1D- and 2D nmr spectroscopy, the structures of the new diterpenoids [1-4] were, in turn; elucidated as 15,16,18,19-tetrahydroxylabd-5-ene, 15-O-acetyl-16,18,19-trihydroxylabd-5-ene, 16-O-p-trans-coumaroyl-15,18,19-trihydroxylabd-5-ene, and 2 beta-hydroxy-15,16-epoxycleroda-1(10),15,16-trien-18,19-olide++ +. The isolated compounds were evaluated in P-388 lymphocytic leukemia cells as well as a battery of human cancer cell lines. Among the diterpenoids, gaudichaudol C [3], gaudichaudone [4], and articulin acetate [5] exhibited significant cytotoxic activity against certain cancer cells.

Two new isoflavones, 6,7,8,3',4',5'-hexamethoxyisoflavone and 7,8,3',4',5'-pentamethoxyisoflavone, have been isolated and characterized from the combined root bark and stem bark of Petalostemon purpureus.