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Background: Despite advances with regard to “do not attempt resuscitation order”, physicians are still reluctant to implement it. In fact, while the nurses could be of great help in making decision about “do not attempt resuscitation order,” they are mostly neglected in this process. The current study was conducted to determine the nurses and physicians’ viewpoints about decision making process of “do not attempt resuscitation order”. Methods: A descriptive analytical study was carried out with participation of 152 physicians and 152 nurses. The participants were selected through stratified quota sampling from three educational hospitals affiliated with Kermanshah University of Medical Sciences. Data gathering tools were a demographics checklist and a researcher-designed questionnaire with 20 statements for measuring the attitudes of the respondents about the decision-making process and implementation of “do not attempt resuscitation order” of incurable patients. Results: Totally, 304 respondents (152 nurses and 152 physicians) participated in the study. The nurses’ attitude score about the consent of the competent patients to “do not attempt resuscitation” was significantly lower in comparison with the physicians, (p < 0.001). However, the nurses’ attitude was more positive than the physicians attitude about the belief that “taking the patient’s consent is the physician’s responsibility” (p < 0.001). Moreover, the nurses’ attitude was more negative compared with the physicians’ attitude about the idea that “obtaining the patient’s consent is the nurse’s responsibility” (p < 0.001). Both groups believed that the nurses cannot recommend “do not attempt resuscitation order” (p < 0.770). Both groups of the respondents believed that the nurses were not qualified to issue the “do not attempt resuscitation order” (physicians’ mean score = 2.85, nurses’ mean score = 2.89). The physicians’ believe in “necessity to negotiate with the nurses about the order” was less deep than that of the nurses (p = 0.035). Conclusions: Given the different attitudes of the nurses and the physicians about the decision-making process of “do not attempt resuscitation,” it is necessary to codify a medical guideline and clarify the decision making and implementation process. The guideline needs to clearly state physician's, nurse's, patient's, and other medical team members’ responsibilities and roles, respectively.

Hexane, dichloromethane and methanol extracts of the roots of Piper sarmentosum Roxb. were screened for toxicity towards Sitophilus oryzae (L.), Rhyzopertha dominica (F.), and Plodia interpunctella (Hübner) and the hexane extract exhibited the highest mortality percentage. Bioassay-guided fractionation of the hexane extract resulted in the isolation of asaricin 1, isoasarone 2, and trans-asarone 3. Asaricin 1 and isoasarone 2 were the most toxic compounds to Sitophilus oryzae, Rhyzopertha dominica, and Plodia interpunctella. Sitophilus oryzae and Rhyzopertha dominica exposed to asaricin 1 and isoasarone 2 required the lowest median lethal time. Insecticidal activity of trans-asarone 3 showed consistent toxicity throughout the 60 days towards all three insects as compared to asaricin 1 and isoasarone 2. Asaricin 1 and isoasarone 2 at different doses significantly reduced oviposition and adult emergence of the three insects in treated rice. Trans-asarone 3 had lowest toxicity with highest LC and LT values in all tested insects relative to its mild oviposition inhibition and progeny activity. Moreover, asaricin 1 and isoasarone 2 significantly inhibited acetylcholinesterase in comparison with trans-asarone 3 and the control. Acetylcholinesterase inhibition of Rhyzopertha dominica and Plodia interpunctella by asaricin 1 and isoasarone 2 were lower than that of Sitophilus oryzae, which correlated with their higher resistance.

The aim of the present study is to isolate bioactive compounds from the roots of Piper sarmentosum and examine the mechanism of action using human breast cancer cell line (MDA-MB-231). Bioassay guided-fractionation of methanolic extract led to the isolation of asaricin (1) and isoasarone (2). Asaricin (1) and isoasarone (2) had significant cytotoxicity towards MDA-MB-231. MCF-10A (human normal breast epithelial cells) cells are less sensitive than MDA-MB-231, but they respond to the treatment with the same unit of measurement. Both compounds increase reactive oxygen species (ROS), decrease mitochondrial membrane potential (MMP) and enhance cytochrome c release in treated MDA-MB-231 cells. Isoasarone (2) markedly elevated caspase -8 and -3/7 activities and caused a decline in nuclear NF-κB translocation, suggesting extrinsic, death receptor-linked apoptosis pathway. Quantitative PCR results of MDA-MB-231 treated with asaricin (1) and isoasarone (2) showed altered expression of Bcl-2: Bax level. The inhibitory potency of these isolates may support the therapeutic uses of these compounds in breast cancer.

Aedes aegypti, Aedes albopictus and Culex quinquefasciatus are vectors of dengue fever and West Nile virus diseases. This study was conducted to determine the toxicity, mechanism of action and the binding interaction of three active phenylpropanoids from Piper sarmentosum (Piperaceae) toward late 3rd or early 4th larvae of above vectors. A bioassay guided-fractionation on the hexane extract from the roots of Piper sarmentosum led to the isolation and identification of three active phenylpropanoids; asaricin 1, isoasarone 2 and trans-asarone 3. The current study involved evaluation of the toxicity and acetylcholinesterase (AChE) inhibition of these compounds against Aedes aegypti, Aedes albopictus and Culex quinquefasciatus larvae. Asaricin 1 and isoasarone 2 were highly potent against Aedes aegypti, Aedes albopictus and Culex quinquefasciatus larvae causing up to 100% mortality at ≤ 15 μg/mL concentration. The ovicidal activity of asaricin 1, isoasarone 2 and trans-asarone 3 were evaluated through egg hatching. Asaricin 1 and isoasarone 2 showed potent ovicidal activity. Ovicidal activity for both compounds was up to 95% at 25μg/mL. Asaricin 1 and isoasarone 2 showed strong inhibition on acetylcholinesterase with relative IC50 values of 0.73 to 1.87 μg/mL respectively. These findings coupled with the high AChE inhibition may suggest that asaricin 1 and isoasarone 2 are neuron toxic compounds toward Aedes aegypti, Aedes albopictus and Culex quinquefasciatus. Further computational docking with Autodock Vina elaborates the possible interaction of asaricin 1 and isoasarone 2 with three possible binding sites of AChE which includes catalytic triads (CAS: S238, E367, H480), the peripheral sites (PAS: E72, W271) and anionic binding site (W83). The binding affinity of asaricin 1 and isoasarone 2 were relatively strong with asaricin 1 showed a higher binding affinity in the anionic pocket.