Pharmaceutical Use Research Articles

Sulfonamides and β-lactam antibiotic residues and human health risk assessment in commercial chicken meat sold in Nairobi City, Kenya

The use of antibiotic pharmaceuticals in chicken husbandry has risen steadily over time. Antibiotic residues in chicken meat poses risks to human health in addition to their contribution to the advancement of antibiotic resistance. Despite the increased use of antibiotics in chicken farming in Kenya, assessments of the residues and human exposure have not been conducted. In this study, the sulfonamides (SAs); sulfapyridine (SPD), sulfadiazine (SDZ) and sulfamethazine (SMZ) and the β-lactams (βLs); ampicillin (AMP), penicillin G (PEG) and amoxicillin (AMX) were determined in three chicken meat types; ex-layers, broilers, and indigenous meat marketed in Nairobi City, Kenya. Residual SAs ranged from 0.1 to 154.4 μg kg−1, with SPD recording the highest concentration in ex-layers’ chicken meat samples. A range of 19.7 to 309.0 μg kg−1of BLs was found, where the highest amount represented AMX in ex-layers. Mean AMX contents in all chicken types, and AMP in broilers were above the Maximum Residue Limits (MRLs). For SAs, only SPD mean content was above MRL in ex-layers. Human health risks from exposure to antibiotic-contaminated chicken meat was evaluated using % ADI. All tested βLs were of no risk (<1% ADI) to human health. SPD and SDZ posed considerable risk (1–5% ADI) in some chicken meat, whereas SPD in ex-layers’ chicken meat posed distinctive risk (>5% ADI) to children. Considering the co-occurrence of different types of antibiotics in same samples, obtained MRLs and % ADI (for some of the antibiotics) are indicative of potential human health risks. Information is valuable in provoking response from concerned agencies and fostering activities that advocate for judicious use of antibiotics.

From accurate genome sequence to biotechnological application: The thermophile Mycolicibacterium hassiacum as experimental model.

Mycobacteria constitute a large group of microorganisms belonging to the phylum Actinobacteria encompassing some of the most relevant pathogenic bacteria and many saprophytic isolates that share a unique and complex cell envelope. Also unique to this group is the extensive capability to use and synthesize sterols, a class of molecules that include active signalling compounds of pharmaceutical use. However, few mycobacterial species and strains have been established as laboratory models to date, Mycolicibacterium smegmatis mc2 155 being the most common one. In this work, we focus on the use of a thermophilic mycobacterium, Mycolicibacterium hassiacum, which grows optimally above 50°C, as an emerging experimental model valid to extend our general knowledge of mycobacterial biology as well as for application purposes. To that end, accurate genomic sequences are key for gene mining, the study of pathogenicity or lack thereof and the potential for gene transfer. The combination of long- and short-massive sequencing technologies is strictly necessary to remove biases caused by errors specific to long-reads technology. By doing so in M. hassiacum, we obtained from the curated genome clues regarding the genetic manipulation potential of this microorganism from the presence of insertion sequences, CRISPR-Cas, type VII ESX secretion systems, as well as lack of plasmids. Finally, as a proof of concept of the applicability of M. hassiacum as a laboratory and industrial model, we used this high-quality genome of M. hassiacum to successfully knockout a gene involved in the use of phytosterols as source of carbon and energy, using an improved gene cassette for thermostable selection and a transformation protocol at high temperature.

A new analytical method to determine trace level concentrations of pharmaceuticals in influent wastewater: A tool to monitor human use patterns

The occurrence of pharmaceuticals in influent wastewater samples (IWW) is a recurrent issue. The monitoring of their presence is not only valuable from an environmental point of view, but also as a tool to analyze patterns of human use by the so-called wastewater-based epidemiology. The development of an analytical method based on solid-phase extraction followed by liquid chromatography coupled to tandem mass spectrometry to monitor the occurrence of a group of seventeen pharmaceuticals including the most representative for various therapeutic families in IWW samples is described in this work. The samples were collected during a monitoring week in six wastewater treatment plants located in different cities and towns across Spain. The developed method provides acceptable figures of merit with apparent recoveries in IWW ranging from 42% to 139%, and low matrix effect (in general lower than ± 30%), and method quantification limits (MQL) between 1 ng/L and 24 ng/L for all compounds, except atenolol (58 ng/L). All the studied pharmaceuticals were found in all samples with concentrations ranging from < MQL to 10,393 ng/L, being the highest concentrations for tramadol. The population normalized daily loads revealed that the use of pharmaceuticals follows, in general, a similar pattern in all cities monitored.

Invasive Alien Species as a Potential Source of Phytopharmaceuticals: Phenolic Composition and Antimicrobial and Cytotoxic Activity of Robinia pseudoacacia L. Leaf and Flower Extracts.

Black locust (Robinia pseudoacacia L.), an invasive tree in Europe, commonly known for its negative impact on biodiversity, is a rich source of phenolic compounds recognized in traditional medicine. Since the metabolite profile depends on the environment and climate, this study aimed to provide the first LC-MS phytochemical screening of the black locust from the Istria region (Croatia). The compounds were extracted from leaves and flowers with 70% ethanol and 80% methanol. Total phenolics (TP) and flavonoids (TF), as well as antioxidant capacity (AC) measured by ABTS (17.49-146.41 mg TE/g DW), DPPH (24.67-118.49 mg TE/g DW), and FRAP (7.38-77.53 mg TE/g DW) assays, were higher in leaf than in flower extracts. Higher TP and total non-flavonoid (TNF) values were displayed in ethanolic than in methanolic extracts. In total, 64 compounds were identified, of which flavonols (20) and hydroxycinnamic acid derivatives (15) were the most represented. Flavanols such as catechin dominated in leaf extracts, followed by flavonols, with kaempferol glucuronyl rhamnosyl hexosides as the main compound, respectively. Flower extracts had the highest share of flavones, followed by ellagitannins, with luteolin dirhamnosyl hexosides and vescalagin, respectively, being predominant. The extracts had good quorum sensing, biofilm formation prevention, and eradicating capacity. The results provided new insights into the phytochemical properties of R. pseudoacacia as the first step toward its potential pharmaceutical use.

Antimicrobial resistance and genotyping of Pseudomonas aeruginosa isolated from the ear canals of dogs in Japan.

The strong bond between dogs and their owners creates a close association that could result in the transfer of antibiotic-resistant bacteria from canines to humans, potentially leading to the spread of antimicrobial resistance genes. Pseudomonas aeruginosa, a common causative agent of persistent ear infections in dogs, is often resistant to multiple antibiotics. Assessing the antimicrobial resistance profile and genotype of P. aeruginosa is crucial for the appropriate use of veterinary pharmaceuticals. However, in recent years, few studies have been conducted on this bacterium in Japan. We determined the antimicrobial resistance profile and genotype of P. aeruginosa isolated from the ear canal of dogs in Japan in 2020. Analysis of antimicrobial resistance using disk diffusion tests indicated a high frequency of resistance to most antimicrobial agents. Particularly, 29 isolates from the ear canals of the 29 affected dogs (100%) were resistant to cefovecin, cefpodoxime, and florfenicol; however, they were susceptible to cefepime and piperacillin/tazobactam. Only 3.4, 10.3, and 10.3% of the isolates were resistant to ceftazidime, tobramycin, and gentamicin, respectively. Furthermore, upon analyzing the population structure using multilocus sequence typing, a considerably large clonal complex was not observed in the tested isolates. Three isolates, namely ST3881, ST1646, and ST532, were clonally related to the clinically isolated sequence types in Japan (such as ST1831, ST1413, ST1812, and ST1849), which is indicative of dog-to-human transmission. Considering the variation in antibiotic resistance compared to that reported by previous studies and the potential risk of dog-to-human transmission, we believe that the survey for antimicrobial resistance profile and population structure should be continued regularly. However, the prevalence of multidrug-resistant P. aeruginosa in dogs in Japan is not a crisis.

A Review of Approaches to the Metallic and Non-Metallic Synthesis of Benzimidazole (BnZ) and Their Derivatives for Biological Efficacy.

Heterocyclic compounds are significant lead drug candidates based on their various structure-activity relationships (SAR), and their use in pharmaceutics is constantly developing. Benzimidazole (BnZ) is synthesized by a condensation reaction between benzene and imidazole. The BnZ structure consists of two nitrogen atoms embedded in a five-membered imide ring which is fused with a benzene ring. This review examines the conventional and green synthesis of metallic and non-metallic BnZ and their derivatives, which have several potential SARs, along with a wide range of pharmacological properties, including anti-cancer, anti-inflammatory, anti-microbial, anti-tubercular, and anti-protozoal properties. These compounds have been proven by pharmacological investigations to be efficient against different strains of microbes. Therefore, in this review, the structural variations of BnZ are listed along with various applications, predominantly related to their biological activities.

Investigation into Brazilian Palygorskite for Its Potential Use as Pharmaceutical Excipient: Perspectives and Applications.

Palygorskite is an aluminum and magnesium silicate characterized by its fibrous morphology, providing it with great versatility in industrial applications, including pharmaceuticals. Although most of the reserves are in the United States, in recent years occurrences of commercially exploited deposits in Brazil have been recorded, mainly in the country's northeast region. This has motivated this study, which analyzes raw Brazilian palygorskite compared to a commercial sample (Pharmasorb® colloidal) to demonstrate its pharmaceutical potential. The chemical and mineral composition of the samples were evaluated for surface properties, granulometry, morphology, crystallography, thermal analysis, and spectroscopy. Raw palygorskite presented 67% purity, against 74% for Pharmasorb® colloidal. The percentage purity relates to the presence of contaminants, mainly carbonates and quartz (harmless under conventional conditions of pharmaceutical use). Furthermore, it was possible to confirm the chemical composition of these phyllosilicates, formed primarily of silicon, aluminum, and magnesium oxides. The crystallographic and spectroscopic profiles were consistent in both samples, showing characteristic peaks for palygorskite (2θ = 8.3°) and bands attributed to fibrous phyllosilicates below 1200 cm-1, respectively. The thermal analysis allowed the identification of the main events of palygorskite, with slight differences between the evaluated samples: loss of water adsorbed onto the surface (~85 °C), removal of water contained in the channels (~200 °C), coordinated water loss (~475 °C), and, finally, the dehydroxylation (>620 °C). The physicochemical characteristics of raw palygorskite align with pharmacopeial specifications, exhibiting a high specific surface area (122 m2/g), moderately negative charge (-13.1 mV), and compliance with the required limits for heavy metals and arsenic. These favorable technical attributes indicate promising prospects for its use as a pharmaceutical ingredient in the production of medicines and cosmetics.

Stakeholders' perspectives and use of web-based knowledge support for environmental information on pharmaceuticals

BackgroundPharmaceuticals treat and prevent diseases but can pose a risk to organisms, predominantly in aquatic environments. The use of pharmaceuticals is predicted to increase due to, among other factors, a growing and aging population and climate change. Therefore, it is important to develop mitigation strategies to prevent pharmaceutical residues from entering the environment. In Sweden, two public pharmaceutical web-based knowledge supports provide information on the environmental impact of pharmaceuticals. ObjectiveTo explore stakeholder perspectives, use and future opportunities related to two webbased knowledge supports publicizing environmental information on pharmaceuticals. MethodsStakeholders identified for their experience with the knowledge supports, pharmaceutical policy, and stakeholder collaboration were recruited using purposive and snowball sampling for semi-structured interviews. Interviews were conducted in person or via video calls. Respondents included twenty-one representatives from the pharmaceutical industry, regional and national authorities, academia, and an independent research institute. Interview transcripts were analyzed using content analysis. ResultsRespondents valued having environmental information on pharmaceuticals publicly accessible on two well-known pharmaceutical knowledge supports. The knowledge supports have been used in Sweden and internationally. Perceived differences were recognized between the impact and perspectives of the two knowledge supports with a general preference for the Janusinfo knowledge support. The preference was especially identified regarding transparency and the use of the information in clinical practice. Barriers to impact were a lack of resources and decision-making criteria. Respondents believed that the impact and value of the knowledge supports could be improved with more authority involvement. ConclusionPublic knowledge support providing environmental information on pharmaceuticals has been valuable across sectors, especially, among Drug and Therapeutics Committees. We believe the results from this study could be useful for other countries interested in implementing a similar system.

Optimization of the Extraction Conditions of Bioactive Compounds from Ocimum basilicum Leaves Using Ultrasound-Assisted Extraction via a Sonotrode.

Sweet basil (Ocimum basilicum) leaves are rich in bioactive compounds that present therapeutic benefits for human health. Ultrasonic-assisted extraction (UAE) is frequently used to obtain phenolic compounds from plants/herbal sources. However, few works have developed multi-variable studies to find the optimal conditions to extract the maximum amount of compounds, especially when applied to UAE via a sonotrode. The purpose of this work was to perform a multi-variable study by employing a Box-Behnken design to collect the highest active compound content from Ocimum basilicum leaves. The efficacy of the design was endorsed by ANOVA. The studied parameters for UAE via a sonotrode were the ethanol/water ratio, amplitude, and time. The analyzed responses were the rosmarinic acid, the sum of phenolic acids, and the sum of phenolic compounds content. The optimal conditions were found to be 50% ethanol/water, 50% amplitude, and 5 min. Twenty bioactive compounds were identified by HPLC-ESI-TOF-MS when the extract was collected by applying the optimal conditions. Ocimum basilicum may be appreciated as a valuable source of important bioactive substances for pharmaceutical use.

Antimicrobial Activities of Mangrove Species in Southeast Asia: A Systematic Review

Antimicrobial resistance in Southeast Asia is a macro-level health dilemma that may cause substantial casualties annually. Fortunately, Southeast Asian mangroves are potent reservoirs of bioactive compounds with antimicrobial properties in correlation to their traditional usage. Hence, this study aimed to systematically review studies concerning antimicrobial activities of mangroves in Southeast Asia as well as provide a technological overview of its prospective use in pharmaceutical industry applications through patents. Through the PRISMA protocol, the search for peer-reviewed studies originated from Southeast Asia and published between 2010 to 2022 were conducted over databases such as CORE, Google Scholar, PubMed (MedLine), Science Direct, Semantic Scholar, Scopus, and Web of Science. Additionally, a patent search was also performed on the Espacenet Patent Search, Google Patents, National Institute of Industrial Property, and United States Patent and Trademark Office. The studies and patents were collated on Mendeley Reference Manager as well as tabulated and assessed on Microsoft Office Excel 2016. After the four-phase screening, 59 studies and one patent regarding antimicrobial activities of Southeast Asian mangroves passed the criteria for the systematic review. It was inferred that Southeast Asia constitutes potentially most species-diverse mangroves with highly varied antimicrobial properties and can form synergism with drugs. The existing studies and patents may provide enlightenment on the future path of studies and inventions which must be continually substantiated in animal and clinical experiments for prospective pharmaceutical industry use. In this way, mangroves can be conserved while antimicrobial resistance and anthropogenic activities can be lowered.

Improvement of DOPA-Melanin Production by Aspergillus nidulans Using Eco-Friendly and Inexpensive Substrates.

Fungal pigments, including melanin, are recognized as promising materials for biomedical, environmental, and technological applications. In previous studies, we have demonstrated that the DOPA-melanin produced by the MEL1 mutant of Aspergillus nidulans exhibits antioxidant, anti-inflammatory, and antimicrobial activities without any cytotoxic or mutagenic effects, suggesting its potential use in pharmaceuticals. In order to increase the yield of this pigment and reduce the costs of its large-scale production, the present study aimed to evaluate agro-industrial by-products, sugarcane molasses, vinasse, and corn steep liquor as inexpensive substrates for fungal growth using experimental design methodology. According to the results obtained, the optimal composition of the culture medium was 0.81% (v/v) vinasse and 1.62% (w/v) glucose, which promoted a greater production of melanin (225.39 ± 4.52 mg g-1 of biomass), representing a 2.25-fold increase compared with the condition before optimization (100.32 mg.g-1 of biomass). Considering the amount of biomass obtained in the optimized condition, it was possible to obtain a total melanin production of 1 g L-1. Therefore, this formulation of a less complex and low-cost culture medium composition makes the large-scale process economically viable for future biotechnological applications of melanin produced by A. nidulans.

Bioactive Lichen Secondary Metabolites and Their Presence in Species from Chile.

Lichens are symbiotic organisms composed of at least one fungal and one algal species. They are found in different environments around the world, even in the poles and deserts. Some species can withstand extreme abiotic conditions, including radiation and the vacuum of space. Their chemistry is mainly due to the fungal metabolism and the production of several secondary metabolites with biological activity, which have been isolated due to an increasing interest from the pharmaceutical community. However, beyond the experimental data, little is known about their mechanisms of action and the potential pharmaceutical use of these kinds of molecules, especially the ones isolated from lesser-known species and/or lesser-studied countries. The main objective of this review is to analyze the bibliographical data of the biological activity of secondary metabolites from lichens, identifying the possible mechanisms of action and lichen species from Chile. We carried out a bibliographic revision of different scientific articles in order to collect all necessary information on the biological activity of the metabolites of these lichen species. For this, validated databases were used. We found the most recent reports where in vitro and in vivo studies have demonstrated the biological properties of these metabolites. The biological activity, namely anticancer, antioxidant, and anti-inflammatory activity, of 26 secondary metabolites are described, as well as their reported molecular mechanisms. The most notable metabolites found in this review were usnic acid, atranorin, protolichesterinic acid, and lobaric acid. Usnic acid was the most investigated metabolite, in addition to undergoing toxicological and pharmacological studies, where a hepatotoxicity effect was reported due to uncoupling oxidative phosphorylation. Additionally, no major studies have been made to validate the pharmacological application of these metabolites, and few advancements have been made in their artificial growth in bioreactors. Despite the described biological activities, there is little support to consider these metabolites in pharmaceutical formulations or to evaluate them in clinical trials. Nevertheless, it is important to carry out further studies regarding their possible human health effects. These lichen secondary metabolites present a promising research opportunity to find new pharmaceutical molecules due to their bioactive properties.

COMPONENT COMPOSITION OF ESSENTIAL OILS FROM LEAVES, INFLORESCENCES AND STEMS OF PEROVSKIA SCROPHULARIFOLIA GROWN IN UZBEKISTAN

Essential oils as secondary metabolites, promising sources of biologically active substances with pronounced antimicrobial, antifungal and antiviral effects, are of considerable interest for study and possible use in medicine, pharmaceuticals, and aromatherapy. We have studied the composition of the essential oil of an endemic species for the first time Perovskia scrophularifolia Bunge. (Lamiaceae = Labiatae). This species of plant is of considerable interest as a medicinal plant, which is widely used in folk medicine in Uzbekistan and neighboring countries. Studies of biologically active substances of this species did not concern the essential oil. During the period of mass flowering in the inflorescences of Perovskia scrophularifolia contains 0.65%, in leaves – 0.71% of essential oil. The stems of the plant contain essential oils in small quantities. The composition and content of the components of the studied samples were determined according to the data of gas chromatographic and chromate-mass-spectrometric analysis. 26 substances were identified in essential oils from leaves, 43 from inflorescences and 18 substances from stems. The main components of essential oils from leaves and inflorescences are 1,8-Cineol up to 19.3% and Isobornyl acetate – up to 15.9%. This species is a promising source of biologically active compounds with biological activity (including antibiotic).

Development and Validation of a Simple and Sensitive ICP-MS Method for the Quantification of Elemental Impurities in Propafenone Hydrochloride Drug Substance

Elemental impurities are substances present in drug products, excipients, or drug formulations. They may be formed by the presence of catalysts and environmental contaminants. Elemental impurities can be detected by a sophisticated method such as Inductively Coupled Plasma Mass Spectrometry (ICP–MS). ICP-MS is an advanced method to detect elemental impurities in drug substances. In this study Propafenone hydrochloride drug was used, Propafenone Hydrochloride is an antiarrhythmic medication belonging to class 1C used to prevent supraventricular and ventricular arrhythmias. The present study was aimed to develop and validate inductively coupled plasma mass spectroscopic (ICP–MS) method for detection of elemental contaminants, i.e., Class 1, Cd, Pb, As, Class 2A, Hg, Co, V, and Class 2B impurities such as Ni, T1, Se, Ag, Au, Pd, Ir, Os, Rh, Ru, and Pt. Total 17 elemental impurities were detected in Propafenone Hydrochloride and this method was employed for the regular sample analysis of 17 elemental impurities in Propafenone Hydrochloride for pharmaceutical use. The instrument conditions were set using RF power of 1550 W, auxiliary gas of 0.5 L/min, and nebulizer flow of 1.01 L/min nebulizer pump pressure was 0.10 rps, spray chamber temperature was 2°C, and mode used was He, He flow rate was 4.3 mL/min and the energy discrimination rate was 3.0 V. The technique is sensitive and may identify desirable elemental impurities within permissible regulatory limits when additional elements are present. The proposed ICP-MS approach has been found to be accurate, precise, linear, rugged, robust, and convenient for the quality control of the drug substance propafenone hydrochloride. The linearity results for each impurity were 0.9990. The methods were validated according to USP requirements and International Council for Harmonization ICH guidelines. The suggested approach is an excellent quality control tool for the concurrent quantitative assessment and detection of elemental contaminants at low levels in the drug substance propafenone hydrochloride.

Formation and Structure Research of a Molecular Conjugate in the L-Ascorbic Acid – Isomaltite System

The formation of L-ascorbic acid molecular complexes with various biologically active substances opens the way to the production of a new drug type promising for the pharmaceutical, food and cosmetic industries use. The research concerns the possibility study of obtaining a conjugate of L-ascorbic acid with isomaltite in an aqueous ethanol (40 %) medium. The method of the target product isolating involves thermostating a solution containing equimolar amounts (0.001 mmol) of components (50 °C, 1 hour), followed by slow solvent removal for 24 hours (25 °C). The authors examined formation processes dynamics by molecular spectroscopy methods through sequential sampling. The optical density values at 350 Nm in the electronic spectra and 1,674 and 1,754 cm−1 bands position in the IR-Fourier solution spectra indicate the components destruction absence during thermostate control. When treated with carbon tetrachloride or diethyl ether, the syrupy mass obtained after solvent removal containing significant solvent amounts crystallizes a yellowish powder (0.32 g, ice point at 146.6 °C). A man studied its structure by the IR-Fourier spectroscopy. The authors recorded the spectra in the transmission mode (in the KBr tablets) and using the diffusion reflection method enabling to record changes in the absorption bands characteristic positions of the molecular complex formation. The transmission spectra of the high-frequency area indicate the 1-O-glycosylated isomaltite component involvement in the conjugation with ascorbic acid. The shifts of the C=C, C−O and C−O−H bond oscillation bands in the diffusion reflection spectrum of the isolated product relative to their position in the initial component spectra in the low-frequency area indicate the endiol ascorbic acid fragment interaction with the secondary OH groups of the acyclic isomaltite component. Structural analogues of the studied molecular conjugate are promising antioxidant preparations. This determines the further study relevance of its properties.

Improving the regulatory environmental risk assessment of human pharmaceuticals: Required changes in the new legislation

One of the flagship actions of the Pharmaceutical Strategy for Europe is to address environmental challenges associated with pharmaceutical use. This includes strengthening the Environmental Risk Assessment (ERA) at marketing authorisation (MA) of pharmaceuticals, and revision of the pharmaceutical legislation where needed. The overall aim of an ERA should be to enable comprehensive and effective identification and management of environmental risks of pharmaceuticals without affecting the availability of pharmaceuticals to patients. As experts in the evaluation of ERAs of human medicinal products submitted by pharmaceutical industries (Applicants), we have summarized the current status of the ERA and suggest legislative changes to improve environmental protection without affecting availability. Six regulatory goals were defined and discussed, including possible ways forward: 1) mandatory ERAs in accordance to the EMA guideline at the time of the MA, 2) enforcement of risk mitigation measures including re-evaluation of the ERA, 3) facilitated exchange of environmental data between pharmaceutical and environmental legislations, 4) substance-based assessments, 5) transparency of data, and 6) a catching-up procedure for active pharmaceutical ingredients that lack an ERA. These legislative proposals can be considered as prerequisites for a harmonised assessment and effective management of environmental risks and hazards of human pharmaceuticals.

Adverse Drug Reaction Reporting in Geriatric Oncology in India: An Understudied Topic that Needs Attention

AbstractIn the elderly, polypharmacy is a common problem, and drug interactions and adverse drug reactions (ADR) have been linked to considerable harm in several population-based studies. However, when compared with other medical disciplines, studies with elderly cancer patients are lacking in oncology and India in particular. Additionally, intake of multiple drugs and, at times, potentially inappropriate medications (PIMs) are also common in older cancer patients. Physiologically, the body's metabolic functions are reduced in the elderly, resulting in altered medication pharmacokinetics and pharmacodynamic characteristics. There is also a high risk of aging-related disorders, and an increase in pharmaceutical use. Because cancer can affect the physiological milieu, patients are more likely to experience negative drug responses, drug–disease interactions, and drug–drug interactions, thereby making the elderly more vulnerable to the ill effects. Considering this, there is a need for greater knowledge and measures that try to lessen exposure to and the risks connected to drug combinations that might be detrimental. As the geriatric population grows, the need to address medical issues among aging cancer patients becomes more pressing, particularly in India. As far as the authors are aware, there is no review that addresses the drug–drug interactions and adverse drug responses brought on by polypharmacy in older cancer patients. It is expected that this endeavor will help the fraternity and the patients, and will serve as a valuable academic material for the health care students.

The environmental impact of pharmaceuticals on surface waters and its estimation through drug utilisation data.

Human use of pharmaceuticals is their primary way of entering the environment. Once consumed, pharmaceuticals are released, through urine and faeces, into wastewater and consequently into surface waters. Furthermore, veterinary use and inappropriate disposal also contribute to the accumulation of these substances in surface waters. These quantities of pharmaceuticals, although small, can cause toxic effects on aquatic flora and fauna, e.g., causing growth and reproduction problems. To estimate pharmaceutical concentration in surface waters, different data sources can be used, such as drug utilisation data, and wastewater production and filtration. Applying a method to estimate aquatic concentrations of pharmaceuticals at national level could allow the implementation of a monitoring system. to prioritize water sampling.

Ameliorative effect of ethanolic extract of Carica papaya leaves on hyper-cholesterolemic rats: The egg yolk induced model

Cardiovascular disease is one of the leading killers in the world today, and hyperlipidemia is one of the main risk factors. The prevalence of hyperlipidemia is rising dramatically worldwide and is mostly felt in poorer nations. The majority of communities and individuals in Africa are known to turn to ethnomedicine for their medical requirements. The tropical plant Carica papaya, which is grown for its edible, ripe fruit in Africa, was used in folk medicine for treatment of cardiovascular issues as well as a number of serious illnesses. This study assessed the anticholesterolemic property of the ethanolic extracts of Carica papaya leaves, adapting the egg yolk-induced hyperlipidaemia model in Wistar albino rats. This study prepared egg yolk to induce hyperlipidaemia in the Wistar rats, then treated some groups with the extract of Carica papaya leaves, and other groups with the standard drug Fenofibrate. The Wistar rats in the control group were given 2% acacia instead of egg yolk. The total cholesterol, triglycerides, as well as biological and haematological parameters, were determined. The Carica papaya leaves extracts significantly (p<0.05) decreased the total cholesterol and LDL cholesterol levels at all doses administered, but the extract and the standard drug had no significant effect on HDL cholesterol. An inverse relationship between the Carica papaya leaves extract doses and the cholesterol levels was observed placing the efficacy in the order of 100 mg/kg > 250 mg/kg > Fenofibrate (2.29 mg/kg) > 500 mg/kg. With the potential efficacy of Carica papaya leaves extract in the treatment of hypercholesterolemia and, as a result, cardiovascular diseases, more research on bioactive molecule isolation/characterisation for pharmaceutical use or incorporation into functional food products for CVD management is required.

Oncologists’ receipt of pharmaceutical industry payments and use of non-recommended and low-value cancer care services.

6639 Background: Personal payments from the pharmaceutical industry to US physicians are common and influence physician practice. Prior studies have found that industry payments sway physicians’ selection among effective, medically appropriate treatments. However, whether industry payments may be associated with non-recommended and low-value care has not been assessed. The objective of this study was to estimate the association between oncologists’ receipt of industry payments and use of non-recommended and/or low-value (NR/LV) interventions. Methods: Population-based cohort study using fee-for-service Medicare claims and Open Payments records of industry payments. We identified four NR/LV cancer interventions: 1) denosumab for castrate-sensitive prostate cancer; 2) GCSF for patients at low risk for neutropenic fever; 3) nab-paclitaxel instead of paclitaxel for breast and lung cancer 4) branded drug instead of a generic or biosimilar. Study sample: Medicare beneficiaries with an incident cancer diagnosis (identified by new occurrence of a cancer diagnosis code in proximity to claims for cancer treatment) from 2014-2019. We applied additional requirements as appropriate to identify four sub-cohorts, corresponding to patients at risk for each of the NR/LV treatments, and identified the treating oncologist using claims. The primary exposure was receipt, by a patient’s oncologist, of any industry payments for the corresponding NR/LV treatment of interest, within 365 days before the patient’s index cancer date. The primary outcome was receipt of the corresponding NR/LV treatment. We fit general linear models controlling for patient characteristics and calendar year. To assess robustness, we also accounted for physician-level fixed effects in separate models. Results: Cohort sizes were: denosumab N = 9,799; GCSF N = 271,485; nab-paclitaxel N = 86,394; branded drug N = 13,386. Controlling for patient characteristics and calendar year, industry payment was associated with an increase in the absolute prevalence of denosumab (+17.5% [95%CI:15.3 to 19.7%]), GCSF (+5.8% [95%CI:5.4 to 6.1%]), and nab-paclitaxel (+7.6% [95%CI:7.1 to 8.1%]) use, but lower branded drug use (-4.6 [95%CI:-5.8 to -3.3]). In physician-level fixed effects models, industry payment was associated with increased denosumab (+7.4% [95%CI:2.5 to 12.2%]) and nab-paclitaxel (+1.7% [95%CI:0.9 to 2.5%]) use, but not with GCSF (+0.4% [95%CI:-0.3 to 1.1%]) or branded drugs (+1.2% [95%CI:-5.8 to 8.3%]). Conclusions: Recent receipt of industry payments by physicians was associated with increased use of several forms of NR/LV cancer treatment. These findings raise quality-of-care concerns regarding physician-industry financial relationships. Additional work is needed to further explore the causal relationship between payments and non-recommended treatments, and between payments and patient outcomes.