Bioassay-guided isolation of anti-inflammatory and antinociceptive metabolites among three Moroccan Juniperus leaves extract supported with in vitro enzyme inhibitory assays

ETHNOPHARMACOLOGICAL RELEVANCE

Herbs of the genus Juniperus (family Cupressaceae) have been commonly used in ancestral folk medicine known as "Al'Araar" for treatment of rheumatism, diabetes, inflammation, pain, and fever. Bioassay-guided isolation of bioactives from medicinal plants is recognized as a potential approach for the discovery of novel drug candidates. In particular, non-addictive painkillers are of special interest among herbal phytochemicals.

AIM OF THE STUDY

The current study aimed to assess the safety of J. thurifera, J. phoenicea, and J. oxycedrus aqueous extracts in oral treatments; validating the traditionally reported anti-inflammatory and analgesic effects. Further phytochemical investigations, especially for the most bioactive species, may lead to isolation of bioactive metabolites responsible for such bioactivities supported with in vitro enzyme inhibition assays.

MATERIALS AND METHODS

Firstly, the acute toxicity study was investigated following the OECD Guidelines. Then, the antinociceptive, and anti-inflammatory bioactivities were evaluated based on chemical and mechanical trauma assays and investigated their underlying mechanisms. The most active J. thurifera n-butanol fraction was subjected to chromatographic studies for isolating the major anti-inflammatory metabolites. Moreover, several enzymatic inhibition assays (e.g., 5-lipoxygenase, protease, elastase, collagenase, and tyrosinase) were assessed for the crude extracts and isolated compounds.

RESULTS

The results showed that acute oral administration of the extracts (300-500 mg/kg, p. o.) inhibited both mechanically and chemically triggered inflammatory edema in mice (up to 70% in case of J. thurifera) with a dose-dependent antinociceptive (tail flick) and anti-inflammatory pain (formalin assay) activities. This effect was partially mediated by naloxone inhibition of the opioid receptor (2 mg/kg, i. p.). In addition, 3-methoxy gallic acid (1), quercetin (2), kaempferol (3), and ellagic acid (4) were successfully identified being involved most likely in J. thurifera extract bioactivities. Nevertheless, quercetin was found to be the most potent against 5-LOX, tyrosinase, and protease with IC50 of 1.52 ± 0.01, 192.90 ± 6.20, and 399 ± 9.05 μM, respectively.

CONCLUSION

J. thurifera extract with its major metabolites are prospective drug candidates for inflammatory pain supported with inhibition of inflammatory enzymes. Interestingly, antagonism of opioid and non-opioid receptors is potentially involved.

Chronic kidney disease in America, Africa, and Asia: Overview of treatment cost and options

Chronic kidney disease (CKD) is one of the non-infectious diseases that threaten patients' lives on a daily basis. Its prevalence is high, but under-reported by patients and those living with the disease, as it is silent and asymptomatic in the early stages. Kidney disease increases the risk of heart and vascular disease. These problems can manifest themselves slowly, over a long period of time. Early detection and treatment can often prevent chronic kidney disease from worsening. As kidney disease progresses, it can lead to kidney failure, requiring dialysis or a kidney transplant to stay alive. In this narrative review, we will mainly discuss different treatment option costs in different countries and how much they cost healthcare systems in countries in three different continents.

Assessment of anti-hyperglycemic and anti-hyperlipidemic effects of thiazolidine-2,4-dione derivatives in HFD-STZ diabetic animal model

Type 2 diabetes mellitus (T2DM) is a chronic endocrine/metabolic disorder characterized by elevated postprandial and fasting glycemic levels that result in disturbances in primary metabolism. In this study, we evaluated the metabolic effects of thiazolidine-2,4-dione derivatives in Wistar rats and Swiss mice that were fed a high-fat diet (HFD) for 4 weeks and received 90 mg/kg of streptozotocin (STZ) intraperitoneally as a T2DM model. The HFD consisted of 17% carbohydrate, 58% fat, and 25% protein, as a percentage of total kcal. The thiazolidine-2,4-dione derivatives treatments reduced fasting blood glucose (FBG) levels by an average of 23.98%-50.84%, which were also improved during the oral starch tolerance test (OSTT). Treatment with thiazolidine-2,4-dione derivatives also improved triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), and total cholesterol levels (P < 0.05). The treatment intake has also shown a significant effect to modulate the altered hepatic and renal biomarkers. Further treatment with thiazolidine-2,4-dione derivatives for 28 days significantly ameliorated changes in appearance and metabolic risk factors, including favorable changes in histopathology of the liver, kidney, and pancreas compared with the HFD/STZ-treated group, suggesting its potential role in the management of diabetes. Thiazolidine-2,4-dione derivatives are a class of drugs that act as insulin sensitizers by activating peroxisome proliferator-activated receptor-gamma (PPAR-γ), a nuclear receptor that regulates glucose and lipid metabolism. The results of this study suggest that thiazolidine-2,4-dione derivatives may be a promising treatment option for T2DM by improving glycemic control, lipid metabolism, and renal and hepatic function.

Tumor Necrosis Alpha (TNF-α) Antagonists Used in Chronic Inflammatory Rheumatic Diseases: Risks and their Minimization Measures

Tumor necrosis factor alpha (TNF- α) inhibitors are widely employed for the management of chronic inflammatory rheumatism. However, their usage carries significant risks, including site and infusion reactions, serious infections, malignancy, heart failure autoimmune and demyelinating disorders. These risks are comprehensively outlined in risk management plans (RMPs) associated with these molecules. RMP provides information on the safety profile of a medicinal product as well as the measures that will be taken to minimize risks; these are known as risk minimization measures. These measures are divided into routine measures related to elements, such as the summary of product characteristics, labeling, pack size, package leaflet, or legal supply status of the product, while additional measures may include educational programs, including tools for healthcare providers and patients, controlled access or pregnancy prevention programs, among others. Additional measures can consist of one or more interventions that need to be implemented in a sustainable way in a defined target group, while respecting the timing and frequency of any intervention and procedures to reach the target population. An evaluation of the effectiveness of these measures is required to determine whether or not an intervention has been effective. This comprehensive review offers an in-depth exploration of the current treatment, uses, and associated risks of TNF-α inhibitors. Additionally, it provides a detailed account of risk minimization measures and risk management practices while shedding light on their real-world implementation and effectiveness.

Strategy for Developing a Stable CHO Cell Line that Produces Large Titers of Trastuzumab Antibody

BACKGROUND

Trastuzumab (Herceptin®) is currently the main treatment option for breast cancer patients that overexpress the human epidermal growth factor receptor 2 (HER2). This antibody binds specifically to HER2, blocks cancer cell growth, and promotes effective cell death. In the present study, we sought to develop a robust and efficient process for the development of a stable Chinese hamster ovary (CHO) cell line with high trastuzumab expression and production.

METHODS

We adapted a process that combines transposon system-based vector construction, suspension cell culture, and a high selection process. The latter, involved enhanced green fluorescent protein (eGFP) expression, fluorescence-activated cell sorting (FACS), and semi-solid methylcellulose media.

RESULTS

The construction of trastuzumab as a humanized monoclonal antibody was achieved by subcloning the synthesized light and heavy chain sequences into a suitable piggyBac expression vector. The optimized piggyBac vector used for the expression of trastuzumab in CHO cells resulted in the production of trastuzumab and reached 4.24 g/L in the T1A7 clone after a 7-day batch culture. The T1A7 clone was selected after screening over 1500 clones.

CONCLUSIONS

The current simple workflow ensures strict monoclonality and relatively high production of trastuzumab. This workflow could potentially be implemented in Research and Development (R&D) laboratories, including in developing countries for the production of recombinant monoclonal antibodies in a cost-effective manner.

A Novel Approach for Therapeutic Drug Monitoring of Valproic Acid Using FT-IR Spectroscopy and Nonlinear Support Vector Regression

BACKGROUND

Recent technological progress has bolstered efforts to bring personalized medicine from theory into clinical practice. However, progress in areas such as therapeutic drug monitoring (TDM) has remained somewhat stagnant. In drugs with well-known dose-response relationships, TDM can enhance patient outcomes and reduce health care costs. Traditional monitoring methods such as chromatography-based or immunoassay techniques are limited by their higher costs and slow turnaround times, making them unsuitable for real-time or onsite analysis.

OBJECTIVE

In this work, we propose the use of a fast, direct, and simple approach using Fourier transform infrared spectroscopy (FT-IR) combined with chemometric techniques for the therapeutic monitoring of valproic acid (VPA).

METHOD

In this context, a database of FT-IR spectra was constructed from human plasma samples containing various concentrations of VPA; these samples were characterized by the reference method (immunoassay technique) to determine the VPA contents. The FT-IR spectra were processed by two chemometric regression methods: partial least-squares regression (PLS) and support vector regression (SVR).

RESULTS

The results provide good evidence for the effectiveness of the combination of FT-IR spectroscopy and SVR modeling for estimating VPA in human plasma. SVR models showed better predictive abilities than PLS models in terms of root-mean-square error of calibration and prediction RMSEC, RMSEP, R2Cal, R2Pred, and residual predictive deviation (RPD).

CONCLUSIONS

This analytical tool offers potential for real-time TDM in the clinical setting.

HIGHLIGHTS

FTIR spectroscopy was evaluated for the first time to predict VPA in human plasma for TDM. Two regressions were evaluated to predict VPA in human plasma, and the best-performing model was obtained using nonlinear SVR.

Predictive Value of ABCC2 and UGT1A1 Polymorphisms on Irinotecan-Related Toxicities in Patients with Cancer

Background: There is extensive interindividual variability in response and tolerance to anticancer drugs. This heterogeneity provides a major limitation to the "rational" use of cytotoxic drugs, and it becomes a major problem in oncology giving a narrow therapeutic window with a vital risk. Among these anticancer drugs, irinotecan can cause dose-limiting toxicities, commonly diarrhea and neutropenia. Interaction among pathways of activation/inactivation (UGT1A1) and hepatobiliary transport of irinotecan and its metabolites could, in part, explain its interindividual variability. The objective of this study was to perform an exploratory analysis to evaluate the correlation between the genetic polymorphisms of UGT1A1 and ABCC2 with the different toxicities associated with irinotecan treatment. Materials and Methods: Seventy-five patients with solid cancers were included, all were administered an irinotecan-based regimen in both Mission Bay Medical Center; and Zuckerberg San Francisco General Hospital from May 2016 to December 2016. The patients' genotyping was performed for both the UGT1A1*28 polymorphism, and the ABCC2 - 1549G>A, and ABCC2 - 1249G>A single nucleotide polymorphism. Comparisons among qualitative data were assessed using the χ²-test, and Fisher's exact test in the case of small group sizes. Results: Diarrhea was observed in 40 patients (53.3%), among them only 9 patients had high grades diarrhea (grades III and IV). Grades III/IV of nausea were more frequently associated with the ABCC2-1549 AA genotype (83.3% p = 0.004) in patients with colorectal cancer. In pancreatic cancer, a significant absence of diarrhea grades III-IV was noted in patients with the ABCC2 1249 GG genotype compared to the other ABCC2 1249 genotypes.

Biological, toxicological and molecular docking evaluations of isoxazoline-thiazolidine-2,4-dione analogues as new class of anti-hyperglycemic agents

In this work, three isoxazoline-thiazolidine-2,4-dione derivatives were synthesized and characterized by FT-IR, ¹H-NMR, ¹³C-NMR and ESI-MS spectrometry. All compounds have been investigated for their α-amylase and α-glucosidase inhibitory activities. In vitro enzymatic evaluation revealed that all compounds were inhibitory potent against α-glucosidase with IC₅₀ values varied from 40.67 ± 1.81 to 92.54 ± 0.43 µM, and α-amylase with IC₅₀ in the range of 07.01 ± 0.02 to 75.10 ± 1.06 µM. One of the tested compounds were found to be more potent inhibitor compared to other compounds and standard drug Acarbose (IC_{50 glucosidase}= 97.12 ± 0.35 µM and IC_{50 amylase}= 2.97 ± 0.01 μM). All compounds were then evaluated for their acute toxicity in vivo and shown their safety at a high dose with LD > 2000mg/kg BW. A cell-based toxicity evaluation was performed to determine the safety of compounds on liver cells, using the MTT assay against HepG2 cells, and the results shown that all compounds have non-toxic impact against cell viability and proliferation compared to reference drug (Pioglitazone). Furthermore, the molecular homology analysis, SAR and the molecular binding properties of compound with the active site of α-amylase and α-glucosidase were confirmed through computational analysis. This study has identified the inhibitory potential of a new class of synthesized isoxazoline-thiazolidine-2,4-dione derivatives in controlling both hyperglycemia and type 2 diabetes mellitus without any hepatic toxicity.Communicated by Ramaswamy H. Sarma.

Identification of the new progress on Pyrazole Derivatives Molecules as Antimicrobial and Antifungal Agents

Microbial infections remain a worldwide leading cause of death, despite the evolution of a large number of new antibiotics every year. Currently, several bacteria have developed resistance against antibiotics drugs which remain a major issue in antibiotics drug discovery. This review provides detailed information about antimicrobial and antifungal agent synthesis belonging to the pyrazoles scaffold. We reassemble the results obtained from several studies to characterize the importance of heteroatom nuclei in many synthetic products. Additionally, several compounds based on pyrazole derivatives such as benzimidazole, benzothiazole, indole, acridine, oxadiazole, imidazole, isoxazole, pyrazole, triazole, quinoline and quinazoline including other pyrazole containing drugs such as pyridazine, pyridine and pyrimidine are highlighted. Furthermore, you will find in this review 134 best promise structures collected from recent studies, relating the pyrazoles structures to the relevant biological activities, in particular, antimicrobial and antifungal one.

Investigation of Antioxidant, Hypoglycemic and Anti-Obesity Effects of Euphorbia Resinifera L

Objectives

The aim of this work is to evaluate the in vitro antioxidant, hypoglycemic, and antiobesity effects of Euphorbia resinifera extracts and investigate the phenolic constituents and the toxicity of these extracts.

Methods

Phytochemical screening was performed to detect polyphenols and flavonoids. Antioxidant activity was evaluated by four methods (DPPH, ABTS, H₂O₂, and xanthine oxidase inhibition). The hypoglycemic effect was determined by the inhibition of α-amylase and α-glucosidase enzymes in vitro and via a starch tolerance study in normal rats. The antiobesity effect was estimated by in vitro inhibition of lipase.

Results

Phytochemical screening revealed that the ethanolic extract was rich in polyphenols (99 ± 0.56 mg GEA/g extract) and tannins (55.22 ± 0.17 mg RE/g extract). Moreover, this extract showed higher antioxidant activity in different tests the DPPH assay (IC₅₀ = 53.81 ± 1.83 µg/mL), ABTS assay (111.4 ± 2.64 mg TE/g extract), H₂O₂ (IC₅₀ = 98.15 ± 0.68 µg/mL), and xanthine oxidase (IC₅₀ = 10.26 ± 0.6 µg/mL). With respect to hypoglycemic effect, the aqueous and ethanolic extracts showed IC₅₀ values of 119.7 ± 2.15 µg/mL and 102 ± 3.63 µg/mL for α-amylase and 121.4 ± 1.88 and 56.6 ± 1.12 µg/mL for α-glucosidase, respectively, and the extracts lowered blood glucose levels in normal starch-loaded rats. Additionally, lipase inhibition was observed with aqueous (IC₅₀ = 25.3 ± 1.53 µg/mL) and ethanolic (IC₅₀ = 13.7 ± 3.03 µg/mL) extracts.

Conclusion

These findings show the antioxidant, hypoglycemic, and hyperlipidemic effects of E. resinifera extracts, which should be investigated further to validate their medicinal uses and their pharmaceutical applications.

Trends in the consumption and cost of antiepileptics in Morocco between 2008 and 2018

INTRODUCTION

Epilepsy is one of the most common chronic neurological diseases. In Morocco, it is the second most common reason for consulting a neurologist. Its prevalence was estimated in Casablanca in 1998 at 1.1%. This study was carried out with the aim of evaluating, on the one hand, the consumption of antiepileptics and, on the other hand, the impact of their generic drugs on the pharmaceutical market between 2008 and 2018 in Morocco.

MATERIALS AND METHODS

We used sales data for antiepileptic drugs collected from the Moroccan subsidiary of IQVIA, a multinational healthcare data science company, and we converted them into a defined daily dose (DDD/1000 inhabitants).

RESULTS

The consumption of antiepileptic drugs increased from 442 to 641 DDD/1000 inhabitants between 2008 and 2018, all molecules combined, recording a 45% increase in the period studied. From an economic point of view, the calculation of the average cost of DDD, all molecules combined, gives an average cost of 2.42 dollars/DDD in 2018 versus 3.53 dollars/DDD in 2008 (1 dirham = 0.11 dollar), which corresponds to a decrease of -30%. This is due mainly to the introduction of generic drugs.

CONCLUSION

These results show that while the average cost of a DDD has decreased, the consumption of antiepileptics has increased in Morocco over the years. Several events that have marked the drug market in Morocco have contributed to this trend, including the arrival on the market of several new molecules indicated for the treatment of epilepsy, the decrease in drug prices in 2014 and the policy of promoting generic drugs.

Preliminary phytochemical screening, acute toxicity and effect of Albuca amoena extracts on the central nervous system

Introduction: Albuca amoena is a Moroccan-Algerian endemic medicinal plant with various implications. The aim of this study is to identify phytochemical compounds of the plant, check its acute toxicity, and test its anti-depressive, anxiolytic, and analgesic effects on the central nervous system (CNS). Methods: The estimation of chemical compounds was carried out according to coloring and precipitation reactions. The Organization of Economic Cooperation and Development guidelines 423 and 402 made it possible to verify the acute toxicity of the plant orally and dermally. The sedative activity was performed according to 4 tests: rotarod, hole-board, traction, and chimney tests. The anti-depressive, anxiolytic, and analgesic effects were evaluated by forced swimming, light/dark, and writhing tests, respectively. Results: The phytochemical analysis showed that A. amoena contained a mixture of phytochemical compounds like terpenes, alkaloids, and polyphenols. According to the acute toxicity tests, the lethal dose of 50% (LD50) of A. amoena hydroalcoholic extract was between 300 and 2000 mg/kg orally and higher than 2000 mg/kg dermally. Moreover, the result of the behaviour tests of sedative and analgesic activities revealed that A. amoena hydroalcoholic extract exerted positive effects on the CNS. Conclusion: These results show the anti-depressive, anxiolytic, and analgesic effects of the bioactive substances present in A. amoena on the CNS and provide access to further investigations to highlight the main compounds of this plant and their mechanisms of actions.

Development of an LC-MS/MS Method for Measurement of Irinotecan and Its Major Metabolites in Plasma: Technical Considerations

OBJECTIVE

Irinotecan (CPT-11) is an important drug used in the treatment of several solid tumor types. To minimize its toxicity, therapeutic drug monitoring of CPT-11 and its major metabolites (SN-38, SN-38-glucuronide [SN-38G], and APC) has been proposed. We aimed to develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of CPT-11 and its major metabolites in plasma.

METHODS

Specimen preparation consisted of protein precipitation, evaporation, and reconstitution. Analyses were performed on a C18 column using reverse-phase gradient elution. Electrospray ionization and multiple reaction monitoring in positive mode were used for MS. The following heavy isotope-labeled internal standards were used: CPT-11 D10, SN-38 D3, SN-38G D3, and APC D3.

RESULTS

We found that CPT-11, SN-38G, and APC eluted at ~4.6 to 4.7 minutes, and SN-38 eluted at ~5.1 to 5.2 minutes. A second peak for SN-38 was detected at ~4.6 to 4.7 minutes. Given that the structure of SN-38 is found in CPT-11, SN-38G, and APC, and in the CPT-11 D10 used here, in-source fragmentation was the likely cause. In addition, we found that a low-level SN-38 impurity was present in CPT-11 D10 and to a lesser extent in SN-38 D3.

CONCLUSION

When developing methods for CPT-11 and its metabolites, it is important to consider the effects of in-source fragmentation and the choice of internal standards.

Synthesis, α-glucosidase and α-amylase inhibitory activities, acute toxicity and molecular docking studies of thiazolidine-2,4-diones derivatives

In the present study, a series of thiazolidine-2,4-diones derivatives (3a-3e) and (4a-4e) were synthesized and characterized by ¹H NMR, ¹³C NMR and ESI-MS spectrometry. All compounds were screened for their α-glucosidase and α-amylase inhibitory activities. In vitro biological investigations revealed that most of compounds were active against α-glucosidase with IC₅₀ values in the range of 43.85 ± 1.06 to 380.10 ± 1.02 µM, and α-amylase with IC₅₀ in the range of 18.19 ± 0.11 to 208.10 ± 1.80 µM. Some of the tested compounds were found to be more potent inhibitors than the clinical drug Acarbose (IC_{50glucosidase} = 97.12 ± 0.35 µM and IC_50amylase = 2.97 ± 0.004 μM). The lead compounds were evaluated for their acute toxicity on Swiss mice and found to be completely non-toxic with LD > 2000 mg/kg BW. Furthermore, the Structure-activity relationship (SAR) and the binding interactions of all compounds with the active site of α-glucosidase and α-amylase were confirmed through molecular docking and stabilizing energy calculations. This study has identified the inhibitory potential a new class of synthesized thiazolidine-2,4-diones in controlling both hyperglycemia and type 2 diabetes mellitus. Furthermore, the theoretical binding mode of the target molecules was evaluated by molecular docking studies against the 3D Crystal Structure of human pancreatic α-amylase (PDB ID: 1B2Y) and α-glucosidase (PDB ID: 3W37)Communicated by Ramaswamy H. Sarma.

Monoclonal Antibodies Application in Lateral Flow Immunochromatographic Assays for Drugs of Abuse Detection

Lateral flow assays (lateral flow immunoassays and nucleic acid lateral flow assays) have experienced a great boom in a wide variety of early diagnostic and screening applications. As opposed to conventional examinations (High Performance Liquid Chromatography, Polymerase Chain Reaction, Gas chromatography-Mass Spectrometry, etc.), they obtain the results of a sample's analysis within a short period. In resource-limited areas, these tests must be simple, reliable, and inexpensive. In this review, we outline the production process of antibodies against drugs of abuse (such as heroin, amphetamine, benzodiazepines, cannabis, etc.), used in lateral flow immunoassays as revelation or detection molecules, with a focus on the components, the principles, the formats, and the mechanisms of reaction of these assays. Further, we report the monoclonal antibody advantages over the polyclonal ones used against drugs of abuse. The perspective on aptamer use for lateral flow assay development was also discussed as a possible alternative to antibodies in view of improving the limit of detection, sensitivity, and specificity of lateral flow assays.

Therapeutic Characteristics, Chemotherapy-Related Toxicities and Survivorship in Colorectal Cancer Patients

Background

Colorectal Cancer (CRC) is a major health problem around the globe. In Morocco, the disease ranks third after breast and lung cancers. This study is the first in Morocco to investigate epidemiological, clinical and therapeutic features while exhaustively describing toxic side-effects to chemotherapy of CRC and studying the 3-years survivorship.

Methods

This is a descriptive and analytical retrospective study of about 290 patients with CRC enrolled during the period of January-December 2013. Statistical analysis was performed to correlate clinicopathological data with chemotherapy toxicity and survivorship in patients, by Chi² test. Overall Survival (OS) rate has been calculated by the Kaplan-Meier method and compared using Log-rank test.

Results

Fifty-five percent had a tumor localized in rectum, and 42,8% in colon. Mean age of these patients at diagnosis was 56,16 ± 14,6. incidence rate of adverse events (grade I to IV) was 85,6%. Diarrhea was the predominant toxicity (4.6%) occurring at a high grade (grade III–IV).

The 3-years OS rate of patients with CRC was 71%. OS decreased by age, and patients with age subgroup between 40 to 59 years had a better OS than the other age subgroups (60 to 79 years and >80 years) with a p-value of 0.0001. Occurence of toxicity (all grades and types) was linked to a higher survival rates compared to the group who had no toxicity noticed (p-value of 0.001).

Conclusion

Our study shows that patients who had a polychemotherapy had a better OS than those who had monotherapy (p-value of 0.002).

[Moroccan pharmacy students' knowledge and perceptions about pharmacovigilance]

OBJECTIVE

The aim of this study was to evaluate the impact of an educational work groups on the knowledge and perception of 2nd year pharmacist students towards pharmacovigilance in a moroccan faculty of medicine and pharmacy.

METHOD

A descriptive study conducted in pharmacology laboratory of the faculty of medicine and pharmacy of Rabat on 2nd year pharmacist students, to assess their knowledge and perception towards PV via questionnaire before and after an educational work groups.

RESULTS

Among the 122 invited students, 108 responded to the questionnaire distributed before working group with a participation rate of 88,5 %. This rate increased to 95,9 % (n=117) after work groups sessions. Pre-work groups, students showed an overall low knowledge, where only 27.7 % knew the ADRs reporting sheet. In addition, most students were not well prepared to report ADR in their future practice (n=82, 75.92 %). Work groups partially offsetting this deficit, and helped to better explain to the students the reporting system. Resulting in only 28 participants maintained their declaration of inability to report ADR in their future practice (25.92 %). On the other hand, students showed a favorable perception.

CONCLUSION

In this study, students expressed the desire to learn more about PV during their university education. This result led to the introduction of a system of PV working groups for 3rd and 4th year pharmacy students for the 2018-2019 academic year.

Evaluation of antidiabetic effect of Cistus salviifolius L. (Cistaceae) in streptozotocin-nicotinamide induced diabetic mice

Objectives Cistus salviifoluis L. is a shrub from Cistaceae family used in many traditional medicines for the treatment of various diseases including diabetes mellitus. The aim of this study was to evaluate the in vivo antidiabetic potential of the aerial parts aqueous extract of Cistus salviifolius L. (CSA). Methods Experimental diabetes was induced in adult male mice by intra-peritoneal injection of Streptozotocin-nicotinamide (STZ-NC). CSA at a dose of 500 mg/kg was administered daily to the diabetic mice for four weeks. The effect of the extract on hyperglycemia, body weight, serum total cholesterol, triglycerides, hepatic and renal functional markers were determined. Histopathological examination of the mice pancreas was also performed. The diabetic animals treated with CSA were compared with animals treated by the standard drug metformin. Results Treatment with CSA showed a significant reduction in blood glucose, total triglycerides and creatinine levels and prevented the reduction of body weight caused by diabetes. Furthermore, histopathological analysis of the mice pancreas showed that the group treated with CSA reduced damage induced by STZ-NC on islets of Langerhans cells when compared to the diabetic control. Conclusions The results suggest that the aqueous extract of Moroccan C. salviifolius L. possesses beneficial effect on treatment of diabetes.

Platelets Can Associate with SARS-Cov-2 RNA and Are Hyperactivated in COVID-19

Rationale: In addition to the overwhelming lung inflammation that prevails in COVID-19, hypercoagulation and thrombosis contribute to the lethality of subjects infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Platelets are chiefly implicated in thrombosis. Moreover, they can interact with viruses and are an important source of inflammatory mediators. While a lower platelet count is associated with severity and mortality, little is known about platelet function during COVID-19. Objective: To evaluate the contribution of platelets to inflammation and thrombosis in COVID-19 patients. Methods and Results: Blood was collected from 115 consecutive COVID-19 patients presenting non-severe (n=71) and severe (n=44) respiratory symptoms. We document the presence of SARS-CoV-2 RNA associated with platelets of COVID-19 patients. Exhaustive assessment of cytokines in plasma and in platelets revealed the modulation of platelet-associated cytokine levels in both non-severe and severe COVID-19 patients, pointing to a direct contribution of platelets to the plasmatic cytokine load. Moreover, we demonstrate that platelets release their alpha- and dense-granule contents in both non-severe and severe forms of COVID-19. In comparison to concentrations measured in healthy volunteers, phosphatidylserine-exposing platelet extracellular vesicles were increased in non-severe, but not in severe cases of COVID-19. Levels of D-dimers, a marker of thrombosis, failed to correlate with any measured indicators of platelet activation. Functionally, platelets were hyperactivated in COVID-19 subjects presenting non-severe and severe symptoms, with aggregation occurring at suboptimal thrombin concentrations. Furthermore, platelets adhered more efficiently onto collagen-coated surfaces under flow conditions. Conclusions: Taken together, the data suggest that platelets are at the frontline of COVID-19 pathogenesis, as they release various sets of molecules through the different stages of the disease. Platelets may thus have the potential to contribute to the overwhelming thrombo-inflammation in COVID-19, and the inhibition of pathways related to platelet activation may improve the outcomes during COVID-19.

Comparative Study of Leaf and Rootstock Aqueous Extracts of Foeniculum vulgare on Chemical Profile and In Vitro Antioxidant and Antihyperglycemic Activities

Foeniculum vulgare is a medicinal plant used in Moroccan folk medicine to treat several diseases such as diabetes. The aim of this study was to determine the phenolic bioactive compounds and to evaluate the antioxidant and antihyperglycemic activities of Foeniculum vulgare leaf and rootstock extracts. Phenolic compounds of F. vulgare rootstock and leaf extracts were determined using HPLC-DAD-QTOFMS analysis. The antioxidant activity was evaluated using 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS•+) radicals. Moreover, the in vitro antihyperglycemic effects were tested by measuring the inhibition of α-amylase and α-glucosidase activities. HPLC-DAD-QTOFMS analysis identified thirty-two phenolic components in both leaf and rootstock extracts. Caffeic acid, quinic acid, and chlorogenic acid were the major compounds of F. vulgare leaf extract (FVLE), while the main compound of F. vulgare rootstock extracts (FVRE) was quinic acid. In the DPPH assay, F. vulgare leaf extract showed important antioxidant activity (IC50 = 12.16 ± 0.02 μg/mL) than F. vulgare rootstock extract (IC50 = 34.36 ± 0.09 μg/mL). Moreover, fennel leaf extracts revealed also the most powerful antioxidant activity (IC50 = 22.95 ± 0.4 μg/mL) in the ABTS assay. The in vitro antihyperglycemic activity showed that F. vulgare rootstock extract exhibited a remarkable inhibitory capacity (IC50 = 194.30 ± 4.8 μg/mL) of α-amylase compared with F. vulgare leaf extract (IC50 = 1026.50 ± 6.5 μg/mL). Furthermore, the inhibition of α-glucosidase was more importantly with F. vulgare rootstock (IC50 of 165.90 ± 1.2 μg/mL) than F. vulgare leaf extracts (203.80 ± 1.3 μg/mL). The funding of this study showed that F. vulgare rootstock and leaf extracts presented several phenolic compounds and showed important antioxidant and antidiabetic effects. We suggest that the identified molecules are responsible for the obtained activities. However, further studies focusing on the isolation and the determination of antioxidant and antidiabetic effects of F. vulgare rootstock and leaf main compounds are required.

[Current antiplatelet agents, new inhibitors and therapeutic targets]

Cardiovascular diseases are the leading cause of deaths in the world. Platelets play a major role in the occurrence of these diseases and the development of antiplatelet drugs is a priority in the fight against cardiovascular diseases-associated mortality. Aspirin and thienopyridine-based P2Y12 inhibitors are the main drugs currently used. These molecules target the initiation of platelets activation and are responsible for a moderate inhibitory action. Other antiplatelet agents, as glycoprotein (GP) IIb/IIIa antagonists, inhibit platelet aggregation independently of initial activation-associated pathways, but are responsible for increased hemorrhagic events. Regarding each antiplatelet agent's specific characteristics, the prescription of these drugs must take into account the type of cardiovascular event, the age of the patient, the past medical history, and the potential hemorrhagic adverse events. Thus, there is a need for the development of new molecules with a more targeted effect, maintaining optimal efficiency but with a reduction of the hemorrhagic risk, which is the principal limitation of these treatments.

Les anti-inflammatoires et SARS-CoV-2 (COVID-19)

À ce jour, les options thérapeutiques pour le COVID-19 sévère restent limitées et il n’existe actuellement aucun médicament ni vaccin efficace pour le traitement ou la prévention du SARS-CoV-2 spécifique pour traiter les patients gravement malades. Une nouvelle stratégie de traitement, en plus de la thérapie antivirale seule, est susceptible d’être nécessaire pour avoir un impact significatif sur les résultats cliniques. Un traitement immunomodulateur pour réguler à la baisse de choc cytokinique peut fournir des informations sur le traitement de COVID-19. L’utilisation combinée d’un agent immunomodulateur avec un agent antiviral peut donner aux médecins plus de temps pour fournir un traitement de soutien aux patients atteints de COVID-19. Dans cette revue de la littérature, les rôles de plusieurs médicaments anti-inflammatoires ont été passés en revue pour explorer leur efficacité dans la lutte contre le SARS-CoV-2.

Overview of recent developments of pyrazole derivatives as an anticancer agent in different cell line

Pyrazole is a five-membered aromatic heterocyclic ring with two adjacent nitrogen atoms C₃H₃N₂H.The presence of this nucleus in pharmacological agents of various therapeutic categories gifts a broad spectrum of biological activities and pharmaceuticals that contain pyrazole like celecoxib (anti-inflammatory), CDPPB (antipsychotic), Rimonabant (anti-obesity), Difenamizole, (Analgesic), Betazole (H2 receptor agonist), Fezolamide (Antidepressant), etc… The pharmacological potential of the pyrazole fraction is proved in many publication where they synthesized and evaluated pyrazoles against several biological agents. The aim of this article review is to survey recent works linking pyrazole structures to anticancer activities corresponding to 9 different type of cancer.

Diagnostic Utility of Human Leukocyte Antigen B*15:02 Screening in Severe Carbamazepine Hypersensitivity Syndrome

Background

Despite many studies suggesting an association between human leukocyte antigen (HLA)-B*15:02 and carbamazepine (CBZ)-induced severe cutaneous adverse drug reactions essentially toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS), the evidence of association in different populations and the degree of association remain uncertain.

Materials and Methods

The primary analysis was based on population control studies. Data were pooled by means of a random-effects model, and sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), diagnostic odds ratios (DOR), and areas under the summary receiver operating characteristic curve (AUC) were calculated.

Results

In 23 population control studies, HLA-B*15:02 was measured in 373 patients with CBZ-induced TEN/SJS and 3452 patients without CBZ-induced TEN/SJS. The pooled sensitivity, specificity, LR+, LR-, DOR, and AUC were 0.67 (95% confidence interval [CI] = 0.63-0.72), 0.98 (95% CI = 0.98-0.99), 19.73 (95% CI = 10.54-36.92), 0.34 (95% CI = 0.23-0.49), 71.38 (95% CI = 34.89-146.05), and 0.96 (95% CI = 0.92-0.98), respectively. Subgroup analyses for Han Chinese, Thai, and Malaysian populations yielded similar findings. Specifically, racial/ethnic subgroup analyses revealed similar findings with respect to DOR for Han Chinese (99.28; 95% CI = 22.20-443.88), Thai (61.01; 95% CI = 23.05-161.44), and Malaysian (30; 95% CI = 7.08-126.68) populations, which are similar to the pooled DOR for the relationship between the HLA-B*15:02 allele and CBZ-induced TEN/SJS across all populations (71.38; 95% CI = 34.89-146.05).

Conclusions

The present study reveals that CBZ is the leading cause of TEN/SJS in many countries. Screening of HLA-B*15:02 may help patients to prevent the occurrence of CBZ-induced TEN/SJS, especially in populations with a higher (≥5%) risk allele frequency.

The displacement study of 99m Tc-DTPA-Human serum albumin binding in presence of furosemide and metformin by using equilibrium dialysis and molecular docking

The ^99m Tc-DTPA (Technetium^99m diethylenetriaminepentaacetic acid), is a radiopharmaceutical used in renal scintigraphy. The human serum albumin (HSA) binding site(s) for the ^99m Tc-DTPA have never been characterized. This study will cover in vitro the binding rates of ^99m Tc-DTPA on HSA and the ^99m Tc-DTPA competition interactions with two drugs having known human serum albumin binding sites. Furosemide (FUR) and metformin (MET) were added to ^99m Tc-DTPA solution (weight ratios 1/1 vol:vol) followed by the quantification of ^99m Tc-DTPA binding rates to HSA (40 g/L) using equilibrium dialysis and the qualification of this binding using Molecular Modeling methods. The ^99m Tc-DTPA binding rates to human serum albumin increased with the highest concentration. Both drugs FUR and MET displaced ^99m Tc-DTPA binding. ^99m Tc-DTPA could bind to human serum albumin in many locations in site I and I-II, but strongly bound to site I through hydrogen bonds.

In vivo anti-inflammatory response and bioactive compounds' profile of polyphenolic extracts from edible Argan oil (Argania spinosa L.), obtained by two extraction methods

The present work examined and assessed the in vivo anti-inflammatory effect of polyphenolic extracts from Moroccan edible Argan oils (Argania spinosa L.), extracted by two extraction processes: Hand pressing and mechanical pressing. Chemical properties, such as acidity, peroxide index, ultraviolet indices, total polyphenols composition, fatty acid composition, tocopherol composition, phenolic profiling, and sterol composition were studied. Then, the anti-inflammatory potential was determined by applying carrageenan, an induced paw edema test in rats. The results revealed an anti-inflammatory effect of edible Argan oil and indicated a higher efficiency of hand-pressed oil compared to mechanical-pressed oil, supporting its traditional use in human health, related to pain and inflammations. The chemical composition of these oils was evaluated, and total polyphenols, tocopherol composition, and some phenolic compounds were found highly concentrated in the hand-pressed oil. PRACTICAL APPLICATIONS: The present study highlights and compares the in vivo anti-inflammatory effect of polyphenolic compounds, extracted from Argan oil by two processes (hand and mechanical extraction). The study demonstrated the better quality of hand-pressed oil over mechanically pressed, supporting the traditional uses of this oil in treating several inflammations and pain-related situations. Moreover, the edible Argan oil may be introduced as a regular diet and food ingredient.

Impact of Disparities in Reimbursement Rules Between Public and Private Sectors on Accessibility to Care in Moroccan Mandatory Health Insurance: A Cross-Sectional Study

BACKGROUND

Disparities in the reimbursement rules between the 2 funds that manage mandatory health insurance in Morocco could negatively affect the accessibility of insured persons to healthcare services and products.

OBJECTIVE

The objective is to analyze the impact of these disparities on access to care and to assess the insured's copayment difference between the 2 funds.

METHODS

Healthcare utilization rates of the insured population in the 2 funds were analyzed by sector, sex, and age groups for 2014. We also looked at the percentage of copayment paid by the insured depending on the fund, methods of reimbursement, type of care, and nature of diseases. The analysis was based on data retrieved and aggregated at the National Agency for Health Insurance.

RESULTS

The healthcare utilization rate differs significantly between the 2 funds. It is higher for the insured in the public sector (45%) compared with those in the private sector (18.5%) (P < .001). The healthcare utilization rate differs significantly according to the age groups in the 2 sectors (P < .001, respectively), and according to the sex of the insured in the 2 sectors (the healthcare utilization rate is higher for women than for men [P < .001, respectively]). The copayment percentage incurred by insured persons was 32.1% for employees in the public sector and 36.4% for employees in the private sector.

CONCLUSION

Differences in reimbursement rules between the 2 funds may be the cause of inequity in access to care between insured persons. This situation can jeopardize the objectives of a universal and equitable health insurance scheme.

Incidence of adverse reactions caused by first-line anti-tuberculosis drugs and treatment outcome of pulmonary tuberculosis patients in Morocco

PURPOSE

The treatment of tuberculosis is associated with a high incidence of adverse reactions with different degrees of severity. The aim of this study was to determine the incidence of adverse reactions caused by first-line anti-tuberculosis drugs and to evaluate the treatment outcome of TB patients in a large region of Morocco.

METHODS

It is a multi-centric observational cohort study conducted from January 01, 2014 to January 01, 2016. A questionnaire was established for data collection from clinical charts of TB patients. The study was carried out in all the 18 centers located in the Rabat-Salé-Kénitra region of Morocco where tuberculosis is treated. Adverse reactions are evaluated from the start of TB treatment until its end by a specialist clinician. The treatment outcomes are evaluated, and the definitions and classifications of these outcomes are defined according to World Health Organization guidelines.

RESULTS

Among a total number of 2532 patients treated for TB, the average age is 37.3 ± 16.4 years, 10.0% of patients produced adverse reactions. 7.4% of adverse reactions are gastrointestinal, 3.7% are cutaneous, 2.0% are hepatic, 1.14% are articular, 1.07% are immunoallergic, 0.7% are neuropsychiatric, and 0.1% are ocular. The treatment outcome of TB patients is 79.1% rate for successful treatment and 15.6% for unsuccessful treatment.

CONCLUSION

Adverse reactions caused by anti-TB drugs are frequent among patients with TB. These ADRs must be followed up by a closer monitoring during anti-TB treatment period. Treatment success outcome in our study is slightly lower than the success rate target of WHO of at least 85%.

Contribution of fibrin glue in the surgery of cyanogenic and non-cyanogenic congenital cardiopathies: retrospective cohort study

Background

Postoperative bleeding in cardiovascular surgery is a frequent and complicated situation for the surgical team, and may also be responsible for significant hospital expenditures. Fibrin glue are indicated in surgery to improve hemostasis when conventional techniques such as compression, sutures or electrocoagulation are insufficient. Through this study, we tried to study the contribution of fibrin glue to the improvement of the clinical parameters (volume of postoperative bleeding, length of stay in intensive care, volume of blood transfusion ...) in two populations having undergone cardiac surgery, one in which we used the fibrin glue and one without fibrin glue.

Methods

This was a retrospective cohort study conducted in the cardiovascular surgery department of our Hospital in Rabat between June 2012 and June 2015. Fibrin glue (Tissucol® of BAXTER) was used in one group with an haemostatic aim. The pre and post-operative clinical data of the patients were analyzed and compared with data from patients who were operated without the use of fibrin glue because it was not yet available in the hospital. The clinical parameters were collected analyzed using the SPSS 13.0 software.

Results

One hundred ten patients were included in this study. The fibrin glue was used intraoperatively in 55 patients and not used in 55 patients. 43 (39.1%) had cyanogenic diseases and 67 (60.9%) had non-cyanogenic pathologies. The volume of transfused red blood cells was lower in patients in whom we used biological glue (p = 0.005), as well as the number of days spent in intensive care (p = 0.02). However, the difference was not significant between the two groups for other parameters such as bleeding volume per kg, the number of units of fresh frozen plasma and the platelet units count transfused.

Conclusions

The results we found show that fibrin glue reduces the duration of hospitalization in resuscitation and reduces the number of units of transfused red blood cells to patients after surgery. However, it does not reduce significantly the total postoperative bleeding volume per weight, the number of fresh frozen plasma units or platelets units transfused. The fibrin glue could therefore be of moderate benefit in pediatric cardiac surgery.

Arbutus unedo L., (Ericaceae) inhibits intestinal glucose absorption and improves glucose tolerance in rodents

ETHNOPHARMACOLOGICAL RELEVANCE

Arbutus unedo L., (Ericaceae) is one of the most traditional plants commonly used to treat diabetes in people living in Eastern Morocco region particularly in Taza and Beni Mellal.

AIM OF THE STUDY

The aim of the study was to find if there is a scientific support to the ethnopharmacological relevance use of Arbutus unedo L., roots bark (AU) to treat diabetes.

MATERIALS AND METHODS

We studied the effects of crude aqueous extract of AU on intestinal glucose absorption using short-circuit current technique in vitro and oral glucose tolerance test in vivo.

RESULTS

The aqueous extract of AU (10 µg/mL to 1 mg/mL) induced concentration-dependent inhibition of sodium-dependent glucose transport across isolated mouse jejunum. The maximal inhibition was obtained with 1 mg/mL, which exhibited more than 80% of the Phloridzin inhibition with an IC₅₀ close to 216 µg/mL. A 6-week AU ingestion (2 g/(kg day)), improved oral glucose tolerance as efficiently as metformin (300 mg/(kg day)). Arbutus unedo L. and metformin also reduced body weight.

CONCLUSIONS

Arbutus unedo L. roots bark aqueous extract directly inhibited the electrogenic intestinal absorption of glucose in vitro. In addition it improved oral glucose tolerance and lowered body weight in rats after chronic oral administration in vivo. These results add a scientific support to the ethnopharmacological relevance use of Arbutus unedo L. roots bark to treat diabetes.

Treatment outcomes of drug resistant tuberculosis patients in Morocco: multi-centric prospective study

Background

Drug resistant tuberculosis is a major public health problem in Morocco and worldwide. Treatment outcome of drug resistant tuberculosis is poor and requires a long period of treatment with many toxic and expensive antituberculosis drugs. The aim of this study is to evaluate treatment outcomes of drug resistant tuberculosis and to determine predictors of poor treatment outcomes in a large region of Morocco.

Methods

It is a multi-centric observational cohort study conducted from January 01, 2014 to January 01, 2016. A questionnaire was established to collect data from clinical charts of patients with confirmed resistant TB. The study was carried out in all the 11 centers located in the Rabat-Salé-Kénitra region of Morocco where drug resistant tuberculosis is treated. Treatment outcomes were reported and the definitions and classifications of these outcomes were defined according to the WHO guidelines. Univariate and multivariate logistic regression were conducted to determine factors associated with poor drug resistant tuberculosis treatment outcomes in Morocco.

Results

In our study, 101 patients were treated for drug resistant tuberculosis between January 01, 2014 and January 01, 2016. Patients’ age ranged from 9.5 to70 years; 72patients (71.3%) were male and 80 patients (79.2%) were living in urban areas. Thirty two patients were smokers, 74 patients had multidrug-resistant tuberculosis, 25 patients had rifampicin resistance and 2 patients had isoniazid resistance. Treatment outcomes of tuberculosis patients were as follows: 45 patients were cured (44.5%), 9 completed treatment (8.9%), 5 patients died before completing the treatment, 35 patients were lost to follow up (34.6%) and 7 patients had treatment failure. In the multivariate analysis, being a smoker is an independent risk factor for poor treatment outcomes, (p-value = 0.015, OR = 4.355, IC [1.327–14.292]).

Conclusion

Treatment success outcomes occurred in more than half of the cases, which is lower than the World Health Organization target of at least a 75% success rate. A significant number of patients abandoned their treatment before its completion. These dropouts are a serious public health hazard that needs to be addressed urgently.

[Traditional camphor misuse: a forgotten danger to children (about 2 cases)]

In our country, the use of traditional medicinal recipes and artisan cosmetic products is very frequent due to the high rate of illiteracy, low purchasing power and of the large number of herbalists. Camphor is a low-cost product, easily accessible and omnipresent in almost every home, making it potentially toxic in case of misuse, in particular among children. We here report two cases of intoxication induced by beauty recipe made with powdered camphor. Patients' medical history gave informations about poisoning in 2 children caused by synthetic powder made with camphor imported from China. Patient 1: little girl aged 2 months, with no previous medical history, admitted to the Emergency Department due to constant crying and refusal to eat. Clinical examination showed no abnormalities. Standard laboratory tests were normal. Neurological, digestive and cutaneous monitoring were performed. Patient 2: girl aged 6 years admitted with atonic seizure associated with syncope and foaming followed by abdominal pain and vomiting after ingesting milk. The evolution was favorable 48 hours after symptom management. Mothers reported two neighbors had received a traditional hair care recipe by a third neighbor. After that they had mixed powdered camphor with olive oil, then they had applied it to the hair of their children for one hour, thus causing the occurrence of these symptoms.

Integrative herbal treatments of diabetes in Beni Mellal region of Morocco

OBJECTIVES

Diabetes is one of the most life-threatening chronic metabolic disorders and is considered a global health problem due to its prevalence and incidence. In Morocco, several herbal preparations are utilized to treat this disease. For this reason, the current study aimed to identify and to collect data about the medicinal plants utilized in folk medicine for the treatment of diabetes in the Beni Mellal region of Morocco.

METHODS

An ethnobotanical survey was carried out among 400 herbalists, competent villagers and traditional healers from the Beni Mellal region through direct interviews using a semistructured questionnaire.

RESULTS

Forty-five medicinal plants belonging to 25 families were identified for their use in diabetes treatment. Interview results showed that the most frequently used plants were Olea europaea, Salvia officinalis, Allium sativum and Trigonella foenum-graecum, with a relative frequency of citation values of 24.3%, 23.0%, 22.5% and 20.5%, respectively. Moreover, in this study, the Fabaceae family was the most commonly reported plant family, and the leaves and roots were the most commonly used parts, for the treatment of diabetes.

CONCLUSION

The Beni Mellal region of Morocco has an important floristic biodiversity of plants used to treat diabetes in traditional medicinal practice. This result provides a good database for pharmacological screenings in the search for plant-based antidiabetic medications.

Analytical Methods Used for the Detection and Quantification of Benzodiazepines

The prescription of psychotropic drugs, especially benzodiazepines (BZDs), occupies a preponderant place in the management of mental illnesses. Indeed, the BZDs have been used in different therapeutic areas including insomnia, anxiety, seizure disorders, or general anesthesia. Unfortunately, these drugs are present in the illegal street market, leading to a lot of drug abuse amongst some addicted users, road insecurity, and suicide. Hence, it has become essential to analyze the BZDs drugs in human biological specimens for drug abuse in forensic sciences. The present review provides a summary of sample preparation techniques (solid-phase extraction and Liquid-liquid phase extraction) and the methods for the detection and quantification of BZDs molecules in the commonly used biological specimens over the ten last years which may potentially lead to better and accurate evaluation of the physiological state of a given person. The commonly used methods for the detection and quantification of BZDs include nuclear magnetic resonance (NMR), chromatography (GC-MS, HPLC, and TLC), immunoassay (ELISA, RIA, LFA, CEDEA, FPIA, and KIMS), and electroanalytical methods (voltammetry and potentiometry).

Discrimination and Quantification of Moroccan Gasoline Adulteration with Diesel Using Fourier Transform Infrared Spectroscopy and Chemometric Tools

In this work, transform-infrared spectroscopy (FTIR) was associated with chemometric tools, especially principal component analysis (PCA) and partial least squares regression (PLSR), to discriminate and quantify gasoline adulteration with diesel. The method is composed of a total of 100 mixtures were prepared, and then FTIR fingerprints were recorded for all samples. PCA was used to verify that mixtures can be distinguished from pure products and to check that there are no outliers. As a result of using just PC1 and PC2, more than 98% of the general variability was explained. The PLSR model based on infrared spectra has shown its capabilities to be suitable for predicting gasoline adulteration in the concentration range of 0 to 98% (w/w), with a high significant coefficient of determination (R² = 99.25%) and an acceptable calibration and prediction errors (root mean squared error of calibration = 0.63 and root mean square of external validation and/or prediction = 0.69).

Antifungal and Insecticidal Properties of Juniperus thurifera Leaves

The hydro-distilled essential oil from the leaves of Juniperus thurifera L. (JTEO) was analyzed by GC-MS and examined for its insecticidal, antifungal and antioxidant activities. A total of 51 compounds were identified. The major components were sabinene (22.4%), followed by terpinen-4-ol (11.0%) and α-pinene (5.9%). JTEO exhibited interesting insecticidal activity against adults of Acanthoscelides obtectus, Tribolium castaneum and Sitophilus oryzae, with LC50 values of 0.1, 0.6 and 2.0×10−2 μL/mL, respectively. Moreover, JTEO showed inhibitory activity against Alternaria alternata, Fusarium oxysporum, Fusarium solani, Rhizoctonia solani and Verticillium dahlia with mycelial growth inhibition ranging from 24.0% to 92.1%. Finally, JTEO demonstrated a moderate antioxidant effect.

Analysis of the drug formulary and the purchasing process at a Moroccan university medical center

AIM

To give an overview of the pharmaceutical policy in the largest medical center in Morocco, a developing country in socio-economic transition.

METHODS

This is an analytical descriptive study of the drug formulary and the purchasing process carried out at the Ibn Sina University Medical Center.

RESULTS

Our formulary included 830 drugs belonging to 14 classes according to the Anatomical, Therapeutic and Chemical (ATC) Classification System. There was a respective predominance of class N (21.8%), class B (13.5%), and class J (12.6%). Injectable route was dominant (46%). Drugs had a significant actual benefit in 70% (according to the French Data), reimbursable in 42.8%, essential in 29.2% according to World Health Organization (WHO) list, and in 36.9% according to the Moroccan list. The calls for tenders included 542 drugs representing 65% of the formulary, and the attribution rate was 71%. The main reason for non-attribution was the lack of offers. Generics accounted for 45% by volume and 26.5% by value.

CONCLUSION

With this first study, we were able to identify key indicators on drugs used in the largest medical center in Morocco. The current challenge is to introduce pharmacoeconomics in decision making concerning the updates of the drug formulary.

Factors associated with asthma control: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco)

BACKGROUND

The purpose of the study is to describe the profile of patients with asthma and to identify the signifiant risks and the protective factors associated with asthma control.

METHODS

A prospective epidemiological study was conducted in three hospitals of Rabat-Morocco and included 396 patients with asthma. Differences in characteristics across the levels of asthma control were compared by the one-way analysis of variance for continuous variables, and chi-square test was used for categorical variables. The risk and protective factors associated with the asthma control levels were determined by Proportional Odds Model (POM) for bivariate and multivariate ordinal logistic regression, also expressed as Odds Ratios (OR) and 95% Confidence Intervals (95% CI).

RESULTS

From 7440 patients screened by 28 physicians, 396 were included in study. 53% of the particiants sufferd controlled, 18% had partly controlled and 29% had uncontrolled asthma symptoms. A multivariate ordinal logistic regression analysis showed that having respiratory infections (AOR = 5.71), suffering from concomitant diseases (AOR = 3.36) and being allergic to animals (AOR = 2.76) were positively associated with poor control of asthma. However, adherence to treatement (AOR = 0.07), possession of health insurance (AOR = 0.41) and having more than 2 children (AOR = 0.47) were associated with good asthma control.

CONCLUSION

The study established a clinical-epidemiological profile of asthmatic patients in Rabat region in Morocco. By ordinal logistic regression we found that 6 factors - respiratory infections, concomitant diseases, animals allergy, adherence to treatment, health insurance and having more than two children - were associated with asthma control.

Detection and analysis of drug-drug interactions among hospitalized cardiac patients in the Mohammed V Military Teaching Hospital in Morocco

INTRODUCTION

Drug-drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. Patients with cardiovascular disorders are at higher risk for DDIs because of the types and number of drugs they receive. The aim of the present study was to assess the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco.

METHODS

A prospective observational study from June 2016 to September 2016 was carried out in the cardiology department of a hospital in Morocco. Those patients who were taking at least two drugs and had a hospital stay of at least 48 hours were included in the study. The medications of the patients were analysed for possible interactions. All the prescriptions of the study population were screened for drug-drug interactions using a computerized DDI database system (Theriaque®).

RESULTS

During the study period, 138 patients were included; 360 interactions were detected among 94 patients, with an average number of drugs taken of 5.2. The prevalence of DDIs was estimated at 68.11%, the most common of which concerned Kardegic/Plavix (12.22%), Kardegic/Heparin (8.33%), and Lasilix/Spironolactone (5.83%). Among the 726 prescribed drugs, (372 [51.24%]) were drugs of the cardiovascular system, followed by blood and hematopoietic organ drugs (288 [39.67%]) according to the Anatomical Therapeutic Chemical Classification codes. These interactions were categorized on the basis of level of severity: interactions with major severity accounted for 11.11% (40) of the total DDIs while those with moderate and minor severity accounted for 37.22% (134) and 51.66% (186), respectively.

CONCLUSION

This study reports the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco. This study shows that DDIs are frequent among hospitalized cardiac patients and highlights the need to screen prescriptions of cardiovascular patients for possible DDIs, as this helps in their detection and prevention.Pan African Medical Journal - ISSN: 1937- 8688 (www.panafrican-med-journal.com)Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)Pan African Medical Journal - ISSN: 1937- 8688 (www.panafrican-med-journal.com)Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net).

Separation, Identification, and Antidiabetic Activity of Catechin Isolated from Arbutus unedo L. Plant Roots

Phytopharmaceuticals play an essential role in medicine, since the need to investigate highly effective and safe drugs for the treatment of diabetes mellitus disease remains a significant challenge for modern medicine. Arbutus unedo L. root has various therapeutic properties, and has been used widely in the traditional medicine as an antidiabetic agent. The current study aimed to isolate the pharmacologically active compound from A. unedo roots using accelerated solvent extraction technology, to determine its chemical structure using different instrumental analytical methods, and also to evaluate the α-glucosidase inhibitory activity. The roots of A. unedo were exhaustively extracted by high-pressure static extraction using the Zippertex^® technology (Dionex-ASE, Paris, France), and the extract was mixed with XAD-16 resin to reach quantifiable amounts of active compounds which were identified by high-pressure liquid chromatography (HPLC), ¹H NMR (300 MHz), and ¹³C NMR. The antidiabetic activity of the isolated compound was evaluated using the α-glucosidase inhibitory assay. The active compound was isolated, and its structure was identified as catechin using instrumental analysis.The results revealed that the isolated compound has potential α-glucosidase inhibitory activity with an IC₅₀ value of 87.55 ± 2.23 μg/mL greater than acarbose. This was used as a positive control, which has an IC₅₀ value of 199.53 ± 1.12 μg/mL. According to the results achieved, the roots of A. unedo were considered the best source of catechin and the Zippertex^® technology method of extraction is the best method for isolation of this therapeutic active compound. In addition, the α-glucosidase inhibitory activity results confirmed the traditional use of A. unedo roots as an antidiabetic agent. Future clinical trials and investigations of antidiabetic and other pharmacological effects such as anticancer are required.

[Not Available]

Bacterial resistance is a major concern and the proper use of antibiotics is a global public health priority. Inappropriate use of antibiotic therapy can have serious ecological and pharmaco-economic consequences. The objective of our work was to study the reevaluation of probabilistic antibiotherapy in the burns intensive care unit. A prospective study concerning the clinical-biological reassessment of antibiotic therapy was set up in the burns intensive care unit at the Military Hospital Instruction Mohammed V of Rabat. The data was collected over a period of 6 months, from June 1, 2017 to November 30, 2017. During the study period, 142 patients received an antibiotic prescription. Only 68 serious hospitalized septic patients were included in our study. The population was predominantly male (75%). The average age of our patients was 36 years, ranging from 15 to 56 years old. The average length of hospitalization in intensive care was 10 days. Of the 68 antibiotic regimens implemented, the reassessment rate was 72.06%, with 75% justified treatment rates, and 25% not justified. Therapeutic de-escalation was performed in 8 cases (11.76%), when it could have been performed 25 times (36.76%). This is justified by the nosocomial context of the burns intensive care unit with a bacterial ecosystem of BMR type (Klebsiella pneumoniae, Acinetobacter baumanii, Escherichia coli and Staphylococcus coagulase negative), which restricts the choice of antibiotic therapy to some molecules. Clinico-biological re-evaluation of antibiotic therapy is essential to fight the misuse of antibiotics. This study allowed us to evaluate the re-evaluation practices of antibiotic therapy at 48-72h in burns resuscitation. Subsequently, several actions were carried out: the appointment of a pharmacist in antibiotherapy within the Pole Pharmacy of the Mohammed V Military Hospital in Rabat, the activation of an Anti-Infectious Committee and the dispensing of antibiotics via Pyxis MedStation.