kerbala journal of pharmaceutical sciences

Start losing its ability to filter nitrogenous waste product from the blood, leading to its retention. kidney failure has become one of the most common diseases in this century. It occurs when the kidneys are harmed. Reduced urine production, swelling of the legs, ankles, and feet, shortness of breath, exhaustion, nausea, confusion, seizures, chest pain, and coma are all indications of renal failure. There are two types of kidney disease: acute renal injury and chronic renal failure. Acute kidney damage is characterized by a reduction in glomerular filtration rate that lasts from hours to days and is usually reversible. For chronic renal disease, which is usually irreversible and is defined by a decline in glomerular filtration rate to less than 60 ml/minute or increased serum creatinine for more than 3 months .Cr, BUN, Alb, UA and Urea, are one of the classic biomarkers that have been used for many years to predict the renal failure, but because they display poor specificity and sensitivity in predicting early changes in kidney function, therefore there were a need for new biomarkers that give more accurate and specific results than the classic biomarkers. The new biomarkers include, kidney injury molecule1 (KIM1), neutrophil gelatinase associated lipocalin (NGAL), cystatin-C (cyc-C), clusterin (clu), interleukin-18 (IL-18), alpha-1 microglobulin (a1 M), beta-2 microglobulin (b-2 M), osteopontin, asymmetric dimethylarginine (ADMA), inducible nitric oxide synthase (iNos), livertype fatty acid binding protein (L-FABP), and Fetuin-A. Therefore the study aims to shed light on the most important of these evidence.

Cytokines are a collection of proteins, peptides, or glycoproteins synthesized by immunity system cells. They are often act as signaling molecules and have a function of immunity, inflammation, and haematopoiesis initiation and regulation. In general, the cytokines are subdivided into two subgroups pro-inflammatory and anti-inflammatory cytokine.
The Pathogenicity of The novel coronavirus illness 2019 (COVID-19), which has now expanded worldwide and became a public health crises, is mainly linked to the cytokine storm according to the latest researches and clinical studies.
In the present article, the major lines of the cytokines and the effects of its storm in the covid-19 sickness and lethality will be discussed in addition to the main strategies that may involve in the storm management and control because as the pandemic spreads, discovering a specific therapy for COVID-19 becomes more important in order to improve patient outcomes and saving the lives.

Hand eczema, also called hand dermatitis is a very common and widespread condition characterized by inflammation of the skin. Endogenous or exogenous factors could induce the pathogenesis. A cross-sectional study was carried out in Karbala city during the period from March 1st to July 31, 2017 aimed to identify the prevalence of hand eczema among women (15-49) years and to recognize the triggering factors and related conditions. A sample of 300 were selected from women who attended 4 primary health care centers in Karbala city through direct interview using a special questionnaire prepared for the purpose of study. Then women had been examined for evaluation of hand dermatitis. The prevalence of hand eczema was high (77.3%), the majority of affected women were single (94.4%) and in younger age group (15-24) years (86.4%), and which involve both hands in (87.1%). Roughness was the most clinical presentation (95.7%). The most frequent triggering factors was using soap and detergent (94%). The most frequent impact of hand eczema was psychological impact (71.6%). Therefore, hand eczema is a common condition among women in Karbala. Further, most of sampled women not using protective measures and not been evaluated or treated for hand eczema.

Amoxicillin/clavulanate has been known as a semisynthetic penicillin/clavulanic acid antibiotic which is commonly used orally for the treatment of cutaneous and respiratory infections. It's an antibiotic that's easy to take. However, amoxicillin/clavulanate can induce a variety of side effects, including gastrointestinal, cutaneous, hematologic, and hepatic problems. In the present work, we aimed to review the possible risks of hepatotoxicity associated with amoxicillin/clavulanate using , since this combination widely administered for treatment of infections at different age stages for patients, This has been done via collecting and reading a large number of published articles and reviews to maintain our study.
It has been suggested that the clavulanic acid or the combination with amoxicillin may cause liver injury even 4 years after the 1st injury. Liver reactions fundamentally cholestatic, however, there are as well some cases with hepatocellular or the mixed cholestatic hepato-cellular hepatitis. The sequel looks to be good. Very rarely, patient died due to amoxicillin induced cholestatic hepatitis or develop a chronic liver disease with permanent abnormal liver function tests. Amoxicillin-clavulanate induced hepatotoxicity is a rare condition, and since it is a diagnostic of exclusion, it may be hard to diagnose. Amoxicillin/clavulanate is considered one of the major used antibiotics, it only causes hepatic injury in alimented number of cases. It starts to develop signs of cholestatic after six weeks of use. It causes significant hyperbilirubinemia and induce cholestatic icterus.
Liver injury may continue for four months. Treatment includes supportive. Related to the severity of cholestatic symptoms, analgesic and antiemetic medicines, along with antihistamine, cholestyramine, sertraline, or even ursodeoxycholic acid, may be used to control pruritus.

COVID-19 is a highly-transmissible, newly emerged, and pathogenic virus in humans which has caused economic disasters as well as global public health issues. To date, millions of mortalities and infections were reported globally and the numbers are continuing to rise. Due to the continual improvements in medical science, various vaccine types were identified and able to reduce the disease's virulence to some extent. However, there is currently no effective treatment for the disease. Enhanced nutrition, including vitamin supplementation to enhance the immune system, was discovered as a viable therapy for alleviating and preventing the severity of COVID-19. To lower the mortalities related to acute respiratory distress, various dietary therapies and alternate supportive treatments are being utilized and tested in patients experiencing COVID-19. A systematic literature review was conducted to uncover nutritional therapies which might assist individuals to recover from COVID-19. Furthermore, electronic databases Science Direct, Google Scholar, PubMed, Scopus, and Web of Science have been searched from February 2020 to April 2021. The purpose of the presented work was give a vision how successful early micronutrient intervention, with an emphasis on vitamin C, vitamin D, and zinc, was at decreasing the escalation of COVID-19, along with the impact of other vitamins in boosting the immune system as well as preventing further complications and improving death rates.

The objective of the present study was to assess the effect of spinal anesthesia in pregnant women undergoing elective cesarean delivery (C-section) and on neonatal apgar score. This is a hospital-based retroprospective study. The pregnant women (n=100) enrolled during October to February and operated with C-section using spinal anesthesia were considered in the study. Apgar is the combination of initial letters of “Appearance, Pulse, Grimace, Activity, and Respiration”, respectively. Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. Mother health and neonatal outcome were recorded. The average ages and BMI of enrolled women were 29.50±0.82 years and 24.50±0.59, respectively. The gestational age, parity and gravidity were 38.07±0.25 weeks, 2.00±0.33, and 2.50±0.40, respectively. The postoperative hemoglobin (10.38±0.22 g/dl) and hematocrit content (34.53±0.62%) were non-significantly decreased as compared to the preoperative parameters (12.18±0.21 g/dl hemoglobin and 35.95±0.83% hematocrit). Platelet count was non-significantly increased in the postoperative stage. The blood RBCs count was significantly decreased in the post-operative stage (3.43±0.05 x1012/L) as compared to pre-operative stage (4.92±0.25 x1012/L). A similar trend was observed in the total white blood count. The neonatal body weight was found to be around 3256 ± 24.36 gm. The apgar scores at 1st and 5th min were 7.54 ± 0.31 and 8.93 ± 0.22, respectively. The spinal anesthesia was found to be better for the mother's and her recovery. Also, child showed higher apgar score, which is a major evaluation of neonatal outcome.

The earth has openhandedly offered a huge number of different herbs like ribwort, thyme, rosemary, basil, sage, cardamom, chamomile, and mint, which are rich in different types of polyphenols with potent biochemical and antioxidant characteristics. This paper concentrates on many natural phenolic acids and their common natural herbal origins. A summary of recent reports of antioxidant effects of phenolics in emulsions (o/w) is delivered as a lipid-based in the vitro-model system. Additionally, exploring the activities of phenolic acids could serve to elucidate their possible health effects toward oxidative conditions. Lastly, this review depends on the newest literature evidence that concerns specific biochemical characteristics of the studied phenolic acids.

Cervical cancer disease is the second most prevalent cause of cancer-related deaths in females. Systemically administered anticancer drugs have difficulty in reaching the cervix with effective concentration. Fortunately, local access to the cervix is possible through the vagina. The present study was designed to formulate and evaluate Methotrexate mucoadhesive nanogel to prolong residence time in addition to improving its efficacy against the cervical tumor. Methotrexate O/W nanoemulsion (consisting of 5 % Eucalyptus oil, 30 % S-mix, and 65 % deionized water) was formulated. Then, this nanoemulsion was incorporated in Carbopol 934 (mucoadhesive gelling agent) dispersion to produce a homogenous Methotrexate mucoadhesive nanogel with a dose of 0.3 mg / 1g.Methotrexate o/w nanoemulsion formulation displayed globules size (57.45 nm) PDI (0.19), zeta potential (-23.67), pH (4.1), electrical conductivity (189 µs/cm), %T (99.57) and % drug content (99.7). Then used to produce a homogenous Methotrexate mucoadhesive nanogel with easy spreading (2.4 ± 0.05 cm) and acceptable Methotrexate content (99.35±0.2). In addition to compatible cervical application as indicated by pH and viscosity values of 4.5 ± 0.1 and 4695.5 mPa.s respectively. The results of Methotrexate release from Methotrexate mucoadhesive nanogel demonstrated a significant (p ≤ 0.05) higher cumulative drug released percent with 4 fold increment than that of pure Methotrexate gel. The overall data obtained revealed the feasibility of preparing Methotrexate as mucoadhesive nanogel for the treatment of cervical cancer.

The present study aims to evaluate the effect of regional anesthesia in the knee replacement surgery. This is a hospital-based prospective study. It was conducted at Al-Saffir hospital between April 2021 to October 2021. Six patients were enrolled in this study. They were divided into two groups, i.e. general anesthesia group (n=3) and regional anesthesia group (n=3). The patients were divided into two groups based on their oral consent, and complexity of the surgery. The patients operated with neuraxial anesthesia showed lower percentages of pulmonary compromise (respiratory distress, respiratory failure or respiratory arrest), acute renal failure, infections, prolong hospital stay, and health care cost parameters as compared to the patients operated with general anesthesia. The study can be concluded as the regional anesthesia was found to be effective over general anesthesia. To drive change in clinical practice, more robust clinical outcome studies will be required to define best practices for the use of general anaesthetic or regional anaesthetic.

Globally, back pain is a problem that costs a lot of money and causes a lot of impairment and disability. Present treatment approaches frequently offer suitable alleviation, but do not tackle the underlying causes. In degenerative disorders, the aim was to restore anatomical function by numerous regenerative cellular methods to alleviate lower back pain. Platelet-rich plasma (PRP) is made up of the large number of autologous platelets that are suspended in a limited plasma volume. Furthermore, PRP is prepared by the use of different modalities and could be administered by injection or applied topically. Whereas the mechanism of action is unknown, in vivo and vitro investigations have revealed cellular and biochemical alterations related to mechanical structure and inflammation. Using patient data and animal models, PRP injection research has revealed insight into chondroprotection, pain relief, and the factors which influence the therapeutic efficiency. PRP injection has lately been recommended in a few types of research as a fairly safe way to treat patients who have degenerative disc disease and failed to find other ways to manage their lower back pain. For the sacroiliac joint discomfort, PRP injections aren’t an approved therapy option, and the evidences for their effectiveness is limited to small RCTs and case report studies. According to limited number of prospective studies, PRP injection might be beneficial in treating pain or functional decline resulting from facet joint arthropathy. For improving the evidence quality and evaluating the safety and efficacy of PRP injections for many prevalent causes of chronic back pain, more research is needed.

A common condition regard as risk inflammatory state like, arthritis, cancer and obesity. NSAIDs widely prescribed for patients but safety concerns must be considered. For a long time, folk medicine has been regarded as a primary source of treatment for a variety diseases, with a great number of medications developed from natural sources. This review focus on chemical compounds isolated from natural ,which possess anti-inflammatory effect and used for treat joint , skin disorders and cardiovascular inflammation and other Inflammatory diseases. These isolated chemical compounds introduce and their biological activity has been evaluated in clinical and experimental studies. This work includes a brief and easy overview of the role of medicinal plants and their primary ingredients in the treatment of inflammatory conditions.

For several years, platelets were identified to be the core blood constituent that facilitates hemostasis and blood clots. In the latest decades, understood that platelets also achieve reflective immune purposes throughout infection by numerous pathogens. Now realize that platelets being moreover interceded a response to numerous other RNA viruses like flu and that numerous viral infections, counting severe Covid19, can impact platelet total. Thrombocytopenia and augmented clotting have been individually connected with amplified death. Laboratory features of Covid19 infection didn't differ according to pregnancy situation. A tendency of incomplete lymphocyte count was detected in the pregnant group.

Medication errors are problems that occur during the treatment of patients, by a health professional or patient themself. They are harmful to patients or may lead to death. They are considered serious problems because they are happening daily and are a significant cause of individual morbidity and mortality. This review aims to know the types of medication errors, their causes, and how to prevent them. In this review, the medical problem was misdiagnosis 59%, an adult who make one medication error at house 12-59 %, administration errors 38%, prescribing errors 39%, and omission 26%. However, medication errors are a popular health problem, and their danger increases day after day, therefore, it is necessary to know their types, any member of health professional cares and patients make medication errors. Finally,Medical errors are widespread and sometimes lead to serious consequences.

Osteoporosis is a condition in which bone growth and loss are out of balance. Vitamin D is one of the most important vitamins for bone metabolism and mineralization. Circulating 25-hydroxyvitamin D levels below 20 ng/mL (50 nmol/L) are considered deficient, and this condition is becoming increasingly common across the world. This review covers all aspects of vitamin D metabolism, vitamin D deficiency consequences, and vitamin D supplementation effects on musculoskeletal health in older individuals. According to current research findings, Vitamin D deficiency has been related to osteoporosis, poor bone mineral density, and muscle problems as well as falls and fractures. Osteoporosis falls and fractures can all be prevented by long-term administration of vitamin D and calcium. When it comes to osteoporosis, fracture risk is our primary concern yet vitamin D therapy has no consistent influence on fracture prevention unless calcium is also provided (particularly in frail populations living in care homes).

Sublingual route of medications is preferred as it easy for patients including old people and children. In addition, it provide quick action and escaping first pass effect of liver when compared with conventional oral tablets because the drug is absorbed through blood vessels located sublingually which are numerous and saliva is efficient for rapid disintegration of sublingual tablets. Therefore, superdisintegrants are used to disintegrate rapidly. In the formulation of pills, many compounds are added, aiming to break the tablets into fine particles when water reaches them, which results in the drug being released quickly. Good disintegrates have a superior ability to act opposing the effectiveness of tablet binding materials and compressive forces to form the tablet. Sublingual tablet manufacturing targets the release of the drug in the mouth and gastrointestinal tract within a few seconds after swallowing. Therefore, the characteristics of Superdisintegrants used are important to be chosen correctly.

Autoimmune rheumatic diseases (ARDs) are many conditions in which autoimmune-mediated tissue damage is caused by innate and adaptive immune responses. ARDs impact about 5% of the population and cause significant morbidity, mortality, and financial expenses. 1–5 As a result, taking steps to prevent ARDs would have a significant public health impact. Many ARDs Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), are two of the most common autoimmune diseases ,are becoming more well-known (SLE). During the Genetic and environmental risk factors interact at the preclinical stage of disease., most likely to trigger and perpetuate autoimmunity in a stepwise manner, eventually leading to measurable Inflammation and damage to tissue Furthermore, disease-related biomarkers, particularly autoantibodies, are being studied., begin and evolve without clinical signs and symptoms of tissue harm at first. These findings suggest that In asymptomatic (or mildly symptomatic) persons, combining biomarkers and other risk factors could identify those at high risk of developing future rheumatic disease, allowing for early treatment intervention to avoid disease progression to a clinically relevant stage. The purpose of this study was to find out about the prevalence, forms, causes, and diagnosis of rheumatic diseases in a community (RA being a common example of autoimmune rheumatic disorders).

Nanotechnology is an emerging multidisciplinary technology that can be described as engineering sciences and design and characterization technology. Interest in nanotechnology has increased greatly, so there is a need to develop a deeper understanding of the nature and behavior of nano-particles, methods of preparation and identifications. In this article, discussed the most important methods of preparing these materials (chemical, physical and biological) and how they can affect their fate and behavior and the important methods for characterization.

Skin is one of the largest organs acts as a barrier against local and systemic impacts. Hydrophilic and high molecular weight medications are unable to penetrate the Stratum Corneum (SC), the outermost layer of the skin.Ethosomes are vehicles that permit drugs to enter deeper layers of the skin’s blood circulation without the need for surgical intervention. "Smooth vesicles" called ethosomes act as novel vesicular carriers for the delivery of active substances to/via the skin. The majority of them are composed of ethanol, water, and phospholipids (phosphatidylcholine, phosphatidylserine, and phosphatidic acid).Due to their amphiphilic characteristics, ethosomes can function as a capsule for the delivery and transportation of both lipophilic and hydrophilic medicines through the skin. Ethosomes have the highest concentration of ethanol, at a rate of 45 percent, compared to other vesicles that function as drug delivery vehicles. Ethosomes are liposomes that contain a lot of ethanol. Ethosomes range in size from tens of nanometers to microns. They can deliver medications to the deep skin or systemic circulation by penetrating through the dermal layers of the skin.

Anastrozole, a third-generation aromatase inhibitor, it treats postmenopausal breast cancer in estrogen receptor-positive patients. The restrictions of anastrozole are involved low aqueous solubility, first-pass effect and stomach troubles. In the current work, anastrozole nanoparticles were developed to manage the transdermal delivery of anastrozole as an alternative to the oral route and to increase patient compliance.
Method: anastrozole nanoparticles were made by nanoprecipitation utilizing Kollicoat MAE100-55 as the polymer and poloxamer 188, polyvinyl pyrrolidone-K30, and hydroxy propyl methyl cellulose E5 as stabilizers. Polymer and stabilizer concentrations and stabilizer types were investigated for their effects on nanoparticle physical parameters such as particle size, zeta potential, entrapment efficiency and in-vitro release. Morphological and compatibility examinations, as well as an ex vivo permeation investigation via rat abdomen skin to investigate the effect of solid polymeric microneedles on drug flux, were also conducted.
Results: The results showed nanoprecipitation can make polymeric nanoparticles. Prepared polymeric nanoparticles ranged in size from 47.41±10.1nm to 541.3±23.6 nm and had a negative zeta potential. Entrapment efficiency ranged from 37.67% to 76.3%. A spherical, uniform shape was seen in transmission electron microscopy of formula (F2). Formula (F2) was chosen for further evaluation due to its small particle size, high entrapment efficiency percent, and 4-hour release pattern. The compatibility analysis didn't consider anastrozole's interaction with other parts. The permeation study found polymer microneedles increased drug penetration into rat skin compared to nanoparticles.
Conclusion: Combining polymeric nanoparticles and microneedles increased the transdermal absorption and penetration of anastrozole, as an alternative to the oral route, to increase patient compliance and minimized side effects.

This study aims to investigate the biological and antimicrobial activity of extracts of two types of plants, which are cuminum cyminum (cumin) leaves and Anethum graveolens (dill) leaves, and these are types of the well-known medicinal plants in Iraq that are having curative properties in folk medicine. Extraction was performed to plants powders by cold process using a vibrating incubator at 40°C. The antimicrobial activity was studied by diffusion by digging - agar at concentrations (0.1, 0.5, 1, 2, 3) % and (0.1, 0.3, 0.5, 0.75, 1) % for cumin and dill respectively. The results of the tests showed that cumin had the highest effective ability when using a concentration of 3%, while the highest effectiveness of dill was at a concentration of 1% of the concentrations used, while it was the least inhibitory ability when using concentrations of (0.1) % from both the two plants against bacteria and fungi used in the research. The inhibition effectiveness of a combination of 2% cumin and 1% dill was determined, which was measured and found to be (21,22,19,18,15) mm and (21,20,20,17,15) mm and (22, 19, 18, 16, 16) mm against Escherichia coli, Staphylococcus aureus, and Streptococcus mutans were obtained, while it gave effectiveness ranged between (20, 20, 21, 21, 16) mm and (21, 20, 20, 17, 17 ) mm towards Staphylococcus epidermis and Candida albicans, with concentrations (100, 75, 50, 25, 12.5)%, respectively.
The active substances available in the alcoholic extract of cumin and dill plants were investigated by chemical methods, as the tests showed that they contain compounds of alkaloids, flavonoids, glycosides, saponins and tannins, which are the substances to which the antimicrobial destructive effect was attributed against various types of bacteria and fungi.

Gentamicin (GM) is one of the aminoglycosides antibiotics, it is effective drug in severe infections caused by Gram-negative bacteria. The major complication of GM is nephrotoxicity. Renin and angiotensin enzymes play important role in physiology of kidney, disturbance in this vasoconstrictor system is one of nephrotoxicity pathway. Several studies suggested that renin angiotensin system inhibitors show improvement in drug- induced nephropathies. This study was aimed to assess the effects of angiotensin receptor blocker losartan on renal functions in nephrotoxic rats. A number of male adult Sprague-Dawley rats 40 were used. They were divided into four groups (10 rats in each group). First group (I) was injected with 0.9% NaCl and regarded as a control, the second group (II) was injected with gentamicin intraperitoneally (IP) 100 mg/kg for 7 days. The third group (III) was pretreated with losartan orally (25 mg/Kg) for 10 days, then injected IP by gentamicin for other 7 days, while fourth group (IV) was treated with gentamicin and losartan (same doses) simultaneously for 7 days. The results indicated that gentamicin causes nephrotoxicity by increasing plasma creatinine (Pcr) and blood urea nitrogen (BUN) significantly. Oral administration of losartan for 7 days concurrently with gentamicin showed statistically significant improvement in kidney functions. However, pretreatment with losartan did not show significant protective effects. The study demonstrated that losartan can provide partial protection against gentamicin induced nephrotoxicity only when administered simultaneously with gentamicin.