Insecticide resistance status of Aedes aegypti and Aedes albopictus in Malaysia(2010 to 2022):A review

This review aimed to determine the prevalence of the insecticide resistance status of the field-collected Aedes(Ae.)aegypti and Ae.albopictus in Malaysia from 2010 to 2022 towards carbamates,organochlorines,organophosphates and pyrethroids.Biological and environmental controls were summarized with an emphasis on the mosquito vector control strategies in Malaysia.The information in this review was extracted from several databases such as PubMed(MEDLINE),Science Direct and Scopus by using keywords including“insecticide resistance”,“carbamate resistance”,“organochlorine resistance”,“organophosphate resistance”,“pyrethroid resistance”,“Aedes”and“Malaysia”,between January 2022 and December 2022.Distribution of resistant Ae.aegypti and Ae.albopictus in Malaysia was mapped using QGIS software.Insecticide resistance in both Ae.aegypti and Ae.albopictus is widespread in Malaysia,although the rates vary by states.The most notable was the steep increase in permethrin resistance of Ae.aegypti in Selangor,Malaysia,over the past decade.Ae.albopictus also displayed moderate resistance to permethrin,though not as widespread as Ae.aegypti in Selangor,but showed sign of resistance in Sarawak,East Malaysia.Resistance towards four main classes of insecticides have been widely documented in Malaysia.The extensive resistance towards permethrin in Malaysia which is one of the current insecticides used in Malaysia suggested that policies supporting the widespread use of permethrin fogging needs further evaluation.

Antidiabetic and antioxidant activities of Nypa fruticans Wurmb. vinegar sample from Malaysia

Objective: To study the antidiabetic and antioxidant activities of nipa palm vinegar(NPV) used in traditional Malay medicine for treating diabetes. Methods: NPV was extracted using liquid-liquid extraction method and the obtained samples were subjected to antidiabetic studies using normal and streptozotocin-induced diabetic rat models whereas antidoxidant activities were investigated via in vitro antioxidant tests namely 2,2-diphenyl-1-picrylhydrazyl and 2,2'-azinobis-3-ethylbenzothiozoline-6-sulfonic acid free radicals scavenging activities and the reducing power assay. Results: Single administration of NPV and its extracts were not effective in both normal and diabetic rats. In intraperitoneal glucose tolerance test, NPV and its aqueous extract showed significant blood glucose lowering effect. In the sub-acute study, compared with the diabetic control, aqueous extract of NPV showed the most notable blood glucose lowering effect(56.6%) and a significant improvement in serum insulin levels(79.8%, P<0.05). To assess NPV's antioxidant activity, three in vitro antioxidant tests were employed: 2,2-diphenyl-1-picryhydrazyl and 2,2'-azinobis-3-ethylbenzothiozoline-6-sulfonic acid free radical-scavenging assays, and the reducing power assay. Ethyl acetate extract had the greatest antioxidant potential and content of phenolic and flavonoid compounds. A linear positive correlation between the antioxidant parameters was observed. Chemical profiling analysis of aqueous extract of NPV revealed the presence of acetic acid(35.25%), the main active constituent which significantly contributed to the observed antidiabetic activity. Conclusions: Aqueous extract of NPV possesses antihyperglycaemic activities comparable to the metformin, while the ethyl acetate extract precipitated significant antioxidant effects attributable to its high phenolic content. These findings suggest that antioxidant compounds of NPV do not contribute much towards the overall observed antidiabetic effect.

Prediction and rate of infections in diabetes mellitus patients with diabetes ketoacidosis in Penang, Malaysia

Study aimed to determine the rate and prediction of infection in diabetes mellitus patients ≥18 year, with diabetic ketoacidosis (DKA). Retrospective cohort study design was adopted to achieve the objectives. Universal sampling technique was employed for data collection among Diabetes ketoacidosis patients, over a period of 3 years (Jan 2008-Dec 2010). Statistical package for social sciences used to analyze data. Over a 3-year period, total of 967 admissions were identified. Of it, 112 (11.6%) with no infection, 679 (70.2%) with bacterial infection and 176 (18.2%) with presumed viral infection. The mean WBC for all the patients was 18,177 (±9431). 721 (74.6%) had leukocytosis, as defined by a WBC ≥ 15,000/mm3. WBC, differential, leukocytosis, as well as sex, temperature were not significant predictors (p > 0.05) of bacterial infection. There was significant (p < 0.05) difference of age between the 3 groups, age above 57 years have high rate of infection as compared to age below and equal 57 years. The infection rate in elderly patients with DKA was high and majority of them had lack of clinical evidence. Major bacterial infections with potential serious sequel were particularly common (33.3%), among every third patient being presumed to have serious consequences.

Unveiling the hidden world of gut health:Exploring cutting-edge research through visualizing randomized controlled trials on the gut microbiota

BACKGROUND The gut microbiota plays a crucial role in gastrointestinal and overall health.Randomized clinical trials(RCTs)play a crucial role in advancing our knowledge and evaluating the efficacy of therapeutic interventions targeting the gut microbiota.AIM To conduct a comprehensive bibliometric analysis of the literature on RCTs involving the gut microbiota.METHODS Using bibliometric tools,a descriptive cross-sectional investigation was conducted on scholarly publications concentrated on RCTs related to gut microbiota,spanning the years 2003 to 2022.The study used VOSviewer version 1.6.9 to examine collaboration networks between different countries and evaluate the frequently employed terms in the titles and abstracts of the retrieved publications.The primary objective of this analysis was to identify key research areas and focal points associated with RCTs involving the gut microbiota.RESULTS A total of 1061 relevant articles were identified from the 24758 research articles published between 2003 and 2022.The number of publications showed a notable increase over time,with a positive correlation(R2=0.978,P<0.001).China(n=276,26.01%),the United States(n=254,23.94%),and the United Kingdom(n=97,9.14%)were the leading contributing countries.Københavns Universitet(n=38,3.58%)and Dankook University(n=35,3.30%)were the top active institutions.The co-occurrence analysis shows current gut microbiota research trends and important topics,such as obesity interventions targeting the gut microbiota,the efficacy and safety of fecal microbiota transplantation,and the effects of dietary interventions on humans.CONCLUSION The study highlights the rapid growth and importance of research on RCTs that involve the gut microbiota.This study provides valuable insight into research trends,identifies key players,and outlines potential future directions in this field.Additionally,the co-occurrence analysis identified important topics that play a critical role in the advancement of science and provided insights into future research directions in this field.

Hypoglycemic and anti-hyperglycemic study of Gynura procumbens leaf extracts

Objective:To study the antidiabetic activity of Gynura procumbens(G.procumbens)used in the traditional management of diabetes in Southern Asia.Methods:G.procumbens leaves were extracted sequentially with graded percentage of ethanol in water(95%,75%,50%,25%and 0%),and the extracts were tested for antidiabetic activity using acute(7 h),subcutaneous glucose tolerance test and sub-chronic(14 d)test in non-diabetic and streptozotocin-induced diabetic rats.The extracts were further subjected to phytochemical studies.Results:In acute dose(1 g/kg),the extracts significantly lowered fasting blood glucose(FBG)in streptozotocin-induced diabetic rats(P<0.05).However,the FBG-lowering effect of the 25%extract compared to the other extracts,was rapid(47%after 2 h)and the highest:53%,53%and 60%in the 3rd,5th,and 7th h,respectively(P<0.05),comparable only to the effect of metformin.Furthermore,the extracts suppressed peak FBG in subcutaneous glucose tolerance test,but only the 0%and 25%extracts,and metformin sustained the decrease until the 90th min(P<0.05).Moreover,in the 14 days study,the 25%extract exerted the highest FBG-lowering effect,namely 49.38%and 65.43%on days 7 and 14,respectively(P<0.05),similar to the effect of metformin(46.26%and 65.42%).Total flavanoid and phenolic contents in the extracts were found to decrease with increase in polarity of extraction solvents.The composition of reference compounds(chlorogenic acid,rutin,astragalin and kaempferol-3-O-nrtinoside)followed a similar trend.Conclusions:G.procumbens contains antidiabetic principles,most extracted in 25%ethanol.Interaction among active components appears to determine the antidiabetic efficacy,achieved likely by a metformin-like mechanism.

Antioxidant and antiangiogenic activities of the essential oils of Myristica fragrans and Morinda citrifolia

Objective:Toinvestigate the anti-angiogenic activity and antioxidant properties of Myristica fragrans（M.fragrans）（nutmeg） and Morinda citrifolia（M.citrifolia）（mengkudu） oils. Methods:The nutmeg and megkudu essential oils were obtained by steam distillation. The antioxidant activities of both essenlial oils were delermined by beta-carotene/ linoleic acid bleaching assay and reducing power while the anti-angiogenic activity was investigated using rat aortic ring assay using various concentrations.Results:The results showed that nutmeg oil has higher antioxidant activity than mengkudu oil.The nutmeg oil effectively inhibited the oxidation of linoleic acid with（88.68±0.1）%while the inhibition percentage of oxidation of linoleic acid of the mengkudu oil is（69.44±0.4）%.The nutmeg oil and mengkudu oil showed reducing power with an EC50 value of 181.4μg/mL and 3 043.0μg/mL,respectively.The anliangiogenic activity of nutmeg oil showed significant antiangiogenic activity with IC50 of 77.64μg/mL comparing to mengkudu oil which exhibits IC50 of 109.30μg/mL.Conclusion:Bioactive compound（s） will be isolated from the nutmeg essential oil to be developed as antiangiogenic drugs.

Enhancement of norfloxacin solubility via inclusion complexation with β-cyclodextrin and its derivative hydroxypropyl-β-cyclodextrin

The objectives of the study were to investigate the effects of β-cyclodextrin(βCD) and hydroxypropyl-β-cyclodextrin(HPβCD) on the solubility and dissolution rate of norfloxacin prepared using three different methods, at drug to cyclodextrin weight ratios of 1:1, 1:2, 1:4 and 1:8. All the methods increased the solubility and dissolution rate of norfloxacin via inclusion complexation with βCD and HPβCD. Norfloxacin was converted from crystalline to amorphous form through inclusion complexation. Solvent evaporation method was the most effective method in terms of norfloxacin solubilisation, while inclusion complex of HPβCD has higher solubility than βCD complex when prepared using the same procedure.

Factors affecting the accumulation of 9-methoxycanthin-6-one in callus cultures of Eurycoma longifolia

A study was conducted to improve 9-methoxycanthin-6-one productivity （potential anti-tumour compound） from callus cultures of Emycorna longifolia （Tongkat All）. Several factors affecting 9-methoxycanthin-6-one production in callus cultures such as different medium compositions and physical factors were investigated and analyzed. Results show that a higher production of 9-methoxycanthin-6-one （3.84 mg-g-1 DW （Dry Weight）） is obtained from callus cultured in 1/4 MS basal media. At fructose of 2% （w/v）, the production of 9-methoxycanthin-6-one （4.59 mgg-1DW） is promoted to gain the highest yield, compared to other carbon sources tested. The addition of 2.0-mg·L^-1 dicamba also increases 9-methoxycanthin-6-one production （12.3 mg·g^-1 DW）. Higher production of 9-methoxycanthin-6-one was obtained at pH 5.5 （1.53 mg·g^-1 DW）. Production of 9-methoxycanthin-6-one （2.34 mg-g^-1 DW） in callus cultures is also increased when the medium is added with 1×10 ^-1μM phenylalanine. This study suggests that the successful production of 9-methoxycanthin-6-one in vitro cultures has a potential in large-scale production using bioreactor technology.

Anticancer effect of Psidium guajava(Guava) leaf extracts against colorectal cancer through inhibition of angiogenesis

Objective:To evaluate the anti-angiogenic and anticancer activities of Psidium guajava leaf extracts against angiogenesis-dependent colorectal cancer.Methods:Three extracts were produced using distilled water,ethanol,and n-hexane as solvents.The extracts were physically characterised through gas chromatography–mass spectrometry,ultraviolet–visible spectroscopy,and Fourier transform infrared spectroscopy.Their antioxidant activity was evaluated using the 2,2-diphenyl-1-picrylhydrazyl,total phenolic content,and total flavonoid content assays.To assess their anti-angiogenic activity,cell viability and rat aortic ring assays were conducted,while cell migration,tube formation,colony formation,and VEGF ELISA assays were conducted to elucidate their effects on different aspects of angiogenesis.Molecular docking was used to assess the antiangiogenic potential of some possible compounds in the extracts.Tumour spheroid assay was used to assess the extracts’potential as a treatment for colorectal cancer.Results:The ethanol extract showed the best antioxidant activity.The distilled water and ethanol extracts exhibited more inhibitory activity against EA.hy926 cell viability and aortic ring microvessel growth.In addition,the ethanol extract performed significantly better than the distilled water extract against cell migration and colony formation,and VEGF expression of the cells was suppressed by the ethanol extract.Both the distilled water and ethanol extracts showed significant inhibitory effect on EA.hy926 tube formation and tumour spheroids consisting of EA.hy926 and HCT116 cells.The ethanol extract containedβ-caryophyllene andβ-elemene by phytochemical analysis and subsequent docking studies,which may contribute to its anti-angiogenic activity.Conclusions:The ethanol extract of Psidium guajava has potential in the treatment of colorectal cancer through the inhibition of angiogenesis.

In vivo hypoglycemic investigation, antihyperglycemic and antihyperlipidemic potentials of Pereskia bleo Kunth. in normal and streptozotocin-induced diabetic rats

Objective: To elucidate the in vivo hypoglycemic capability, antihyperglycemic and antihyperlipidemic activities of Pereskia bleo(Kunth) leaves extracts and bioactive fraction. Methods: The various solvent extracts of Pereskia bleo were investigated for the hypoglycemic and antihyperglycemic activities using a relevant in vivo normal rat model and streptozotocininduced diabetic rat model with glibenclamide and metformin utilized as positive controls. The effects of the most potent extract and its bioactive fraction on the insulin level, lipid profile and body weight of the diabetic rats were also analyzed. Results: All the extracts showed no hypoglycemic effect while petroleum ether, chloroform and aqueous extracts demonstrated significant(P<0.05) reduction in blood sugar level in the intraperitoneal glucose tolerance test. Aqueous extract and aqueous fraction significantly(P<0.05) reduced the blood glucose level in streptozotocin-induced diabetic rats as early as day 6 compared to the diabetic control as well as significantly restored the serum insulin of diabetic rats. Moreover, the aqueous extract and aqueous fraction disclosed a significant(P<0.05) reduction in total cholesterol, triglycerides, and low-density lipoprotein levels. An elevation in high-density lipoprotein as well as improved body weight loss of the diabetic rats were also observed. Conclusions: In summary, Pereskia bleo appears effective in the management of diabetes and correlated impairments arising from high blood sugar level. Further studies will possibly bring about the discovery of effective and secure plant derived antidiabetic drugs.

Eradication of malaria through genetic engineering:the current situation

Malaria is an intra-cellular parasitic protozoon responsible for millions of deaths annually.Host and parasite genetic factors are crucial in affecting susceptibility to malaria and progression of the disease.Recent increased deployment of vector controls and new artemisinin combination therapies have dramatically reduced the mortality and morbidity of malaria worldwide.However, the gradual emergence of parasite and mosquito resistance has raised alarm regarding the effectiveness of current artemisinin-based therapies.In this review,mechanisms of anti-malarial drug resistance in the Plasmodium parasite and new genetically engineered tools of research priorities are discussed.The complexity of the parasite lifecycle demands novel interventions to achieve global eradication.However,turning laboratory discovered transgenic interventions into functional products entails multiple experimental phases in addition to ethical and safety hurdles.Uncertainty over the regulatory status and public acceptance further discourage the implementation of genetically modified organisms.

Hypoglycemic and anti-hyperglycemic study of Ocimum tenuiflorum L.leaves extract in normal and streptozotocin-induced diabetic rats

Objective:To investigate the antidiabetic activity of Ocimum tenuiflorum L.(O.tenuiflorum) leaves used in the traditional medicine management of diabetes in Malaysia.Methods:O.tenuiflorum leaves were extracted sequentially with hexane,chloroform,ethyl acetate,methanol,and water.The extracts were evaluated in terms of antidiabetic activity by using acute,subcutaneous glucose tolerance,and sub-chronic tests in streptozotocininduced diabetic rats.The extracts were also subjected to phytochemical analyses.Results:With an acute dose(1 g/kg),the methanol extracts showed significant reduction(31%) in fasting blood glucose(FBG) of the streptozotocin-induced diabetic rats.The FBG-decreasing effect of ethyl acetate extract was more rapid than that of the other extracts;the decreasing rates were 20%after 2 h,21%after 3 h,and 8%after 5 and 7 h.After 7 h(31%),the effect of methanol extract on FBG was significantly lower than that of metformin.In the subcutaneous glucose tolerance test,only methanol and hexane extracts showed the similarity of metformin in diabetic rats.After 14 days,the effects of these extracts were similar to those of metformin(63.33%).The total flavonoid and phenolic contents of extracts decreased as the polarity of the extraction solvent increased.Conclusions:The results obtained provide support for a possible use of O.tenuiflorum leaves in managing hyperglycemia and preventing the complications associated with it in type 2 diabetic.

The characterization and dissolution performances of spray dried solid dispersion of ketoprofen in hydrophilic carriers

Solid dispersion is one of the most promising strategies to improve oral bioavailability of poorly soluble API.However,there are inconsistent dissolution performances of solid dispersion reported which entails further investigation.In this study,solid dispersions of ketoprofen in three hydrophilic carriers,i.e.PVP K30,PVPVA 6:4 and PVA were prepared and characterized.Physical characterization of the physical mixture of ketoprofen and carriers shows certain extent of amorphization of the API.This result is coinciding to evaluation of drug-polymer interaction using ATR-FTIR whereby higher amorphization was seen in samples with higher drug-polymer interaction.XRPD scanning confirms that fully amorphous solid dispersion was obtained for SD KTP PVP K30 and PVPVA system whereas partially crystalline system was obtained for SD KTP PVA.Interestingly,dissolution profiles of the solid dispersion had shown that degree of amorphization of KTP was not directly proportional to the dissolution rate enhancement of the solid dispersion system.Thus,it is concluded that complete amorphization does not guarantee dissolution enhancement of an amorphous solid dispersion system.

Chemometrics of differentially expressed proteins from colorectal cancer patients

AIM:To evaluate the usefulness of differentially expressed proteins from colorectal cancer (CRC) tissues for differentiating cancer and normal tissues.METHODS:A Proteomic approach was used to identify the differentially expressed proteins between CRC and normal tissues.The proteins were extracted using Tris buffer and thiourea lysis buffer (TLB) for extraction of aqueous soluble and membrane-associated proteins,respectively.Chemometrics,namely principal component analysis (PCA) and linear discriminant analysis (LDA),were used to assess the usefulness of these proteins for identifying the cancerous state of tissues.RESULTS:Differentially expressed proteins identified were 37 aqueous soluble proteins in Tris extracts and 24 membrane-associated proteins in TLB extracts.Based on the protein spots intensity on 2D-gel images,PCA by applying an eigenvalue > 1 was successfully used to reduce the number of principal components (PCs) into 12 and seven PCs for Tris and TLB extracts,respectively,and subsequently six PCs,respectively from both the extracts were used for LDA.The LDA classification for Tris extract showed 82.7% of original samples were correctly classified,whereas 82.7% were correctly classified for the cross-validated samples.The LDA for TLB extract showed that 78.8% of original samples and 71.2% of the cross-validated samples were correctly classified.CONCLUSION:The classification of CRC tissues by PCA and LDA provided a promising distinction between normal and cancer types.These methods can possibly be used for identification of potential biomarkers among the differentially expressed proteins identified.

Development and Validation of a Liquid Chromatography-Tandem Mass Spectrometry Method for Determination of Artemisinin in Rat Plasma

Artemisinin is a potent anti-malarial drug isolated from traditional Chinese medicinal herb, Artemisia annua. The objective of this study was to develop and validate a sensitive and specific LC-MS/MS method for the determination of artemisinin in rat plasma using amlodipine as Internal Standard. The method consist of a simple liquid-liquid extraction with methyl tertiary butyl ether （MTBE） with subsequent evaporation of the supernatant to dryness followed by the analysis of the reconstituted sample by LC-MS/？vIS with a Z-spray atmospheric pressure ionization （API） interface in the positive ion-multiple reaction monitoring mode to monitor precursor--〉product ions of m/z 282.70--〉m/z 209.0 for artemisinin and m/z 408.9--〉m/z 237.0 for amlodipine respectively. The method was linear （0.999） over the concentration range of 7.8-2000 ng/mL in rat plasma. The intra and inter-day accuracy were measured to be within 94-104.2% and precision （CV） were all less than 5%. The extraction recovery means for internal standard and all the artemisinin concentrations used were between 82-85%.

The potential of standardized quassinoid-rich extract of Eurycoma longifolia in the regulation of the oestrous cycle of rats

Objective: To evaluate the effects of Eurycoma longifolia(E. longifolia) standardized extract on the oestrous cycle, levels of reproductive hormones and histology of the ovaries of Sprague-Dawley rats.Methods: Female rats were orally treated with E. longifolia standardized extract at the dose levels of 2.5, 5.0, 10.0, 25.0, 50.0 and 100.0 mg/kg of body weight over 5 days.Vaginal smears were monitored daily within the duration and after withdrawal of the treatment before being sacrificed. The body weights of the females were recorded before and after the 5 days treatment. At the end of the experiments, blood samples were collected for determination of testosterone, oestradiol and progesterone levels. Ovaries were removed, weighed and examined for histomorphological changes.Results: The administration of E. longifolia standardized extract did not significantly alter the oestrous cycle of the rats during the 5 days treatment and after withdrawal of the treatments. This was supported by normal testosterone, oestradiol and progesterone levels as well as normal morphology of the ovaries.Conclusions: The data obtained showed that E. longifolia standardized extract did not exhibit any toxic effect on reproductive activities of female rats suggesting potential use in the management of infertility.

Evaluation of antihyperlipidemic effect of Polygonum minus,a South East Asian salad plant in poloxamer 407-induced acute hyperlipidemic rats

OBJECTIVE To investigate the antihyperlipidemic effect of methanol and aqueous extracts of the leaves of Polygonum minus in acute hyperlipidemic rat model.METHODS Acute hyperlipidemia was chemically induced in Sprague Dawley rats by using poloxamer 407(500mg·kg-1 of body weight;intraperitoneal).Increase in total cholesterol was confirmed after six hours of induction.The normal and hyperlipidemic control groups were administered with 1mL carboxymethylcellulose(CMC),the two test groups received aqueous and methanol extract of leaves of P.minus respectively(1000mg·kg-1;orally;suspended in 1% CMC)whereas reference standard treated group received atorvastatin(60mg·kg-1;orally;suspended in 1% CMC)once daily for 3consecutive days.Blood samples were collected at 10 th and 24 th hour of the study for total cholesterol and triglycerides determination,while terminal blood samples were collected at58 th hour for full lipids profile analysis.RESULTS In the present study,both methanol and aqueous extracts lowered the serum total cholesterol and triglycerides significantly(P<0.001 and P<0.05,respectively)when compared with the hyperlipidemic control,similar to the standard drug atorvastatin.Varying effects were observed for both extracts on the other lipid parameter studied.Methanol extract showed significant reduction in LDL(P<0.05),VLDL(P<0.01)and atherogenic index(AI;P<0.001)and it showed a significant elevation in HDL levels(P<0.05).On the other hand,the aqueous extract showed significant reduction only in VLDL and AI(P<0.05)but no increase in HDL levels.CONCLUSION Present study confirmed the antihyperlipidemic effect of leaves of P.minus in acute hyperlipidemic rat model.The study also suggested that the methanol extract possess higher antihyperlipidemic effect than aqueous extract.Currently a study is ongoing to evaluate the antihyperlipidemic effect of the methanol extract in high-fat diet-induced chronic hyperlipidemic rat model.

Analysis of differentially expressed proteins in cancerous and normal colonic tissues

AIM： To identify and analyze the differentially expressed proteins in normal and cancerous tissues of four patients suffering from colon cancer. METHODS： Colon tissues （normal and cancerous） were homogenized and the proteins were extracted using three protein extraction buffers. The extraction buffers were used in an orderly sequence of increasing extraction strength for proteins with hydrophobic properties. The protein extracts were separated using the SDS-PAGE method and the images were captured and analyzed using Quantity One software. The target protein bands were subjected to in-gel digestion with trypsin and finally analyzed using an ESI-ion trap mass spectrometer. RESULTS： A total of 50 differentially expressed proteins in colonic cancerous and normal tissues were identified. CONCLUSION： Many of the identified proteins have been reported to be involved in the progression of similar or other types of cancers. However, some of the identified proteins have not been reported before. In addition, a number of hypothetical proteins were also identified.

Impact of Training of Dispensers on Case Management of Acute Respiratory Tract Infections at Community Pharmacies in Pakistan

Purpose: To evaluate the impact of training of dispensers on the process of case management of ARI at community pharmacies in context to history taking and provision of advice working at community pharmacies in Islamabad, Pakistan. Method: A randomized, controlled, blinded intervention study was designed and implemented. Before the implementation of intervention, a baseline study was performed to assess the process of case management for ARI at community pharmacies. The study population included all community pharmacy outlets in Islamabad. After data collection, data was analyzed. The result of the study revealed that the overall process of disease management of ARI at community pharmacies in Pakistan is not satisfactory. Pharmacies of Islamabad which were visited in pre intervention phase (118) were divided into two geographical regions A (intervention) and B (control). From which thirty pharmacies were selected randomly from each region. The targeted group of the interventions was drug sellers. Keeping in view the results of the base line study an educational intervention was designed to improve the case management of ARI at community pharmacies in Pakistan. Results: No significant difference (p ≤ 0.05) was seen in the process of history taking and advice provision in case of ARI management at community pharmacies between pre and post control groups. On the other hand significant difference in the process of history taking and provision of advice for ARI was observed in the intervention group before and after training. Conclusion: The study has highlighted that improvements in the current dispensing practices at community pharmacies are possible through appropriate educational interventions. The dispensers have the potential to provide fast and low cost healthcare to the masses in the country where the presence of doctors and qualified pharmacist is low;to date they are an untapped and underutilized source in the country.

Clinical critics in the management of diabetes mellitus

There is a global epidemic of diabetes with its prevalence expected to increase from 5.1% in 2003 to 6.3% in 2025. This increase in diabetes is occurring in all nations, however, developing nations are particularly at risk. It spares no group and affects men, women, the elderly, young and people from very racial and socio-economic background. Nevertheless, certain ethnic groups including Asians are affected more than Caucasians. Large randomized clinical trials have shown that improvement in glycaemic control, together with management of diabetes-related risk factors like blood pressure and lipid control significantly reduce the micro and macro complications in individuals with type 1 and type 2 diabetes. Patient education plays a crucial role in the prevention of diabetic fool problems. In Geneva, the rate of lower limb amputations was reduced by almost 75% after an educational intervention. People with diabetes must acquire the knowledge and skills through education to provide daily self-care in diabetes management which involves maintenance of healthy living, recognition and management of diabetes problems when they arise and taking preventive measures. Some factors include patients’ biomedical variables, the psychosocial environment, the knowledge, attitudes and beliefs of patients themselves, home careers and health care providers, healthcare systems’ accessibility and availability and even the national political context may influence these self-care behaviors.