This study aimed to determine phytochemical contents, antibacterial properties, and antibiotic modulating potential of Punica granatum leaf extracts: hexane, chloroform, ethyl acetate, ethanol, and aqueous extracts as well as an extract enriched with total oligomer flavonoids (TOFs). The TOF extract contained the highest value of phenols and flavonoids. Rutin, luteolin, gallic acid, and ellagic acid were determined by HPLC analysis of this extract. The antibacterial activity was assayed by the disc diffusion method and microdilution method against Staphylococcus aureus and Escherichia coli standard ATCC strains and clinical isolates resistant strains. The TOF extract was the most active against all tested strains. The checkerboard method was used for the determination of synergy between two antibiotics (amoxicillin and cefotaxime) and P. granatum leaf extracts. The best synergistic interaction was found with TOF extract combined with amoxicillin for penicillin-resistant E. coli and penicillin-resistant S. aureus. These results can be assigned to tannins, flavonoids, and phenolic acids found in P. granatum leaf extracts. Pomegranate leaf extracts or active compounds isolated from these extracts could be used to fight the emergence and spread of resistant bacterial strains.

Enzyme-assisted extraction has emerged as an attractive green, cost-effective and high bioactive yielding technology by which desired bioactives with preserved or better efficacy are released. In the present study, the ability of cellulase, hemicellulase and their binary mixture (cellulase:hemicellulase; 1:1) in improving the extraction of essential oils from coriander ( L.) seeds, or the residue by-products from the distillation process containing value-added phytochemicals (fatty acids and phenolics) were evaluated. Cellulase and the binary mixture improved the extraction of essential oils by 44.2 and 40%, respectively. Application of enzymes was associated with increased amount of oxygenated terpenes in the essential oils derived from enzyme-treated samples. Linalool, camphor and geranyl acetate were the prominent compounds. From the hydrodistillation residues, a better recovery of petroselinic-rich oil with a good nutritional quality was also observed in enzyme-treated seeds. They also contained an appreciable amount of polyphenols and showed an improved antioxidant activity as revealed by the DPPH, FRAP and cellular antioxidant activity assays. The results suggested that enzyme pre-treatment allowed better recovery without alteration of the essential oil composition. The hydrodistillation residues obtained could be potentially exploited for the development of functional food ingredients and nutraceuticals.

BackgroundHypoglycaemia may result in significant anxiety and worry or even a fear of hypoglycaemia, which may have clinical implications for diabetes management.PurposeThis study aimed to assess the fear of hypoglycaemia in patients with diabetes type 2, to identify factors affecting this and to seek correlation with treatment adherence.Material and methodsThis was an observational cross sectional study carried out in patients with type 2 diabetes in the endocrinology department. Patients with secondary or gestational diabetes were excluded. Fear of hypoglycaemia was measured using the Hypoglycaemia Fear Survey II scale (HFSII). Total scores range from 0 to 60 for the behaviour subscale and from 0 to 72 for the worry subscale. The Morisky Medication Adherence Scale 4 items (MMAS 4 ITEM) was used to asses treatment adherence. Statistical test ANOVA was applied and statistical signficance was accepted at p<0.05.Results141 type 2 diabetic patients with different therapeutic regimens were included. In the elderly, fear of hypoglycaemia was more important. Hypoglycaemia fear had a positive correlation with previous history of hypoglycaemia and hypoglycaemia fear (p<0.001) causing increasing worry and behaviour change among type 2 diabetic patients. Patients with a high HFS score had therapeutic adherence problems. Equivalent results were found in similar studies.ConclusionThere was evidence that fear of hypoglycaemia may have a negative impact on therapeutic adherence and diabetes management in general. This requires better care from health professionals.References and/or acknowledgementsQuilliam BJ. Clin Ther2011;33:1781–91.No conflict of interest

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Objective The objective of this study was to assess the level of Vitamin K antagonist (VKA) therapy knowledge among VKA newly treated patients. Methods Questionnaire-based interviews were administered in a university hospital to VKA newly treated patients covering both cognitive (i.e. indication, route of administration, treatment monitoring and side effects) and know-how (i.e. safety precautions, what affects anticoagulant therapy and the management of overdose signs) aspects of therapy knowledge. Key findings A total of 55 patients were included. The mean overall score of patients’ knowledge was 5.78 (SD = 3.425) out of 20. The mean scores of cognitive and practical knowledge were 3.8 (2.26) and 1.98 (1.78) out of 10, respectively. Factors associated with an insufficient level of VKA therapy knowledge included low level of education, lack of access to therapy information and continuous access to this information. Conclusions Knowledge about VKA therapy among newly treated patients is insufficient. Patient’s medication knowledge should be improved to ensure better adherence.

made following the DDI alert. Thirty-one (84%) of the alerts flagged by clinical pharmacists did not trigger an electronic DDI alert. Conclusion and relevance The volume and pattern of flagged DDIs varied between the electronic and pharmacist alerts. Override rates were high but consistent with the reported literature. Findings suggest changes which could be made to reduce the volume of redundant or irrelevant alerting.

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