During our extensive surveillance of opiates in urine specimens of opium users, we noticed the appearance of an unknown peak (compound X) in total ion chromatograms obtained by gas chromatography-mass spectrometry (GC-MS) after enzymatic hydrolysis and trimethylsilyl (TMS) derivatization. We identified the compound X as oripavine. Oripavine was found to be a new and useful putative marker of opium/poppy seed use in differentiation from heroin, pharmaceutical codeine, and pharmaceutical morphine use. The presence of oripavine in the urine of opium users is probably the result of O-demethylation of the opium alkaloid thebaine. Analytical method optimization for GC-MS detection of oripavine in urine was also undertaken. Underivatized oripavine could not be detected by GC-MS, and trials for derivatization of oripavine with acetic anhydride and propionic anhydride were unsuccessful. Trials were successful with bis(trimethylsilyl)trifluoroacetamide/trimethylchlorosilane. It was also disclosed that almost all amounts of oripavine in human urine existed in the unconjugated form; it was absolutely necessary to hydrolyze the conjugate before TMS derivatization of oripavine for its GC-MS analysis.Keywords Oripavine Á Marker of opiate product use Á Opium Á Poppy seed Á Thebaine metabolism Á GC-MS

The present study aims to assess the level of knowledge of DM among non diabetic people from Ajman and Ras Al Khaimah (UAE) regard to causes, complication, clinical manifestation, management, treatment, drug adherence and control, hypoglycemia associated with diabetic therapy, hypoglycemia management and other aspects related to diabetes. A cross-sectional study was conducted among non diabetic people who were attending GMCH (Gulf Medical College Hospital) community pharmacy in Ajman and RAK hospitals during the period between July and December 2009. A self-administered questionnaire was used as a tool for data collection. The percentage of participants aware of diabetes causes, symptoms, complications, management, drug treatment, drug therapy adherence and diabetes monitoring were 60.4%, 78.7%, 54.8%, 68.9%, 89.8%, 50.6%, and 76.6% respectively. Awareness of hypoglycemic symptoms which can complicate diabetes therapy was only low 23.8%. For the management of hypoglycemia 45.1% of the participants recommended the use of sugar, 23% of them suggested the use of oral medicine and 32% of the participants recommended the use of insulin. The proportions of participants who had correct knowledge of the recommended frequency of follow-up of eye exam, urine test, blood sugar measurement and blood pressure test in diabetic patients were 33.6%, 39.6%, 87.2% and 23.8 respectively. The study showed low awareness of the population about various aspects of diabetes and the least knowledge was noticed on hypoglycemic symptoms, hypoglycemia management and diabetes complications. We recommend education program to improve population knowledge regards diabetes which can create enthusiasm to improve diabetes care and can go a long way in the prevention and management of diabetes in the Gulf region and UAE in particular.

Drug-Drug Interactions (DDIs) are the main problem among patients treated with multidrug therapy. Cardiovascular Diseases (CVD) consider the main cause of all morbidities and mortalities in universal. The major cause of CVDs death is hypertension. Clinical trials have reported that the treatment of hypertension minimizes CVD cases and all reason of mortality. Hypertensive patients are especially suspectable to DDIs due to their age, polypharmacy, comorbid conditions, long hospital stay and the presence of a drug therapy for other comorbid conditions that arise as a complication of long‑term hypertension. This article reviews different case studies evaluating DDIs in hypertensive elderly patients with polypharmacy. The most generally prescribed drug group that observed mostly in all case studies are: antihypertensives, Non-Steroidal Anti-Inflammatory Drug (NSAIDs), antidiabetics, antibiotics, antihistaminic, cardiac glycosides, calcium supplements, antimicrobial, Central Nervous System (CNS) depressant, thiazide diuretics, Lipid lowering drug, antigout, anticoagulants, analgesics, antibacterial and antianxiety. DDIs checker tool used in different case studies are REAX-Micromedex, Beers Criteria, Lexi-Interact software and Medscape checker software. The common interacting drug pairs among the antihypertensive drugs were atenolol-amlodipine, furosemide-telmisartan, furosemide-enalapril, furosemide-atenolol and metoprolol-amlodipine. Both pharmacokinetics and pharmacodynamics type of DDIs were found in most cases but with different rates. The severity of DDIs was mainly significant and moderate. The prevalence of DDIs was differ from case to case depend on drug pair used and clinical disorder in each case. The majority of DDIs can be addressed through the dosage adjustment and lab monitoring of patient. This is particularly significant in the case of accompanying medication with various groups of antihypertensive drugs.