Pakistan Journal of Pharmaceutical Sciences

Abstract: Background: Painless bronchoscopy has become a common clinical procedure. Propofol, as a mainstream sedative, has problems such as respiratory and circulatory depression and injection pain. Propofol is a widely used sedative, is associated with adverse effects such as respiratory and circulatory depression and injection pain. Cyclopofol is a novel intravenous anesthetic developed in China that is associated with higher potency and a wider safety window, but controlled studies on its combination with opioids are still insufficient. Objectives: To compare the anesthetic efficacy, hemodynamic stability, respiratory effects and safety of cyclopofol combined with low-dose sufentanil versus propofol combined with low-dose sufentanil in painless bronchoscopy. Methods: 100 outpatients of American Society of Anesthesiologists (ASA) physical status class I or II were randomly assigned into group A (cyclopofol 0.4 mg/kg + sufentanil 0.1 μg/kg) and group B (propofol 1.5 mg/kg + sufentanil 0.1 μg/kg), with 50 patients in each group. Vital signs were monitored at predefined time points and the anesthesia duration, drug dosage, and adverse reactions were recorded. Results: Group A received a significantly lower total sedative dose, had a shorter onset time, faster recovery, and a higher Steward recovery score; the incidence of hypoxemia, injection pain, coughing and total adverse reactions was lower in Group A than in Group B and heart rate, blood pressure, and oxygen saturation showed smaller changes after induction and during glottic insertion. Conclusion: Cyclopofol combined with low-dose sufentanil was associated with a lower sedative dose, faster recovery, better recovery scores, and fewer adverse reactions than propofol combined with low-dose sufentanil. In addition, the proportion of patients rated as having excellent anesthesia was higher, according to the predefined assessment scale. Statistically significant differences were observed in most indicators, suggesting that cyclopofol may be a promising alternative for outpatient painless bronchoscopy.

Abstract: Background: Hepatic ischemia–reperfusion injury (HIRI) is primarily mediated by oxidative stress and inflammatory activation, yet effective pharmacological interventions remain limited. Objectives: This study aimed to elucidate the key active ingredients, hub targets and molecular pathways through which Wuwei Shaji Powder may exert anti-inflammatory effects in HIRI using integrated network pharmacology and experimental validation. Methods: Active components of WSP and their predicted targets were obtained from TCMSP and HERB, while HIRI-related genes were obtained from GeneCards, OMIM and analysis of differential expression for the GEO dataset GSE228782. Differentially expressed genes were identified using the thresholds of |log2FC| ≥ 1 and adjusted P-value, also known as false discovery rate (FDR), < 0.05. Common targets underwent GO and KEGG enrichment, PPI network construction and molecular docking. Subsequently, functional verification was performed using a hypoxia/reoxygenation (H/R) model in AML12 cells treated with low- or high-dose WSP. Cell viability, inflammatory cytokines, ROS levels and protein expression of TLR4, AKT1, p-AKT (Ser473) and p-NF-κB were evaluated. Results: Network analysis highlighted inflammation- and immunity-related pathways, with AKT1, TNF, JUN, STAT3 and TP53 characterized as potential core regulatory targets. Docking results indicated favorable binding between selected WSP components and AKT1. Experimental data demonstrated that WSP significantly restored cell viability (P < 0.001), reduced IL-6, TNF-α and IL-1β secretion (all P < 0.001), attenuated ROS accumulation (P < 0.001) and suppressed activation of the TLR4–AKT1–NF-κB axis, as indicated by reduced protein levels of TLR4, p-AKT (Ser473) and p-NF-κB (all P < 0.001). Conclusion: WSP mitigates HIRI-induced inflammatory injury mainly by suppressing TLR4-mediated activation of the AKT1/NF-κB signaling cascade, thereby attenuating ROS accumulation and pro-inflammatory cytokine secretion (IL-6, TNF-α and IL-1β). The data furnish mechanistic evidence for its therapeutic potential against ischemia–reperfusion–triggered hepatic inflammation.

Abstract: Background: viral fever is a common acute infectious disease among infants and young children. Oseltamivir, a first-line antiviral drug, has limitations in inflammation regulation. In contrast, Evodia Rutaecarpa (E. Rutaecarpa) has been proven to exert antipyretic effects in traditional Chinese medicine. Objectives: This study, for the first time, systematically evaluated the efficacy of topical E. Rutaecarpa acupoint preparation plus Oseltamivir in treating viral fever in infants and young children. Methods: In this retrospective analysis, we included 60 pediatric cases between the ages of 6 months and 3 years and assigned them 1:1 according to propensity score matching (PSM): a combined group (topical E. Rutaecarpa acupoint application + oral Oseltamivir) and a control group (oral Oseltamivir alone). The treatment course lasted for 5 days. The main outcome measure was antipyretic time and the secondary outcome measures included changes in body temperature at different time points, serum inflammatory factors (tumor necrosis factor-α [TNF-α] and interleukin-6 [IL-6], interleukin-1β [IL-1β], high-sensitivity C-reactive protein [hs-CRP]) levels, treatment comfort score (TCS), sleep quality index (SQI), adverse reactions and parents' satisfaction. Results: The antipyretic time was found to be shorter in the combined group than in the control group. Besides, the combined therapy led to markedly milder body temperature fluctuations at 24 hours and 48 hours, as well as greater decreases in serum inflammatory markers (tumor necrosis factor-α [TNF-α] and interleukin-6 [IL-6]), compared to Oseltamivir monotherapy. Additionally, improved TCS and PSQI scores were found in pediatric patients receiving E. Rutaecarpa + Oseltamivir, together with superior parental satisfaction (P<0.01). The two groups showed no notable difference in the incidence of adverse reactions, with no added burden on liver and kidney functions with the combination therapy. Conclusion: Topical E. Rutaecarpa preparation exerts a three-dimensional effect of "acupoint stimulation‒transdermal drug delivery‒systemic anti-inflammation", synergizing with oral Oseltamivir. This combined therapy demonstrates greater advantages in rapidly reducing fever, regulating inflammation and improving patient comfort.

Abstract: Background: Patients’ self-perceived awareness of drug–drug interactions (DDIs) and drug–food interactions (DFIs) is important for medication safety, yet interaction-related counseling remains limited. Objectives: To assess patients’ self-perceived awareness of DDIs/DFIs and identify sociodemographic correlates of insufficient awareness in tertiary outpatient pharmacies of southern Saudi Arabia. Methods: A cross-sectional survey was conducted at two tertiary hospitals over six months. Adults ≥18 years attending outpatient pharmacies were recruited via consecutive sampling. A structured, self-administered questionnaire, refined by expert review, collected data on demographics, awareness, attitudes and behaviors. Insufficient self-perceived awareness was defined a priori as a moderate, weak, or very weak rating on a five-point Likert scale. Internal consistency was assessed via Cronbach’s alpha. Associations were examined using χ² with Cramer’s V and multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Of 401 patients approached, 353 consented; after excluding 12 records aged <18 years, 341 participants (52.8% female) formed the analytic sample. Overall, 22.3% (95% CI 18.2–27.0) reported insufficient awareness. Counseling on DDIs (7.6%) and DFIs (6.2%) was uncommon; DDIs (54.0%) and DFIs (51.3%) were the most frequent unclear topics. A two-item attitudinal subscale showed acceptable internal consistency (α = 0.75). After adjustment, only older age remained an independent predictor (aOR ≥51 vs 18–40 = 8.33, 95% CI 3.10–22.40), while education was not (aOR 1.11, 0.57–2.16). Conclusion: Insufficient self-perceived awareness of DDIs/DFIs was substantial. Older age, rather than education, was the only independent correlate, suggesting the unadjusted education association may be age-confounded. Targeted, age-sensitive pharmacist-led counseling may improve medication safety. Findings are exploratory given reliance on a self-perceived measure.

Abstract: Background: Oral heat-clearing and detoxifying Chinese patent medicines (CPMs) are frequently added to conventional therapy for pediatric acute upper respiratory tract infection (AURTI), but comparative evidence among products is sparse. Objectives: To compare adjunctive oral CPMs, prioritizing time to fever resolution and to assess total effective rate, cough resolution and adverse events. Methods: Eight databases and grey-literature sources were searched from inception to 31 May 2026. Eighteen studies were synthesized qualitatively; ten studies contributed to quantitative analyses. Two loop-enabling trials were added: One head-to-head comparison of Xiaoer Chiqiao Qingre Granules (CQ) with Lianhua Qingwen Granules (LHQW) and one LHQW-plus-conventional-therapy comparison. Loop-specific direct-versus-indirect inconsistency was assessed. Results: The CT-CQ-LHQW triangle formed one closed loop. No statistically detectable inconsistency was found for total effective rate (inconsistency factor 1.06, 95% CI 0.86-1.31; P=0.583) or adverse events (0.13, 95% CI 0.003-5.27; P=0.283), although the safety interval was very wide. The consistency-model RRs versus conventional therapy were 1.24 (95% CI 1.12-1.38) for LHQW and 1.18 (95% CI 1.07-1.32) for CQ. Pairwise analyses favored adjunctive CPMs for fever and cough resolution, with substantial heterogeneity. Conclusion: A real closed loop permits a limited consistency check, but certainty remains very low because only one loop was available, safety events were sparse and clinical and outcome definitions varied. Product rankings remain exploratory. Registration: The review was not prospectively registered. Funding: None.