Gumarabic.my
Life Science Journal 2013;10(4) http://www.lifesciencesite.com Biological Study on the Beneficial Effects of Arabic Gum on Biological Parameters of Hyperglycemic AlbinoSafaa Moustapha Abd El Fatah Faid Home Economics Department, Faculty of Specific Education, Ain Shams University, Cairo, Egypt [email protected], [email protected] Abstract: The purpose of the present work was to study the beneficial effects of Arabic Gum used in the diet of
Alloxanized diabetic rats by single intraperitoneal injection of Alloxan at a dose 105 mg/kg b. wt on biological
parameters. Thirty Adult albino male rats were classified into 5 groups (each involved 6 rats) one of which is control
negative (-ve) group, another one was kept as control positive (+ve) and the remaining three rat groups were given
Arabic Gum with 5%,10% and 15% respectively. Feeding was continued for 6 weeks. The study showed that the
hyperglycemic group of rats fed with 5% had highly significant reducing serum glucose (68.17) compared to control
positive (+ve) group. The lowest percentage of Arab Gum seems to be effective in the treatment of diabetic rats in
improving BodyWeight Gain, Feed Intake, Feed Efficiency Ratio, Urea, Creatinine, Albumin and Total Protein
concentration The recorded improvement of these parameters was highly significant and significant with both 10%
&15% Arabic Gum. Arabic Gum corrected the changes in internal organs relative weight. The group of
hyperglycemic rats fed with 5% had highly significant in the mean values of serum electrolytes,(Na,K.Ca and Ph),
the recorded results were significant in 10% &15% Arabic Gum for these parameters. Sensory evaluation,
Farinograph and Extensograph properties of dough of toast bread samples prepared with replacement of wheat flour
by 5%, 10% and 15% Arabic Gum respectively showed that the flavor and general acceptability of 5%,10% of
Arabic Gum were higher than those of all Arabic Gum toast bread samples. In conclusion, Arabic Gum had
beneficial effects in improving the health status of hyperglycemic rats.
[Safaa Moustapha Abd El Fatah Faid. Biological Study on the Beneficial Effects of Arabic Gum on Biological
Parameters of Hyperglycemic Albino Rats. Life Sci J 2013;10(4):3570-3579]. (ISSN:1097-8135).
http://www.lifesciencesite.com. 475
Key words: Arabic Gum, hyperglycemic, diabeties, bakery product
1.Introdction
Eastern countries GA is widely used in the treatment Diabetes mellitus is a metabolic disease of patients with chronic kidney disease and end-stage characterized by hyperglycemia resulting from renal disease (Al Majed et al., 2002). GA was found
defects in insulin secretion, insulin action, or both. to increase fecal nitrogen excretion (Bliss et al.,
The type-1 diabetes is caused by absolute deficiency 1996) to decrease production of free oxygen radicals
of resistance to insulin action and an inadequate (Al Majed et al., 2002), and to modestly counteract
compensatory insulin-secretory response (Bunker,
nephrotoxicity in rats (Ali et al., 2003). In healthy
Arabic gum (AG) is a branched-chain, complex mice, GA treatment has been shown to increase polysaccharide, either neutral or slightly acidic, found creatinine clearance and renal ADH excretion as well as a mixed calcium, magnesium and potassium salt of as intestinal and renal excretion of Mg2+ and Ca2+ a polysaccharidic acid. GA has been shown to have (Nasir et al., 2008). It has also been shown to lower
an adverse effect on electrolyte balance and vitamin plasma concentration of 1,25(OH)2D3 as well as D in mice, and to cause hypersensitivity in humans. urinary Pi and Na+ excretion (Nasir et al., 2008). A
Diabetes mellitus (DM) is a chronic disease that major cause of end-stage renal disease is diabetic affected human kind throughout the world Recently, nephropathy (Schernthaner. 2008). The present
less precise records report that at random one of 5 to study thus explored the beneficial effects of Arabic 10 persons in Egypt is inflicted with DM. (Ahmed,
Gum on biological parameters of hyperglycemic 2007). Hyperglycemia can cause oxidative stress,
which, in turn, may result in cellular tissue damage. 2.Materials and Methods
The harmful influence of diabetes on metabolism of Materials:
tissues and organs is well known Likewise, Arabic Gum The dried exudates (gum) from uncontrolled hyperglycemia can lead to disturbances Acacia Sudan and related species (Acacia Seyal).
in the structure and function of organs (Gupta et al.,
Alloxan was a pure chemical fine (BDH), obtained 2004). Arabic gum (AG) is spontaneously develop
from Al Gomhorria company. insulin deficiency and thus hyperglycemia. In Middle Preparation of bread:
Life Science Journal 2013;10(4) http://www.lifesciencesite.com Control bread was prepared to the recipe of The organoleptic properties of fresh pan bread Food Technology Research Institute Agricultural produced by using 100% wheat flour (72% ext.) as Research Center, Giza, Egypt. Experiment bread was control sample and pan bread samples which prepared with replacement of 5, 10 and15% of kg prepared by partial replacement of wheat flour by flour by 5, 10 and15% grinded Arabic Gum. 5,10 and 15% of Arabic gum were evaluated to select Biological Experiment:
the best substitution level for high quality pan bread. Thirty adult male albino rats of Sprague Dawly The bread samples were evaluated by ten panelists strain, average weight 150±15gm were obtained from for their external and internal properties. Sensory Institute of Ophthalmology,Giza, Egypt.Rats were Evaluation was done in Food Technology Research housed in individual stainless steel aerated cages for Institute Agricultural Research Center, Giza, Egypt one week before starting the Experiment. This was A.O.A.C (1995) to detect Crust Color, Crust Quality,
carried out under hygienic laboratory conditions and Volume, Crumb Color, Crumb grain, Textual, Taste. fed basal diet for adaptation. Rats were then divided Aroma and total scores or General Acceptability. All into 5 groups as follows: characteristics were evaluated from 1- 10 degree (1 Group(1): Control negative (-ve); 6 rats fed on represents very poor and 10 represents very good) except, Textual, Taste were evaluated from 1- 20 Other 24 rats were injected subcutaneous with a degree (1 represents very poor and 20 represents very single dose of Alloxan (150 mg/kg body weight to good) and the total scores values were a reflection of induce hyperglycemia (Buko et al., 1996).
all the tested quality attributes and acceptability of Group (2): Control positive(+ve); 6 diabetic rats the studied pan bread. These values were calculated fed on the basal diet. from 100 as a sum of received sensory score. Group (3): 6 diabetic rats fed on the basal diet (Penfield and Camphell,1990). (Klein, 1984).
with replacement 5% Arabic Gum. The evaluated of each product was done at Group (4): 6 diabetic rats fed on the basal diet 11.30 am in laboratory of the Institute of food with replacement 10% Arabic Gum. Technology Research Giza Egypt. Application of the Group (5): 6 diabetic rats fed on the basal diet score sheet is attached in the appendix (Coultate,
with replacement 15% Arabic Gum. Basal diet consisted of protein 10% (as casein), Rheological properties of the dough:
corn oil 10%; mineral 4%, cellulose 5%, starch Rheological properties of the dough were 69,8%, choline chloride 0.2% and vitamin mixture assessed in Food Technology Research Institute 1%. Basal diet was prepared according to Cambell
Agricultural Research Center, Giza, Egypt, using (1963) minerals and vitamin mixture were added
Farinograph to determine: Water absorption(%), according to Hegested et al. (1941).
Arrival time (min), Dough development (min), Body weight (BW) and feed consumption (FC) Dough stability (min) and Degree softening(B.U). were calculated as reported by Chapman et al.
Extensograph properties of dough test was used to (1959). Feed efficiency ratio calculated as follow,
Extensibility(mm), (B.U.mm) and dough energy (cm) according to Internal organs were reported accurately dried from liquids and their weights calculated as Physical Experiment:
percentage ( %) of final weight. Physical Experiments were assessed in Food Biochemical analysis of serum:-
Technology Research Institute Agricultural Research At the end of the experimental period (6 weeks) Center, Giza, Egypt to determine weight, volume and rats were fasted overnight, anaesthetized, sacrificed Specific Volume according to A.O.A.C, (1995)
and blood serum collected. The blood was Statistical Analysis
centrifuged to obtain the serum which was stored at - Statistical Analysis of the obtained data was 18ºC till analysis (Asstoor and king, 1954)
performed by calculating the mean and standard Glucose was determined in the serum according error, while T-test was used to represent the to the colorimetric method by Wayne (1998).
quantities data (Snedecor, 1969).
Calcium was determined in the Serum according 3.Results :
to Baginski, (1973), phosphorus by Yee, (1968),
Table (1) The demonstrated The effect of
sodium and potassium by Riely, (1966).
feeding with Arabic Gum on Blood glucose (mg/dl), Urea, Creatinine, Total Albumin and Total which revealed 66.49% seems to be effective in the protein was analyses by Fawcett and Scott (1960).
diabetic groups compared to control negative (-ve) Sensory Evaluation
group. Arabic Gum (5%) was significantly (p < 0.05) decreased the mean value of serum glucose as Life Science Journal 2013;10(4) http://www.lifesciencesite.com compared to control groups. The lowest effect as effects in Urea, creatinine, Alb and T.P recorded for anti-diabetic recorded for Arabic Gum 10% and 15% the 5% of Arabic Gum compared to 10% and 15% of compared to the 5% of Arabic Gum. Glucose level in diabetic rats.The lowest percentage of Arabic Gum Table (6): Showed The results the effect of
(126.33± 4.23). substitution of strong wheat flour 72% extraction rate Table(2 ) showed the Body weight gain (BWG),
with 5,10 and 15% of Arabic Gum on Farinogram feed intake (FI) and feed efficiency ratio (FER) of parameters. It could be observed that the water hyperglycemic rats fed on Arabic Gum. The results absorption and the stability time was gradually recorded the body weight is significantly (p < 0.05) increased as the level of substitution with Arabic gum improved with controlling the diabetes through increased respectively in compared to control wheat Arabic Gum in its lowest percentage (5%) while in flour dough. while, both of arrival time and dough 10% and 15% of Arabic Gum the results recorded development time were not affected. On contrary, the decreased in BWG,FI and FER treatment as degrees of softening values were gradually decreased compared with diabetic control group. with increasing replacement levels by Arabic gum Table (3) showed the mean values of relative
internal organs weights of Diabetic rats fed on Arabic Table (7): presented the effect of Arabic gum
Gum. The results indicated that the mean values of on Extensograph properties of dough. From the internal organs weights (% of final body weight) of obtained data, it could be noticed that the elasticity of diabetic rats were affected by feeding on different wheat flour dough was in increased as result to percentage of Arabic Gum. The lowest percentage of increase substitution levels with Arabic gum, it was Arabic Gum is significantly (p < 0.05) highest 240,275 and 445 mm for wheat flour replaced by effective in decreasing the mean weight values of 5,10 and 15% of Arabic gum, respectively, in heart, liver and kidney, however, the mean weight compared with 140mm for wheat flour dough. Also, value of the spleens is not effectively deceased. both of proportional number and energy had the same Table (4): showed the effected the Arabic gum
trained with dough elasticity Fig (2). on the serum Electrolytes of Diabetic rat which feed Table (8): Represented the effective of the
on different of percentage of Arabic gum. The results partial replacement of wheat flour with 5,10 and 15% indicated that the mean values of serum Electrolytes of Arabic gum on the physical examinations. It could (Na,K,Ca,ph) of diabetic rats were affected by be observed that, the partial replacement with Arabic feeding on different percentage of Arabic Gum. The gum increased the weight of loaves and bread volume lowest percentage of Arabic Gum (5%) is gradually in parallel with increasing the level of significantly (p < 0.05) highest effective on the substitution. As expected, the values of specific volume recorded the similar trend as that of volume. Table (5) The demonstrated The effect of
Table(9): Showed that there were gradually
feeding with Arabic Gum on serum Analysis of liver improvement in all properties of produced pan bread and kidney function in diabetic rats.The lowest by increasing the level of substitution with Arabic percentage of Arabic Gum seems to be effective in gum until 10% than, all the above mentioned the diabetic groups compared to control negative (- properties of produced pan bread were decreased ve) group. Arabic Gum (5%) was significantly to when, used 15% of Arabic gum. control groups. The highly significantly (p < 0.05) Table(1):The effect of feeding with Arabic Gum on Blood glucose level in diabetic rats (mg/dl).
Control negative (-ve) Control positive (+ve) Arabic Gum (10%) Arabic Gum (15%) % of diabetic control % of normal control Normal value of glucose = (74 – 109) Table (2): Body weight gain (BWG), feed intake (FI) and feed efficiency ratio (FER) of hyperglycemic rats fed on
Arabic Gum.
Control negative Control positive Life Science Journal 2013;10(4) http://www.lifesciencesite.com Table (3) Mean values of relative internal organs weights of Diabetic rats fed on Arabic Gum.
Table(4) Mean values of serum Electrolytes of Diabetic rats fed on Arabic Gum.
Table (5): Mean values of serum Analysis of kidney of Diabetic rats fed on Arabic Gum.
Table (6): Effect of different percentage of Arabic gum on Farinograph properties of dough in comparison to
Arabic Gum (10%) Arabic Gum (15%) Water absorption (%) Arrival time (min) Dough development (min) Dough stability (min) Degree softening (B.U) Table (7): Effect of different percentage of Arabic gum on Extensograph properties of dough in comparison to
Arabic Gum (10%) Arabic Gum (15%) Elasticity (B.U) Extensibility(mm) properties Number Table (8): The physical examinations results of toast bread fortified by Arabic gum in comparison to control.
Arabic Gum (15%) Loaf volume (cm3) Specific volume (cm3/g)
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Table (9): The sensory evaluation results of toast bread fortified by Arabic gum in comparison to control.
Crust Color (10)
Crust Quality (10)
Crumb Color (10)
Crumb grain (10)
Total scores (100)
Control (1)
Fig.(1) Effect different percentage of Arabic gum on farinograph properties of dough in comparison to control.
Replacement 5%
• Replacement 10 %
• Replacement 15%
Control (1)
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Fig.(2) Effect different percentage of Arabic gum on exiensograph properties of dough in comparison to control.
• Replacement 5%
• Replacement 10 %
• Replacement 15%
included greater enhancement of weight gain, food
Wadood et al.(1989) concluded, albeit without
and fluid intake, and a lower fecal output in rats
experimental evidence, that Arabica initiated the
whose ORS contained GA. This increase was evident
release of insulin from pancreatic beta cells of normal
after 4 h of recovery and persisted for 24 h. The
rabbits. Previously, experiments were carried out in
authors ascribed the weight gain to the increased fluid
vitro and in normal human subjects to evaluate
intake and solid food consumption. However, no
alternative food-grade viscous polysaccharides as
ready explanation for the persistent increased solid
agents for reducing postprandial hyperglycemia and
food intake was offered. The relative decrease of
to assess the relationship between the in vitro and in
fecal output noted was ascribed to the increased fluid
vivo performance of the polysaccharides
absorption – a feature that was also observed with
(Edwards et al., 1987). Mixtures of different
GA in acute jejunal perfusion studies. The previous
types of gum have been shown to inhibit glucose
data suggest that GA is equally effective when
movement in vitro, and lower postprandial blood
consumed orally as when directly introduced post-
glucose and plasma insulin in human subjects when
stomach, as in intestinal perfusion studies (Rehman
incorporated in a drink containing 50 g glucose
et al., 2000, 2001, 2003; Wingertzahn et al., 2001).
(Edwards et al., 1987; Torsdottir et al., 1989).
In this study the mean values of internal organs
Infusion of meals containing starch showed that a
weight is effective in decreasing the mean weight
decrease in the digestion rate of starch in the upper
values of the heart, liver and kidney, however, the
small intestine accounted for part of the effect of
mean weight value of spleens is not effectively
viscosity on glycemic response, whereas the main
decreased. fatty change (fatty degeneration) that
effect of gum was apparently to slow gastric
means abnormal intra cellular accumulation of fats
emptying (Leclère et al., 1994). the results of our
(free fatty acids or triglycerides and chylomicron) in
study showed that Arabic gum significantly treatment
the following organs particularly the liver, heart and
of diabetic rats increases gliclazide bioavailability
kidney that are named as parenchymatous organs.
and lowers blood glucose levels probably through the
Decreasing the weight of the parenchymatous organs
activation of B-cell function of Islet of Langerhans of
pancreas or increase the formation of B-cell
accumulation,redistribution of fatty subcutaneous fat
(proliferation cells) or it may be antagonists the
occurs in uncontrolled diabetes. (Mochida et al.,
blockage immune of receptors of B-cell of islets of
Phosphate and uric acid concentrations were
Also, the results of our study showed that the
reported to be significantly reduced by GA, while the
body weight is improved with controlling the
treatment significantly increased that of serum
diabetes through treatment compared to control
calcium. It was concluded that GA could alleviate
groups. These results were agreement with (Wapnir
‘‘adverse effects of CRF". The small intestine is the
et al., 1996, 1997) who showed that drinking the GA-
major site of electrolytes and organic non-electrolytes
supplemented ORS ad libitum showed accelerated
absorption in the gastrointestinal tract (GIT) (Wapnir
recovery in comparison to those receiving either
and Teichberg, 2002). It has been shown that GA
water or ORS without gum. Recovery parameters
improves small intestinal absorption of sodium in
Life Science Journal 2013;10(4)
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normal rats (Codipilly and Wapnir, 2004) and of
metabolites in the sera of patients with CRF on a low-
sodium and water in two animal models of diarrheal
protein diet (Ali et al., 2008). Short chain fatty acids
disease (Wapnir et al., 1997). In normal male
have considerable effects on intestinal and liver
juvenile rats, addition of 5 and 10 g/L of GA
metabolism as either fuels or metabolic effectors.
increased the rates of sodium removal from the
Propionate produced by bacterial fermentation from
intestinal lumen perfused with oral rehydration
GA is the major SCFA metabolized by the liver
solutions (ORS) containing either 60 mM or 90 mM
(Moundras
et
gluconeogenic substrate. It is utilized at a faster rate
bidirectional fluid movement in these Addition of GA
than amino acids, thus reducing amino acids
to the jejunal ORS-perfusate resulted in roughly a
deamination and luminal ammonia generation.
twofold increase in absorption of sodium, potassium
Bacterial growth within the large intestinal lumen
and water in the chronic osmotic- secretory diarrheal
requires a nitrogen source (Younes et al., 1995) and
model, and neutralized theophylline induced abolition
GA fermentation provides the energy for bacteria to
of net sodium and potassium absorption, in addition
uptake ammonia as a nitrogen source. In addition,
to reversing water and glucose mal absorption
propionate is also known to reduce ureogenesis from
(Wapnir et al., 1997) The results of our study
ammonium chloride in hepatocytes (Wyatt et al.,
confirmed which the mean values of serum
1986; Kishimoto et al., 2006). The decrease in
Electrolytes (Na,K,Ca,ph) of diabetic rats were
luminal ammonia concentration may enhance
affected by feeding on different percentage of Arabic
diffusion of urea down its concentration gradient
Gum. The positive effects of the GA on fluids and
from the blood into the lumen. As such, nitrogen is
electrolyte absorption observed in jejunal perfusion
trapped for elimination in the faeces.(Fujiwara et al.,
studies were also reported in rats recovering from
chronic osmotic diarrhea induced by cathartic agents
Also, the results of our study showed the effect
(Teichberg et al., 1999a,b).
of Arabic gum on dough properties by Farinogram
It could be observed from results of the effect of
parameters, Extensograph properties and physical
feeding with Arabic Gum on serum Analysis of liver
examinations. presented Arabic gum has been an
and kidney function in diabetic rats, effects in Urea,
effective in improver dough properties such as
creatinine, Alb and T.P, which the most valuable
decreasing crumb hardness, increasing specific
serological tests to identify the real liver function are
volume and dough stability and these results
total protein and total albumin measurements. That
agreement with McCarthy et al., 2005). Which
are more specific for liver when the proteins
showed Gluten may be to some extent replaced by
including albumin are decreased, this means impaired
natural or synthetic raw materials, which can
liver function. These results were in agreement with
significantly swell in water and form structural
Nasir (2007) who showed one of the unexplained
equivalent of gluten network in wheat dough. The
findings that GA treatment was associated with an
most commonly used are such hydrocolloids as
increased 24 h-creatinine clearance in healthy mice.
pectin, guar gum, Arabic gum, egg albumin,
The exact mechanism for this remains unclear, since
galactomannans and methylcellulose. Hydrocolloids
it represents a remote effect of GA on the kidney,
and their mixtures impact rheology of the dough as
which requires one or more humoral factors. It is well
well as its baking properties and the final bread
known that GA is fermented by intestinal bacteria
texture. Technical difficulties during gluten-free
leading to formation of various degradation products,
bread production (as well as gluten-free pasta).
such as short-chain fatty acids (Bliss et al., 1996). In
Arabic gum has been used as a gluten substitute in
a recent study, serum butyrate concentrations were
the formation of gluten – free breads (Toufeili et al.,
increased following treatment with GA in healthy
1994). Arabic gum has also been an effective
subjects (Matsumoto et al., 2006) and this may have
improver, decreasing crumb hardness and increasing
a role in the claimed salutatory effect on creatinine
specific volume of the bread obtained from frozen
clearance and GFR. In contrast, in an experimental
doughs (Asghar et al., 2006; Ali et al., 2005). Arabic
model of chronic renal failure CRF (rat kidney
gum does not affect hydration properties of the
remnant model), Ali et al. (2004) showed that
gluten. Arabic gum has a branched but compact
treatment of rats with GA at doses of 3 or 6 g/100 mL
structure that could inhibit possible interaction
in the drinking water for five consecutive weeks was
between its polar groups with the peptide chains of
not effective in either reversing the decrease in body
the gluten. Arabic gum act primarily on the
weight or the increases in creatinine and urea
viscometric properties of starch (Ali et al., 2005).
observed 2 weeks after the surgical induction of the
The results in table organoleptic properties of
CRF. Recently, a report from Sudan assessed the
pan bread showed their gradually improvement in all
effect of GA on the concentration of certain
properties (crust color, crust quality, bread volume,
Life Science Journal 2013;10(4)
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crumb color, crumb grain, texture, taste and aroma).
Cellulose and Gum Arabic on the Stability of
The results confirmed with Guarda et al., 2004). The
Frozen Dough for Bakery Products. Institute of
effects of hydrocolloids on the functional properties
Food Science and Technology University of
of wheat bread have been investigated; in such
Agriculture, Faisalabad, PAKISTAN.237-239
products gums improve dough stability, bread
Ali, B.H.( 2004): Does G.A. have an antioxidant
performance and bread shelf. Exclusion of gluten
action in rat kidney? Ren. Fail. 26, 1–3.
from the diet is a formidable task for dietitians, as
Ali, BH, Al Qarawi AA, Haroun EM, Mousa
wheat flour is present in a wide range of products
HM.( 2003): The effect of treatment with gum
including bread, biscuits, cakes, and pastas. The
arabic on gentamicin nephrotoxicity in rats: a
situation is particularly irksome in the case of bread,
preliminary study. Ren Fail;25:15–20.
as flat bread consumption constitutes the cornerstone
Al-Majed, A.A., Abd-Allah, A.R., Al-Rikabi,
of dietary patterns for these populations. Gluten-free
A.C., Al-Shabanah, O.A., Mostafa, A.M.(2003):
breads require polymeric substances that mimic the
Effect of oral administration of Arabic gum on
viscoelastic properties of gluten in bread doughs. To
cisplatin-induced
this end, gluten-free pan breads have been
10. nephrotoxicity in rats. J. Biochem. Mol.
successfully formulated by incorporating gums. At
Toxicol. 17, 146–153.
the lowest level of gum Arabic, gluten-free
11. Al Majed AA, Mostafa AM, Al Rikabi AC, Al
formulations met the reference criterion for Tearing1
Shabanah OA.(2002): Protective effects of oral
over a wide range of methylcellulose (Smith 1971).
arabic gum administration on gentamicin-
induced nephrotoxicity in rats. Pharmacol
Conclusions
Res;46:445–451.
GA is a non-digestible food ingredient that has
12. Asatoor,A.M. and King,E.J (1954):Simplified
calorimetric blood sugar method. Biochem.
pharmaceutical industries. The gums claimed
therapeutic usefulness in hepatic and renal failure
13. Asghar, A., Anjum, F. M., Butt, M. S., Hussain,
awaits further verification in animal models and
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dough bread by the use of different hydrophilic
International
Engineering, 2: 1–11. ISSN 1556-3758
14. Baginski, E. S.(1973): Method of calcium
pharmacological properties of GA can be utilized in
determination. Clin.Chem.Acta.:46:49.
15. Bliss DZ, Stein TP, Schleifer CR, Settle
RG.(1996): Supplementation with gum arabic
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Investigation report
Scottish Parliament Region: North East Scotland Case 201002867: Tayside NHS Board Summary of Investigation Health: Hospital; Care of the elderly The complainant (Mrs C) raised a number of concerns about the prescription of antipsychotic drugs to her aunt (Miss A) during her admission to hospital in September 2009 and that the prescribing chain of command of the drugs was
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LEY N° 2902 LEY DE 29 DE OCTUBRE DE 2004 CARLOS D. MESA GISBERT PRESIDENTE CONSTITUCIONAL DE LA REPUBLICA Por cuanto, el Honorable Congreso Nacional, ha sancionado la siguiente Ley: EL HONORABLE CONGRESO NACIONAL, DECRETA: AERONÁUTICA CIVIL DE LA REPUBLICA DE BOLIVIA