Evaluation of orthosiphon stamineus aqueous extract for in vitro antimycobacterial activity and its interaction with isoniazid

In addition to a number of traditional medicinal uses, recently the consumption of leaves of Orthosiphon stamineus infusion (Misai kuching Tea and Java Tea) has gained popularity in many countries such as Malaysia, Indonesia and Thailand. The plant is known to have antioxidant activities and some constituents possessing antimycobacterial activity, hence may have interaction with isoniazid (INH), an anti-TB drug acting through free radicals. Therefore, the present study aims to investigate a standardized aqueous extract of the plant and some of its fractions for antimycobacterial activity and to evaluate potential interaction with INH. Using HPLC, total contents of betulinic, oleanolic and ursolic acids in the extract, hexane (HF), chloroform (CF) and ethyl acetate fractions (EA) were found to be 0.016, 0.62, 0.183 and 0.00 mg/g, respectively. In antimycobacterial assays, the minimum inhibitory concentrations (MICs) of the extract, HF, CF and INH were found to be 25.00, 3.12, 6.25 and 0.39 μg/mL, respectively. The combinations of the extract as well as the fractions with INH -in various proportions- exhibited fractional inhibitory concentration index (FICI) > 0.5 and ≤ 4, which indicated no statistically significant interaction. The results of the present study indicate that aqueous extracts of the plant have no significant interaction with INH.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Impact of duration of therapy on side effect profile of anti-HCV protocol: A retrospective cohort study from two tertiary health facilities in Pakistan

Purpose: To evaluate the plausible risks and adverse effects related to the duration of therapy in hepatitis C (HCV) patients in Lahore, Pakistan.Method: A retrospective observational study involving 250 HCV patients who received combination therapy with ribavirin and interferon was conducted. The patients were segregated into two groups on the basis of duration of therapy (≤ 6 months and > 6 months). Adverse effect profiles of patients under treatment were collected using a pre-validated questionnaire and compared using Pearson’s Chi- Square Test/Chi-Square Goodness-of-Fit tests and unpaired t-test.Results: Patients who underwent treatment for ≤ 6 months frequently encountered side-effects such as GIT disturbance (23.77 %) and joint pains (29.63 %). Additionally, diabetes mellitus (27.86 %) and frequent injections (74.59 %) were the most commonly observed co-morbid condition and disease risk, respectively. On the other hand, in patients who underwent therapy for > 6 months, skin disorders (30.46 %) and gastric acidity (10.15 %) were the most frequently observed side-effects with less frequent reporting on co-morbid conditions and disease risk factors. Moreover, there was a significant reduction in body weight (p = 0.03), serum bilirubin (p = 0.0005), albumin (p = 0.003) and triglycerides (p = 0.006) levels due to longer duration of treatment.Conclusion: The data suggest that treatment-related risks are higher among HCV patients on shorter treatment duration whereas adverse events subside in patients on longer duration of therapy (>6 months). Changes in biochemical profile were also more evident in those receiving treatment for periods >6 months.Keywords: Interferon, Ribavirin, Side effects, Duration of therapy, Outcomes of therap

Extended Health Services of Pharmacists: Role in COVID-19 Management

COVID-19 is creating a chaotic scenario all over the world. Due to the unavailability of approved therapy, the number of affected cases is escalating day by day. Different components of the healthcare system have been consistently working in different settings for its containment. Pharmacists are one of the healthcare experts, who are working on the front-line. In this review, we aimed to evaluate the activities of pharmacists as a healthcare professional in disasters such as; COVID-19 management. The focus on services offered by pharmacists has shifted from traditional dispensing and compounding to patient-specific over a period contributing to the quality use of medicine and primary care. Pharmacists are thus, considered essentially one of the main pillars of the healthcare team for the provision of extended health services (EHS), for instance, the effective management of COVID-19. They are working from community to clinical setting. Practicing tele-pharmacy health services, they can reach out to remote places as well. Utilizing their expertise on clinical as well as managerial aspects, they have proved to be dynamic professionals in such a global health crises. Adequate training, inclusion of disaster management in the curriculum of pharmacy, support from the legislative body, and inter- as well as intra-professional collaboration are the key factors for professional development and recognition

Assessment of medication prescription errors and their contributory factors in major cities of Punjab Province, Pakistan: A cross-sectional survey

Purpose: To evaluate the prescription errors and their contributory factors in Punjab, Pakistan.Methods: An observational, cross-sectional study was conducted in 12 major cities of Punjab, Pakistan. A total of 1,184 prescriptions were collected from patients using a convenient sampling method from homes, pharmacies, clinics, and hospitals. The data were presented in frequency and percentage using descriptive statistics. To determine the association between the variables assessed, Chi-square (X2) test was used.Results: A total of 1,184 prescriptions were analyzed; 432 of them (36.5 %) were from prescribers who are graduate degree holders, and 752 (63.5 %) from prescribers who are post-graduate degree holders. The most commonly missing parameters in the prescriptions were the age of the patients (835 representing 29.4 %), signatures of the prescribers (755 representing 26.5 %), and prefix (622 representing 21.9 %). The number of prescription errors was significantly correlated to prescriber qualification (p = 0.001). The prescription errors were more common in age groups of prescribers: 21 - 30 years (654 representing 23.0 %), and 31 - 40 years (1,012 representing 35.6 %) (p = 0.001). The higher number of prescription errors by post-graduate prescribers working in teaching hospitals can be attributed to the higher patient load and lack of continuing medical education programs for the prescribers.Conclusion: The government should take necessary measures for the implementation of electronic prescribing systems, and devise mechanisms for the uniform distribution of patient load amongst the prescribers working in different hospitals. Keywords: Prescription error, Prescribers, Patient load, Continuing medical education, Electronic prescribin

Evaluation of seeds of phoenix sylvestris as novel candidate adsorbent in paracetamol poisoning

The adsorption of certain metal ions and dyes on powdered seeds (pits) of Phoenix sylvestris (Arecaceae) suggests the investigation of such material for the adsorption of oral poisoning substances from the gastrointestinal tract. Therefore, the present study was undertaken to prepare different types of adsorbents from date pits and explore their adsorption capacity for paracetamol at two physiological conditions, enzyme free simulated gastric and intestinal fluids. The activated charcoal was used as a control. The equilibrium contact time, determined by combining the three forms of date pits and activated charcoal separately with paracetamol in a ratio of 15:1 w/w in both the fluids, was found to be 60 min. The adsorption of all the adsorbents for paracetamol was investigated by increasing the amount of adsorbents while keeping the amount of adsorbate fix, and the data obtained was found to be fit in the Langmuir isotherm. The bonding constants of all the adsorbents were significantly different in SGF (p < 0.05), whereas not significantly different in SIF. The adsorption capacities of all the adsorbents were not significantly different in SGF, whereas, significantly different in SIF (p < 0.05). The results of this study indicate that date pits may be used to prepare activated carbon that may serve as an economical adsorbent for the management of paracetamol oral poisoning cases.Colegio de Farmacéuticos de la Provincia de Buenos Aire

A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan

Background In recent decades, community pharmacies reported a change of business model, whereby a shift from traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations. Within this context, the present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan. Methods A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. Although majority of our study respondents were unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary structures were reported as barriers towards the provision of EPS at the practice settings. Conclusion Although the study reported poor awareness towards EPS, the findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward practice change provided to the support and facilitation of health and community based agencies in Pakistan

A national study to assess pharmacists' preparedness against COVID-19 during its rapid rise period in Pakistan.

To evaluate the pharmacist's preparedness against the COVID-19 during its rapid rise period in Pakistan, an online cross-sectional study was carried out from March 30 to May 22, 2020 among the pharmacists using a pre-validated self-administered questionnaire. A total of 1149 participants completed the survey, amongst which 430(37.9%) were working as retail pharmacists, 216 (18.8%) as community pharmacists, and 213(18.5%) as hospital pharmacists. The mean COVID-19 knowledge score of the participants was 6.77±0.5, which indicated that 84% of them had good knowledge about COVID-19. The multiple linear regression model revealed that attitude was significantly associated with gender (p = 0.001), marital status (p<0.0001) and resident (p = 0.013). The mean practice score was 2.85±0.4, showing that 94% of the participants were following adequate preventive practices against this infection. The results from this study suggest that Pharmacists demonstrated good knowledge, positive attitudes, and acceptable practices regarding COVID-19

Qualitative exploration of perspectives of the pharmacists working in public-sector hospitals during COVID-19 pandemic

Abstract Background The COVID-19 pandemic, a serious global health threat, has excruciating social and economic implications given its transmissibility, lack of therapy, and severity. In such a situation, pharmacists as frontline healthcare professionals hold a significant position to tackle. This study was designed to explore the perception and preparedness of pharmacists working in public sector hospitals amid such a pandemic in Pakistan. Methods A total of 11 pharmacists were interviewed for this qualitative study design through a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Results The thematic content analysis yielded six major themes; understanding of COVID-19, perceptions towards COVID-19, preventive aspects, management aspects, changes to lifestyle, and psychological aspects. Though efficient preparedness and approach to fighting against such pandemics were reported, pharmacists were found susceptible to infection and psychological stress. They also expressed lockdown as an effective measure to prevent the disease from spreading but still were concerned about its economic and social impact. Conclusions Adequate planning and facilities from the national level should be made available for strengthening the hospital pharmacy service that helps improve the overall healthcare system of low- and middle-income countries like Pakistan. The provision of a protective facility, incentives, and occupational health surveillance packages are deemed necessary to boost the self-esteem and morale of hospital pharmacists that safeguard the early and effective management of such disasters

Parents’ behaviour toward antibiotic self-medication in children and incidence of resistance: a cross-sectional study from Punjab, Pakistan

Background. Antibiotic resistance is mostly brought about through antibiotic self-medication, which is a common issue in impoverished countries. The most at-risk group is children, while there is no protection evidence released for them. Due to a lack of proper knowledge, parents often inappropriately administer antibiotics to their children. Objectives. The current study aims to evaluate the parents’ knowledge of antibiotic use and their knowledge of the medical conditions for which self-medication is used. Material and methods. A cross-sectional descriptive study was carried out in parents. Parents’ direct interviews and self-administered questionnaires were used to gather the data. Descriptive analysis and chi-square tests were performed to determine the significance of these findings using IBM SPSS Statistics version 22. Results. There were 1,034 individuals who self-medicated their children in total. Male participants outnumbered female participants by a small margin. In the past 12 months, 88.6% of parents gave antibiotics to their children. Pharmacy advice and past prescriptions were the main causes of this behaviour, whilst cough, fever and tooth discomfort were the conditions for which antibiotics were prescribed. Throughout the course, 45.5% of patients changed antibiotics on their own. Conclusions. The findings of this study underscore the urgent need to address the issue of self-medication of antibiotics in children, emphasising the potential harm it can cause. Parents often resort to self-medication without a proper understanding of the underlying causes of their children’s illnesses, relying on antibiotics as a panacea. To mitigate this practice and protect the well-being of children, it is imperative to implement a multifaceted approach involving regulatory measures and educational initiatives beyond the scope of pharmacist interventions