ASSESSMENT OF COMMUNITY PHARMACISTS’ INVOLVEMENT IN PUBLIC HEALTH PROMOTION SERVICES IN BEIRUT, LEBANON

Background: The role of pharmacists is growing globally; the shift from the traditional role of preparing and dispensing medications, to a role in medication therapy management and public health services is started to be acceptable worldwide. Objective: The aim of the study was to assess the participation level of community pharmacists’ in certain public health services promotion as well as the barriers that hindered such provision. Method: A questionnaire based study has been carried targeting Lebanese community pharmacists working in Beirut, Lebanon. Socio-demographic information, types of public health consultations offered in the pharmacy, and the barriers confronted by the community pharmacists were collected and analyzed using SPSS version 24. Results: The level of involvement of community pharmacists in the provision of public health services accounted for 72.6, 72.2, 65, 46.2, 46.2, and 45.3% in counseling on hypertension, weight management, diabetes, contraceptive use, smoking cessation, and drug abuse, respectively. The Level of education, as well as years of experience, affected the pharmacist’s involvement in most of the services. Sixty-one percent from the participants offer drug treatment options to help their patients in smoking cessation. Nutrition and diet showed the highest ranked in terms of percentage (82.9%) in weight management. Eighty-three percent of the respondents counseled their patients when to start their combined hormonal contraceptives pills. Fifty-eight percent from the respondents offer psychological support when counseling on drug abuse. The highest percentage is seen when counseling regarding lifestyle modifications in both diabetes and hypertension management. Lack of time was one of the most common barriers to practice health promotion encountered by pharmacists. Conclusion: Even though the community pharmacists are playing a vital role in public health promotion, this role should be strengthen by implementing rules that impose this service and the necessary skills needed to achieve better outcomes

KNOWLEDGE AND ATTITUDE TOWARD COMMON COLD IN BEIRUT, LEBANON

Background Common cold is a self- limiting condition targeting the upper respiratory tract. Even though it resolves on its own yet it accounts for 40% of absentees from work and a large number of visits to the physician clinic. The most common sign and symptoms include sore throat, coryza, runny nose or congestion, muscle pain, and sometimes cough. Symptomatic treatment of this minor ailment can be either by herbal products or over the counter drugs. Nevertheless, it is always mistaken for Influenza or bacterial infection. The proper knowledge of this condition could prevent mistreatment and would keep the country’s resources intact. Accordingly, the aim of the current study is to assess the knowledge and attitude of a sample of the Lebanese population on the common cold. Method A cross-sectional descriptive questionnaire-based study was performed in Beirut area. The questionnaire was divided into three parts that included demographic information, as well as knowledge and attitude questions. Results were considered significant when P-value was ≤ 0.05 with a confidence interval of 95%. Results Three hundred eighty-five adult Lebanese participants were enrolled in the study. The youngest age group was more knowledgeable on common cold than the elderly. Moreover, Ph.D. holders scored the highest on the knowledge score (6.71/10). Alarmingly, 14.8% of the tested sample still use antibiotics as soon as their cold symptoms start. Around 88% of the participants believed that the Ministry of Public Health should be involved to ensure the understanding of this condition in Lebanon. Conclusion The role of all health care providers as well as their orders and the Ministry of Public Health is to ensure proper education on the common cold by conducting awareness campaigns

GENUS MICROMERIA: A REVIEW ARTICLE

Micromeria (Family Lamiaceae) is widespread across Europe, Asia, Africa and North America, with a center of diversity in the Mediterranean region and the Canary Islands. More than 78 species of Micromeria have been known, famous examples is: M. fruticose.Genus Micromeria comprises plants of different chemical nature. Based on previous studies, Micromeria species is considered as a rich source of essential oils, mainly; monoterpene hydrocarbons, oxygenated monoterpenes, sesquiterpenes hydrocarbons, and oxygenated sesquiterpenes. About ten species of Micromeria have been identified to grow widely in Lebanon, of which Micromeria fruticosa is the most common and abundant. Several pharmacological activities were reported including antimicrobial, antioxidant, anticancer, and antidepressant effect. This is a review article where we thoroughly discuss the chemical nature and classes of all isolated metabolites from Micomeria plant especially Micromeria fruticosa and their reported biological activities in an attempt to inspire the researchers to isolate and structural elucidate the compounds that could have valuable use in drug discovery and medical application

KNOWLEDGE AND ATTITUDE OF LEBANESE ADULTS TOWARDS ASTHMA IN BEIRUT, LEBANON

Asthma, a serious global health problem, has been an area of interest due to its increasing prevalence, expanding treatment costs, and rising burden on patients and the community. Since asthma cannot be cured, clinical episodes can be prevented and controlled by adequate management and sufficient knowledge of the disease. Appropriate treatment may relieve asthma symptoms and improve quality of life. However, poor knowledge of asthma disease and medication use, misdiagnoses, misuse of inhalers and inadequate self-management of disease symptoms may have a greater impact on the disease process. Therefore, assessment of the population’s knowledge and attitude toward asthma is essential. To the best of our knowledge, no previous studies has assessed the population’s knowledge and attitude regarding asthma in Beirut, thus this study was conducted to assess the knowledge and attitude of Lebanese adults regarding asthma in Beirut, Lebanon. Additionally, the goal of this study was to determine the incidence from the studied sample of participants with physician-diagnosed and physician-undiagnosed asthma treated by bronchodilators/inhaled corticosteroids (BD/ICS). Furthermore, to identify from the sample studied the participants having the likelihood of asthma disease and to highlight the natural products used by the participants in managing asthma-related symptoms. Four hundred participants were enrolled in a cross-sectional study that was carried out using web-based anonymous questionnaires about asthma disease evaluating their knowledge towards the disease and attitude in Beirut, Lebanon. The study revealed that Lebanese adults had an inadequate level of knowledge regarding asthma, its medications, and asthma triggers. This lack of knowledge was reflected in their attitude towards the disease. Moreover, our study showed that 9.1% of the asthmatic participants who were questioned were undiagnosed yet by the physician and 33.3% of those were using BD/ICS to relieve their asthma symptoms. Furthermore, it is noteworthy that 18.75% of the questioned participants had recurrent respiratory symptoms and had features that associated with asthma, thus increasing the risk of developing chronic airway disease and asthma. However, only 8.25% of questioned participants were asthmatic. In conclusion, there is a need to improve the Lebanese community’s knowledge and attitude by increasing the level of awareness about the disease. Several recommendations were suggested to advance the knowledge of asthma in order to improve future health outcomes

ASSESSMENT OF THE LEBANESE COMMUNITY PHARMACIST KNOWLEDGE, PRACTICE AND BARRIERS REGARDING THE PREVENTION OF OSTEOPOROSIS

Osteoporosis is a silent skeletal disease that is often recognized when fractures occur as a result of minimal trauma. Limited studies have assessed the degree of pharmacists’ involvement in osteoporosis prevention, risk-assessment/screening and physician referrals. To assess the Lebanese community pharmacists’ knowledge, practice and barriers regarding osteoporosis prevention. Secondary aim is to assess the pharmacists’ ability to identify high-risk patients who should be referred for bone mineral density (BMD) testing. A cross-sectional study was carried out in Beirut, Lebanon between September and October 2020 using self-administered questionnaire. Pharmacists completed a multi-component questionnaire that consisted of socio-demographic characteristics, practices, knowledge and barriers in relation to osteoporosis prevention and high-risk identification. Frequencies and proportions were used to describe the data. Simple and multiple linear regression analysis were used to examine the determinants of knowledge in the study population. The majority of pharmacists were rarely/never involved in counseling patients on osteoporosis risk factors (57.5%) and healthy lifestyle habits (62.5%) as well as engaging in risk-assessment (63.1%), screening using Fracture Risk Assessment Tool (FRAX) (0%) and physician referrals (sometimes-55.6%). In addition, pharmacists were also scarcely involved in reducing the risk of falls (55.1-59.4%). Pharmacists were knowledgeable about osteoporosis prevention however had important gaps in the diseases that increase osteoporosis risk as well as in FRAX tool, indications that require BMD testing and increased risk of fall medications. Significant predictors of knowledge were receiving postgraduate training on osteoporosis and earning the pharmacy degree from a university in Lebanon. Barriers to providing osteoporosis services included lack of time, staff, space, patients’ interest in prevention activities and limited inter-professional collaboration. The study findings provided important insights on the practices, knowledge and barriers of pharmacists regarding osteoporosis prevention and high-risk identification. Concerted efforts of multiple stakeholders are needed to promote the active role of community pharmacists in order to reduce the risk of morbidity, mortality and health-care costs associated with osteoporosis and related fractures

MEDICINAL PLANTS’ STRESS FACTORS: EFFECTS ON METABOLITES AND NOVEL PERSPECTIVES FOR TOLERANCE

Medicinal plants are rich in secondary metabolites representing different chemical classes and synthesized by various biochemical pathways. However, these compounds are susceptible to potential herbal predators and to environmental influences. Several factors induce different biotic and abiotic stresses (drought, cold, salinity, heat) that lead to fluctuations in the biogenesis and accumulation of secondary metabolites by which plants react to overcome the threatening stress conditions. This contribution aims to give an overview of the various medicinal plant defense mechanisms against imminent threats and their impact on secondary metabolites profiles in the most effective medicinal plant species such as the levels of vincristine in Catharanthus roseus which is affected by salinity and drought stress, sage (Salvia officinalis) that showed fluctuations in terpenes level under drought stress and mineral contents in the soil and Papaver somniferum that exhibited a decrease in alkaloids content under cold stress. From a wider perspective, the aim of this study is to present novel tools and strategies used for the preservation of some plant species from extinction by minimizing as much as possible the risk of exogenous influences on phytochemicals levels and on plant bio genome and manipulating the stress factors to ensure plants quality and safety. It also aims to raise awareness about the consumption of herbal medicines without respecting the herbal monographs information about the safe dose, the interactions with drugs, and the side effects, in addition to the necessity of performing toxicity studies by pharmaceutical industries, especially on herbal medicines raised under various stress factors because of the risk of SMs (secondary metabolites) accumulation in these plants at a critical level that may be toxic to consumers

GENUS MELALEUCA: PHYTOCHEMISTRY, PHARMACOLOGY AND EFFECT AGAINST COVID-19

Medicinal plants are used for the prevention and treatment of many diseases as they are rich in phytochemical constituents (like terpenes, flavonoids, and alkaloids) responsible for the pharmacological effects of these plants. Genus Melaleuca named the tea tree, belonging to the family Myrtaceae, is cultivated in Australia as well as in the Pacific and some regions of Asia. It has been employed in Australian traditional medicine for its broad antimicrobial activity because of its contents of phenolic compounds, monoterpenes, tannins, flavonoids, sesquiterpenes, and essential oils. Owing to the valuable uses of plants of genus Melaleuca, for different medical purposes, it was deemed interest to summarize the previous studies reported from 2004 to 2020 in the available literature about the phytochemistry and pharmacological potential of both volatile and non-volatile components of Melaleuca species. Accordingly, this article may help researchers work on plants of genus Melaleuca to promote clinical applications towards the development of novel drugs of diverse pharmacological activities, including inhibitory effects on COVID 19 obtained from Melaleuca species

Evaluation of Analgesic Activity of Papaver libanoticum

Papaver libanoticum is an endemic plant to Lebanese region (family Papaveraceae) that has not been investigated before. The present study aimed to explore the analgesic activity of dried ethanolic extract of Papaver libanoticum (PLE) using tail flick, hot plate, and acetic acid induced writhing models in mice. The involvement of opioid receptors in the analgesic mechanism was investigated using naloxone antagonism. Results demonstrated that PLE exhibited a potent dose dependent analgesic activity in all tested models for analgesia. The analgesic effect involved activation of opioid receptors in the central nervous system, where both spinal and supraspinal components might be involved. The time course for analgesia revealed maximum activity after three hours in both tail flick and hot plate methods, which was prolonged to 24 hours. Metabolites of PLE could be responsible for activation of opioid receptors. The EC50 of PLE was 79 and 50 mg/kg in tail flick and hot plate tests, respectively. The total coverage of analgesia by PLE was double that of morphine in both tests. In conclusion, PLE proved to have opioid agonistic activity with a novel feature of slow and prolonged effect. The present study could add a potential tool in the armaments of opioid drugs as a natural potent analgesic and for treatment of opioid withdrawal syndrome

Anti-Inflammatory and Antioxidant Activities of Salvia fruticosa

Objectives. Salvia fruticosa Mill. (S. fruticosa) is widely used in folk medicine. Accordingly, the present study was designed to evaluate the antioxidant and anti-inflammatory activities of S. fruticosa, and to determine the phenolic constituents of its extracts. Methods. The antioxidant activity was determined using 2,2-diphenylpicrylhydrazyl assay. Total phenolic contents were estimated using Folin-Ciocalteu reagent, and high-performance liquid chromatography was performed to identify phenolic constituents. To evaluate the anti-inflammatory activity, carrageenan-induced mouse paw edema was determined plethysmographically. Key Findings. Different plant extracts demonstrated strong radical scavenging activity, where the ethyl acetate extract had the highest value in the roots and the lowest in the aerial parts. This antioxidant activity was correlated to the total phenolic content of different extracts, where rutin and luteolin were the most abundant constituents. Interestingly, both the roots and aerial parts revealed a significant anti-inflammatory activity comparable to diclofenac. Conclusions. This study is the first to demonstrate pharmacologic evidence of the potential anti-inflammatory activity of S. fruticosa. This activity may partly be due to the radical scavenging effects of its polyphenolic contents. These findings warrant the popular use of the East Mediterranean sage and highlight the potential of its active constituents in the development of new anti-inflammatory drugs