Assessment Of Pharmacist Initiated Medication Therapy Management Program In Improving Disease Related Knowledge, Medication Adherence And Health Related Quality Of Life Among Type 2 Diabetic Patients In Sargodha, Pakistan

Ubat Program Pengurusan Terapi adalah satu perkhidmatan inovatif, ahli farmasi yang diterajui dan menyampaikan yang bercadang untuk menyelesaikan masalah terapi dadah, meningkatkan pendidikan pesakit dan meningkatkan pematuhan kepada regimen terapeutik. The Medication Therapy Management Program is an innovative, pharmacistled and delivered service that intends to resolve drug therapy problems, enhance patient education and improve adherence to the therapeutic regimen

COMPARATIVE EVALUATION OF KETOPROFEN CREAM WITH DICLOFENAC AND PIROXICAM CREAM IN PATIENTS WITH RHEUMATOID ARTHRITIS DISORDERS:

Non steroidal Anti- inflammatory drugs have their origin as the derivatives of plants, which were observed to have their therapeutic effects in different disease states. They have the advantage of local action without developing central adverse effects and cognitive impairments. Side effects have been well described, although partly neglected. Topical delivery of NSAID has its therapeutic applications in management of pain and inflammation in Rheumatoid arthritis patients. Rheumatoid arthritis is a chronic systemic inflammatory disorder that may affect many tissues and organs but principally attacks the synovial joints. It can be disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated. The aim of the present investigation was to compare the Ketoprofen cream with Diclofenac and Piroxicam cream in a group of volunteers suffered from Rheumatoid arthritis and to compare the efficacy of these creams in reduction of inflammation. This single blind comparative study was done to determine the efficacy, tolerability and acceptability of topical application of Ketoprofen cream (1%w/w) vs diclofenac cream (1%w/w) and piroxicam cream (0.5%w/w) in Rheumatoid arthritis patients. In this study, one hundred and twenty five volunteers suffering with acute Rheumatoid arthritis and age group between 40-70 years were analyzed for assessing the intensity of pain and anti-inflammatory effects of these three creams. The study revealed that Ketoprofen cream provides a good level of pain relief removes swelling and tenderness and improves the functional impairment, without the systemic adverse events associated with oral NSAIDs.Key Words: Cream, Diclofenac, Ketoprofen, Piroxicam, Rheumatoid arthriti

Hypertension-related knowledge, medication adherence and health-related quality of life (HRQoL) among hypertensive patients in Islamabad, Pakistan

Purpose: To determine knowledge regarding hypertension, adherence to medication and HealthRelated Quality of Life (HRQoL), and their associations in hypertensive patients in Pakistan. Methods: A cross-sectional study was conducted among 384 hypertensive patients attending a tertiary health care public sector hospital in Islamabad, Pakistan. Data were collected using knowledge questionnaire regarding hypertension, Morisky Medication Adherence Scale, and EuroQol (EQ-5D) scale. Results: The mean systolic and diastolic blood pressures of the 384 patients were 140.39 ± 15.485 and 88.74 ± 10.683 mmHg, respectively. The coefficient of correlation between knowledge regarding hypertension and adherence was 0.638 (p < 0.001), showing a positive association. The correlation coefficient between knowledge and HRQoL was 0.709 (p < 0.001), suggesting a good association. The correlation coefficient between adherence to medication and HRQoL was 0.545 (p < 0.001), which indicated a positive correlation. Conclusion: These results indicate that there are statistically significant associations between hypertension knowledge and HRQoL, hypertension knowledge and medication adherence, and between adherence and HRQoL in the hypertensive patients studied

CHILDREN QUITTING SOIL EATING HABIT AFTER HAVING A DIET CONSISTING OF MEAT AND CALCIUM

The objective of this study was to make children quit the habit of soil eating by administeringmeat, as a source of nutrients like proteins, vitamins and minerals along with oral calcium which can be given in the form of a chewable tablet. Data of 85 children of both genders was taken having a soil eating habit. On the basis of age children were divided into 3 groups, i.e. children of 2 to 6 years of age, childrenof 6 to 12 years of age and children above 12 years of age. Children were given one tablespoon of minced meat and a tablet of calcium daily for as long as the child takes to quit the soil eating This course of treatment was proven to be fairly effective. The reason forthis success was the fact that the cause behind soil eating is the body’s requirement forcertain nutrients (e.g.Anemicpeople have been reported to have such a habit, cause being iron deficiency) and soil or clay has all these nutrients, i.e. iron, calcium, zinc, proteins, vitamins etc. and so this need can also be fulfilled through a diet of meat and additional administration of calcium. Results showed that children of ages 2 to 6 years quit the soil eating habit the fastest in which males quit in 10 days while females in 12 days. Keywords: Soil eating habit, Oral Calcium, Vitamin and Protein

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

EFFECT OF LUBRICANTS ON THE STABILITY OF CLOPIDOGREL BISULPHATE TABLETS

The objective of the current study was to develop oral formulation of Clopidogrel Bisulphate 75mg tablet and perform the accelerated stability study to obtain the stable product by using the various lubricants like magnesium stearate, stearic acid and pregelatinized starch. Three different formulations of tablets were prepared and coded as F1, F2 and F3 containing the various lubricants i.e. magnesium stearate, stearic acid and combination of magnesium stearate and pregelatinized starch respectively. Tablets were prepared by direct compression method and the compressed tablets were film coated. The tablets were placed in a stability chamber and accelerated stability studies at 400C and 75% RH were carried out at time 0, 3 and 6 months duration. In accelerated stability study, various tests were performed including hardness, disintegration, chemical assay and in-vitro dissolution test. After preparation of tablets, the physical and chemical parameters of tablets at zero period of time were tested, and were found within their specification. After test the tablets were kept in the stability chamber for six months. After three and six months the physical and chemical parameters of tablets were also tested. According to the results, the formulations containing the magnesium stearate and stearic acid degraded with the passage of time but the formulation containing the combination of pre-gelatinized starch and magnesium stearate were more stable as compared to the formulations containing the lubricants as magnesium stearate and stearic acid. Key words: Clopidogrel Bisulphate, Pregelatinized starch, Accelerated stability studies, In-vitro dissolution

PREVELANCE OF METFORMIN-INDUCED GASTROINTESTINAL PROBLEMS

Metformin is used as an anti-diabetic drug among oral hypoglycemic drugs, which produces many gastrointestinal problems. Study aims to investigate the effect of metformin induced gastrointestinal problems and its prevalence. A cross-sectional study design was adapted using convenience sampling technique, at different Diabetic Centers of Lahore and Faisalabad, Pakistan from, June-2017 to November-2017. A total of 300 male and female patients participated in the study between 26 to 85 years and diagnosed with type-II diabetes. Data was directly collected from the patients and prevalence of metformin-induced gastrointestinal intolerance was determined by the symptoms of the patients. Data was analyzed by SPSS version 21. Results showed a significant difference between gender and symptoms (p=0.029). Moreover, the gastrointestinal problems were found to be dose related. A significant difference existed between patients who were taking 500mg and those taking 850 mg of metformin (p=0.006), patients who were taking 500mg and those taking 1000mg of metformin (p=0.000) and patients who were taking 850mg with those taking 1000mg of metformin (p=0.022). The prevelance of metformin-induced gastrointestinal symptoms was 45.8%. Most commonly occurring symptoms were, constipation (41.35%) followed by dyspepsia (27.89%), abdominal pain (26.92%), bloating and heart burn (25%), indigestion (15.38%), anorexia (11.54%), diarrhea (6.58%), flatulence (7.69%), nausea (6.73%) and vomiting (2.88%). It was concluded that gastrointestinal intolerance was more in females as compared to males. The gastrointestinal problems increased with the increase in dose. The side effects occurred were irrespective of the age and the most common gastrointestinal symptom was found to be constipation

A cross-sectional assessment of health-related quality of life among type 2 diabetic patients in Pakistan

Objective: This study aims to describe the health-related quality of life (HRQoL) profile of Type 2 diabetes mellitus (T2DM) population attending outpatient clinics in Sargodha City, Pakistan. Methods: The study was designed as a cross-sectional descriptive survey. T2DM patients attending a tertiary care institute in Sargodha, Pakistan were targeted for the study. The EuroQol EQ-5D was used for the assessment of HRQoL and was scored using values derived from the UK general population survey. Descriptive statistics were used for the elaboration of sociodemographic characteristics. The Chi-square test was used to depict the possible association between study variables and HRQoL. Where significant associations were noted, Phi/Cramer's V was used for data interpretation accordingly. SPSS version 21 (SPSS Inc., Chicago, IL, USA) was used for data analysis and P < 0.05 was taken as significant. Results: Three hundred and ninety-two patients were approached for the study. The cohort was dominated by males (n = 222, 56.60%) with 5.58 ± 4.09 years of history of T2DM. The study highlighted poor HRQoL among the study participants (0.471 ± 0.336). Gender, marital status, education, monthly income, occupation, location and duration of the disease were reported to be significantly associated with HRQoL (P < 0.001). Conclusion: T2DM imposes a negative effect on HRQoL of the patients. Attention is needed to highlight determinants of HRQoL and to implement policies for better management of T2DM, particularly in early treatment phases where improving HRQoL is still possible

Formulation Design and In Vitro Characterization of Etoricoxib Cream for the Treatment of Rheumatoid Arthritis: Formulation Design and In-Vitro Characterization of Etoricoxib Cream for the Treatment of Rheumatoid Arthritis

Non-Steroidal Anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase (COX)-2 inhibitors, have come to play an important role in the pharmacologic management of musculoskeletal disorders. Clinical trials have established the efficacy of etoricoxib in Osteoarthritis, Rheumatoid Arthritis, Acute Gouty Arthritis, Ankylosing Spondylitis, Low back pain, acute postoperative pain, and primary dysmenorrheal. The present research has been undertaken with the aim to develop a novel topical cream formulation of etoricoxib, which would attenuate the gastrointestinal relater toxicities associated with oral administration. Etoricoxib is a highly selective cyclooxygenase‐2 (cox‐2) inhibitor. In the present study, a fixed concentration of Etoricoxib cream (1%) was prepared by using a different combination of Active ingredient and Excipients. To access the efficacy of formulated cream, in vitro evaluation including stability studies, tube extrudes ability, spread ability, pH, viscosity andrheological properties as well as drug diffusion studies were done. After in vitro evaluation of cream formulations, the formulation was evaluated for the anti‐inflammatory and skin irritation study. The results obtained were encouraging and formulation containing Etoricoxib (1%) exhibited the most satisfying results of all the parameters