Self-medication with antibiotics in Sana’a City, Yemen

Purpose: To determine the prevalence of self-medication with antibiotics in Sana’a City, Yemen and its associated risk factors.Methods: In a descriptive cross-sectional study, a self-administered questionnaire was developed and distributed among consumers attending community pharmacies in Sana’a city, Yemen. Chi-square test was used to identify the risk factors associated with self-medication with antibiotics.Results: The prevalence of antibiotics use during self-medication was 87.1 % (58.2 % of males and 41.8 % of females). Among all respondents, only 49.5 % were aware of bacterial resistance due to antibiotic use. The majority of illness/symptoms treated with antibiotics during self-medication were common cold, cough, diarrhea and fever. The high cost of physician consultation was the main reason for self-medication with antibiotics. The most common source of information was community drug dispensers. Although different factors were assessed, no association could be found between factors like age, gender, material status, educational status, employment, monthly income or knowledge regarding bacterial resistance and self-medication with antibiotics.Conclusion: Self-medication with antibiotics is high among consumers in Sana’a City, Yemen.Keywords: Self-medication, Antibiotics, Community pharmacies, Sana’a City, Yeme

Assessment of the Halal Status of Respiratory Pharmaceutical Products in a Hospital

AbstractRespiratory pharmaceutical products are among the most commonly used products in the hospital setting. However the halal status of these products is unknown and has never been investigated before. The objective of this study is to assess the status of these products at a hospital. Halal assessment was based on academic and other websites references. From 132 respiratory products that have been investigated, 11.4% are halal followed by 6.1% of them haram, 10.6% mushbooh and 72.0% are not known in terms of their halal status. All the haram medications are related to the presence of ethanol as the inactive ingredient. No information of inactive ingredients in medication leaflets is the most contributive factor leading to unknown halal status of the medications. In conclusion, cooperation between the government, pharmaceutical manufacturers, religious scholars and health care professionals is suggested in order to achieve a goal towards using halal medications

DO CURRENT AWARENESS AND EDUCATIONAL PROGRAM TOWARDS UNREGISTERED DRUGS EFFECTIVE FOR PUBLIC? PHARMACISTS' PERCEPTIVE

Objective: Awareness and educational programme are one of the solutions to reduce unregistered drugs usage. In Malaysia, an agency called Pharmaceutical Services Division (PSD) and Pharmacy Enforcement Division (PED) are highly active in yielding many awareness programmes throughout the country as well as in its website. The goal of this research was to explore the pharmacist views or perceptions on the current awareness and educational programme on registered drugs.Methods: These findings emerged from one-on-one semi-structured interview guided with sixteen pharmacists in Klang Valley who have represented the voice from the pharmacists throughout Malaysia.Results: Six themes identified: ‘Consumer utility', ‘low health literacy', ‘social and education influenced', ‘equitable access to information', ‘promotion' and ‘persistent'. These themes emphasise the current awareness to improve and provide the programme to everyone in Malaysia to get the same information regardless they're staying. Pharmacists also expressed their concern about the current consumer who only cares about their benefit such as fast effect; cheap and easy to get by ignoring the bad impact if they consume the unregistered products. The pharmacists also believed that the health literacy, the social and educational level also influenced the purchase behaviour amongst consumer.Conclusion: The findings indicate that the management of unregistered drugs needs to involve every organisation. Future research could develop a particular measure and score on awareness and knowledge amongst public on this issue. This test can be used as the indicator to evaluate the outcome of the future knowledge programmed.Keywords: Unregistered drugs, Awareness and educational programme, Pharmacist, Public, Perspective

PREDICTORS OF GOOD GLYCEMIC CONTROL AMONG TYPE II DIABETES PATIENTS IN PALESTINE

  Objectives: The aim of this study is to assess glycemic control and its relationship with patient characteristics, health-care system factors, and self-care management in type II diabetes patients.Methods: A retrospective cross-sectional study was conducted among 330 type II diabetes patients who met the inclusion criteria and whose medical records covered a period of 1 year. Data concerning patient characteristics, health-care system factors, self-care management, and available last reading of hemoglobin A1c (HbA1c) were collected through personal interviews and a medical records' review using structured questionnaires and data collection forms. Good glycemic control was defined as HbA1c ≤7%. To assess the results, the Statistical Package for Social Sciences (version 16) was used to undertake descriptive, univariate, and multivariate analyses.Results: The mean±standard deviation age was 60±9.7 years. More than half of the participants were male (51.2%), and the majority had additional chronic diseases (88.5%). Of the total 271 participants whose HbA1c levels have been monitored, 16.7% had good glycemic control. Multivariate analysis showed that unemployment was significantly related to a decreased odds of good glycemic control (odds ratio=0.34; 95% confidence interval=0.12-0.98; p<0.05).Conclusion: The study noted that the proportion of patients with good glycemic control was low, a result comparable to studies from many countries. Further investigation and improvement of inappropriate health-care system factors and self-care management together with educational programs that emphasize the importance of self-care management and the health-care providers' role would be of great benefit in glycemic control

Tobacco use prevalence, knowledge, and attitudes among newly diagnosed tuberculosis patients in Penang State and Wilayah Persekutuan Kuala Lumpur, Malaysia

<p>Abstract</p> <p>Background</p> <p>There is sufficient evidence to conclude that tobacco smoking is strongly linked to tuberculosis (TB) and a large proportion of TB patients may be active smokers. In addition, a previous analysis has suggested that a considerable proportion of the global burden of TB may be attributable to smoking. However, there is paucity of information on the prevalence of tobacco smoking among TB patients in Malaysia. Moreover, the tobacco-related knowledge, attitudes, and behaviors of TB patients who are smokers have not been previously explored. This study aimed to document the prevalence of smoking among newly diagnosed TB patients and to learn about the tobacco use knowledge and attitudes of those who are smokers among this population.</p> <p>Methods</p> <p>Data were generated on prevalence rates of smoking among newly diagnosed TB patients in the State of Penang from January 2008 to December 2008. The data were obtained based on a review of routinely collated data from the quarterly report on TB case registration. The study setting comprised of five healthcare facilities (TB clinics) located within Penang and Wilayah Persekutuan, Kuala Lumpur health districts in Malaysia, which were involved in a larger project, known as SCIDOTS Project. A 58-item questionnaire was used to assess the tobacco use knowledge, attitudes and behaviors of those TB patients who were smokers.</p> <p>Results</p> <p>Smoking status was determinant in 817 of 943 new cases of TB from January to December 2008. Of this, it was estimated that the prevalence rates of current- and ex-smoking among the TB patients were 40.27% (329/817) and 13.95% (114/817), respectively. The prevalence of ever-smoking among patients with TB was estimated to be 54,220 per 100,000 population. Of 120 eligible participants for the SCIDOTS Project, 88 responded to the survey (73.3% response rate) and 80 surveys were analyzed (66.7% usable rate). The mean (± SD) total score of tobacco use knowledge items was 4.23 ± 2.66 (maximum possible score=11). More than half of the participants (51.3%) were moderately dependent to nicotine. A moderately large proportion of the respondents (41.2%) reported that they have ever attempted to quit smoking, while more than half (56.3%) have not. Less than half (47.5%) of the study participants had knowledge about the body system on which cigarette smoking has the greatest negative effect. The majority wrongly believed that smokeless tobacco can increase athletic performance (60%) and that it is a safe and harmless product (46.2%). An overwhelming proportion (>80%) of the patients believed that: smoking is a waste of money, tobacco use is very dangerous to health, and that smokers are more likely to die from heart disease when compared with non-smokers. The use of smokeless tobacco was moderately prevalent among the participants with 28.8% reporting ever snuffed, but the use of cigar and pipe was uncommon.</p> <p>Conclusion</p> <p>Smoking prevalence rate is high among patients with TB in Malaysia. These patients generally had deficiencies in knowledge of tobacco use and its health dangers, but had positive attitudes against tobacco use. Efforts should be geared towards reducing tobacco use among this population due to its negative impact on TB treatment outcomes.</p

Impact of connecting tuberculosis directly observed therapy short-course with smoking cessation on health-related quality of life

<p>Abstract</p> <p>Background</p> <p>With evolving evidence of association between tuberculosis (TB) and tobacco smoking, recommendations for the inclusion of tobacco cessation interventions in TB care are becoming increasingly important and more widely disseminated. Connecting TB and tobacco cessation interventions has been strongly advocated as this may yield better outcomes. However, no study has documented the impact of such connection on health-related quality of life (HRQoL). The objective of this study was to document the impact of an integrated TB directly observed therapy short-course (DOTS) plus smoking cessation intervention (SCI) on HRQoL.</p> <p>Methods</p> <p>This was a multi-centered non-randomized controlled study involving 120 TB patients who were current smokers at the time of TB diagnosis in Malaysia. Patients were assigned to either of two groups: the usual TB-DOTS plus SCI (SCIDOTS group) or the usual TB-DOTS only (DOTS group). The effect of the novel strategy on HRQoL was measured using EQ-5D questionnaire. Two-way repeated measure ANOVA was used to examine the effects.</p> <p>Results</p> <p>When compared, participants who received the integrated intervention had a better HRQoL than those who received the usual TB care. The SCIDOTS group had a significantly greater increase in EQ-5D utility score than the DOTS group during 6 months follow-up (mean ± SD = 0.98 ± 0.08 vs. 0.91 ± 0.14, <it>p </it>= 0.006). Similarly, the mean scores for EQ-VAS showed a consistently similar trend as the EQ-5D indices, with the scores increasing over the course of TB treatment. Furthermore, for the EQ-VAS, there were significant main effects for group [F (1, 84) = 4.91, <it>p </it>= 0.029, η²= 0.06], time [F (2, 168) = 139.50, <it>p </it>= < 0.001, η²= 0.62] and group x time interaction [F (2, 168) = 13.89, <it>p </it>= < 0.001, η²= 0.14].</p> <p>Conclusions</p> <p>This study supports the evidence that an integrated TB-tobacco treatment strategy could potentially improve overall quality of life outcomes among TB patients who are smokers.</p

A rapid MCM-41 dispersive micro-solid phase extraction coupled with LC/MS/MS for quantification of ketoconazole and voriconazole in biological fluids

A rapid dispersive micro-solid phase extraction (D-μ-SPE) combined with LC/MS/MS method was developed and validated for the determination of ketoconazole and voriconazole in human urine and plasma samples. Synthesized mesoporous silica MCM-41 was used as sorbent in d-μ-SPE of the azole compounds from biological fluids. Important D-μ-SPE parameters, namely type desorption solvent, extraction time, sample pH, salt addition, desorption time, amount of sorbent and sample volume were optimized. Liquid chromatographic separations were carried out on a Zorbax SB-C18 column (2.1 × 100 mm, 3.5 μm), using a mobile phase of acetonitrile–0.05% formic acid in 5 mm ammonium acetate buffer (70:30, v/v). A triple quadrupole mass spectrometer with positive ionization mode was used for the determination of target analytes. Under the optimized conditions, the calibration curves showed good linearity in the range of 0.1–10,000 μg/L with satisfactory limit of detection (≤0.06 μg/L) and limit of quantitation (≤0.3 μg/L). The proposed method also showed acceptable intra- and inter-day precisions for ketoconazole and voriconazole from urine and human plasma with RSD ≤16.5% and good relative recoveries in the range 84.3–114.8%. The MCM-41-D-μ-SPE method proved to be rapid and simple and requires a small volume of organic solvent (200 μL); thus it is advantageous for routine drug analysis

The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

<p>Abstract</p> <p>Background</p> <p>There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.</p> <p>Methods</p> <p>An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate.</p> <p>Results</p> <p>A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB treatment alone (77.5% vs. 8.7%; p < 0.001). Furthermore, at the end of TB treatment (6 months or later), there were significantly higher rates of treatment default (15.2% vs. 2.5%; p = 0.019) and treatment failure (6.5% vs. 0%; p = 0.019) in the DOTS group than in the SCIDOTS group.</p> <p>Conclusion</p> <p>This study provides evidence that connecting TB-tobacco treatment strategy is significant among TB patients who are smokers. The findings suggest that the integrated approach may be beneficial and confer advantages on short-term outcomes and possibly on future lung health of TB patients who quit smoking. This study may have important implications on health policy and clinical practice related to TB management among tobacco users.</p

SELF-MEDICATION AMONG ADULT POPULATION IN SELANGOR, MALAYSIA

Objective: Self-medication is a common practice and an important health issue worldwide. The aim of this study was to determine the percentage of self-medication practice, patterns of use, self-medication attitudes, and to explore the occurrence of side effects resulting from self-medication practice among the adult population in Selangor, Malaysia.Methods: This cross-sectional survey used a validated questionnaire administered to adults 18 y and above residing in Selangor.Results: A total of 401 completed questionnaires were analyzed. The majorities of the participants were Malay (91.5%) and went to college or university (89.3%). One-third self-medicated in the past two weeks prior to the survey. Self-medication was significantly associated with age (p=0.009) and race (p=0.038). Among the respondents, 83.8% would search for information before practicing self-medication. Modern healthcare professionals (58.4%) and the internet (47.1%) were the most common source of information about drugs for self-medication. The main reason for self-medication was the illness perceived as minor (79.1%). Two-thirds of the respondents (66.6%) had a satisfactory attitude towards self-medication practices.Conclusion: The public needs to be better informed on responsible self-medication to ensure safe, effective, and rational use of medicines