Antibiotic Stewardship: A Handshaking Strategy Among Physicians and Pharmacists to Improve therapeutic Outcomes in Hematology-Oncology.

Background: Infections are highly susceptible in patients with hematological malignancies due to immune suppression, immunosuppressive therapies and disease progression. Rational use of antibiotics following Antimicrobial Stewardship (AMS) guidelines in early detection and response to infection is significant to improve patient care. Objectives: The present study was conducted to determine the impact of clinical pharmacists' interventions (PIs) on antibiotics usage in hematology-oncology set up in Karachi, Pakistan. Methodology: An observational prospective study was conducted for a period of 4 months in a well-known 75-bed teaching hospital, specializing in bone marrow transplantation in Karachi, Pakistan without a structured Antimicrobial stewardship programs (ASPs). The information was gathered from patient medical histories, laboratory, and microbiological records. Results: A total of 876 PIs (1 to 5 per patient) were implemented. Dose modifications or interval changes accounted for the major interventions (n = 190, 21.6%). The majority of all recommendations were related to antipseudomonal ß-lactams, aminoglycosides, sulfamethoxazole-trimethoprim and vancomycin. Overall, 94.3% (n = 876) of the 928 PIs were accepted. Conclusion: The PIs and the high physician acceptance rate may be useful for improving the safe use of antibiotics, lowering their toxicity, lowering the need for special-vigilance medications and potentially improving patient care.

The Strategic Role of Healthcare Professionals in the Battle Against COVID-19: Do We Really Need Help from Community Pharmacists?

Wuhan, the capital of China's Hubei province, was recognised in December 2019 as the centre of an outbreak of an unknown originator of pneumonia. Intense concentrations of illness spread throughout China and, ultimately, globally. Consequently, on 7th January, 2020, Chinese researchers identified a case of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in an affected person in Wuhan as the cause. Symptoms of SARS-CoV-2 vary from mild (fever, dry cough, difficulty in breathing, and pain in muscles) to severe (acute respiratory distress syndrome [ARDS}, azotemia or acute renal failure, ventilation associated pneumonia [VAP], and shock from sepsis). In a multidisciplinary team, pharmacists play a strategic role as medical healthcare professionals in restricting the dissemination of SARS-CoV-2 and can serve as sentinels in their communities to control and counteract this epidemic domestically. Key Words: SARS-CoV-2, Community pharmacists, Frontline healthcare workers.

Incorporating a clinical oncology pharmacist into an ambulatory care pharmacy in pediatric hematology-oncology and transplant clinic: Assessment and significance.

BACKGROUND: Beta thalassemia patients, post-bone marrow transplant, and leukemia patients require long term therapy with an intense care follow-up especially for pediatric hematology-oncology origin. Emergence of side effects and noncompliance to therapy lead to reduced efficacy of medicines resulting in relapse of diseases. There is an increasing fact to support the incorporation of a pharmacist into clinical team due to their distinctive skills. Clinical oncology pharmacist with experience and specialized training in hematological cancers and bone marrow transplantation (BMT) patient care has in-depth knowledge and skills of chemotherapy regimens including drug information, monitoring parameters of cancer treatment, dose adjustment, drug-drug interactions, adverse effects, and patient counseling skills. AIM AND OBJECTIVES: The main objective of our study was to assess the significance of incorporation of clinical oncology pharmacist in ambulatory care in pediatric hematology-oncology and transplant clinic. MATERIAL AND METHOD: This study was conducted at National Institute of Blood Diseases and Bone Marrow Transplantation hospital with duration of five months from 17 March 2019 to 16 July 2019. In this study the clinical oncology pharmacist was made available at ambulatory clinic of hematology-oncology and transplantation. The activities performed by a clinical oncology pharmacist were observed by resident BMT clinical pharmacist during the visits of patients and their families in a clinic. The BMT pharmacist is a clinical oncology pharmacist with experience and specialized training in hematological cancers and BMT patient care. Only pediatrics patients with beta thalassemia major and those who were on chemotherapy treatment and post-transplant patient were included in this study. RESULTS: During the five months' tenure, there were 1820 pediatric patients' visits in total. The clinical oncology pharmacist performed 980 direct patient interviews and documented 1665 pharmacist interventions. The majority of the documented clinical oncology pharmacist interventions were review of medication histories (n: 404, 24%) and "deferiprone" dose adjustments (n:400, 24%). Genomic profiling interventions were also among the commonly reported activities by the clinical oncology pharmacist. For beta thalassemia patients undergoing hydroxyurea therapy, the genomic profiling was performed to assess whether the hydroxyurea treatment is clinically effective or not (n:396, 23%). CONCLUSION: The involvement of clinical oncology pharmacist into a specialized outpatient clinic of hematology-oncology and transplant clinic plays an integral role in minimizing the adverse effect and reduction in readmission into the hospital. This is new expansion of pharmacist's role especially in underdeveloped country, considering the relevant clinical participation of clinical oncology pharmacist into specialized clinic revealing through optimized therapy and future prospect of clinical oncology pharmacist in pediatric hematology.

Electron ionization gas chromatography-mass spectrometry (ei-gc-ms) analysis of extracted oil from Tribulus terrestris seeds.

The fine powdered form T. terrestris seeds, was extracted with n-hexane by soxhlet apparatus. The aim of the study was to analyze the T. terrestris seed oil (sample-A) by electron ionization Gas Chromatography-Mass Spectrometry (EI-GC-MS) using full scan method within mass range from 40-700 charge to mass ratio (m/z). Out of 102 compounds (1A-102A) 11 compounds (30A, 32A, 37A, 45A, 47A, 48A, 49A, 64A, 83A, 101A and 102A) could not be identified and 91 were identified by classical interpretation of the mass spectrum and by using NIST14 library with match factor > 95 of mass spectrums. While among the 91 identified compounds 18 were found common therefore finally 73 compounds were identified in the present EI-GC-MS analysis of sample-A.