Prevalence of potential drug-drug interactions in breast cancer patients and determination of their risk factors.

Breast cancer patients use numerous medications, which include cytotoxic chemotherapy drugs, hormonal agents and supportive medication, so they are more vulnerable to potential adverse drug interactions. This study aimed to evaluate frequency, severity, clinical importance and risk factors responsible for the Drug-drug interactions (DDIs) in a cohort of patients suffering from breast cancer. Data was obtained from 150 patients in the oncology ward (both inpatient and outpatient) with a confirmed diagnosis of breast cancer and currently receiving standard breast cancer-directed treatment. The data was recorded into a pre-designed form specifically made for this study through individual patient interviews and by reviewing the detailed medical chart records of the patients. DDIs were identified by using drug interaction software such as Medscape mobile application and Micromedex version 2.The results of this study showed that all patients were female. The mean numbers of drugs that patients used were 7. Potential drug interactions were identified in 92% of the patients. When drug groups were overviewed, 32% of interactions were between anti neoplastic drugs, 62.9% interactions were between the anti neoplastic agent and supportive care drugs and 5% of them were between anti-cancer drugs and drugs used to treat comorbidities. Major DDIs were found in 62.2% of patients, 25.3% of DDIs were moderate and 12.4% were minor. The number of drugs, comorbid diseases, and selection of chemo protocols were the risk factors for drug interactions. Most of the DDIs found in breast cancer therapy may have adverse consequences on patient health and therapeutic outcomes. Therefore, health care professionals should review the medication regimen of patients with breast cancer before starting any chemotherapy treatment.

Thyroid cancer risk factors and Pakistani University students' awareness towards its preventive practice.

OBJECTIVES: Thyroid Cancer is one of the rarest cancers but its prevalence has been increasing worldwide for the last couple of decades. METHODS: The data collection tool was designed to assess knowledge, awareness, perception, and attitude towards preventive practices of thyroid cancer in Pakistani university students. The data were collected over a duration of six months and a total number of 3722 students participated. RESULTS: The knowledge of risk factors of thyroid cancer was an important parameter of this study. The students who knew all the early signs of thyroid cancer were 28.7%. In this study, the independent variables such as age, gender, demographic location, and financial status were found to be highly significant with knowledge, attitude towards warning signs of cancer, and the perception of students about developing thyroid cancer. CONCLUSIONS: The participants were found to have poor knowledge about early signs of thyroid cancer. The study participants perception, behavior, and attitude towards preventive practices of thyroid cancer were found inadequate and appropriate measures on a National level should be taken to enhance the knowledge about preventive practices of thyroid cancer. Increasing knowledge and awareness shall help decrease the overall morbidity and mortality linked with thyroid carcinomas and thyroid diseases.

Implications of self-medication among medical students-A dilemma.

OBJECTIVE: To evaluate the knowledge, attitude and practice of self-medication in medical undergraduate students. METHODS: This cross-sectional questionnaire-based survey was conducted from January to June, 2017, among undergraduate students of Ayub Teaching Hospital, Women Medical College, International Medical College and Frontier Medical College in Abbottabad, Pakistan. The sample comprised students of first, second, third, fourth and fifth professional year. Data was collected using self-generated questionnaire. RESULTS: Of the 400 subjects approached, 300(75%) returned the questionnaire fully completed. Of them, 208 (69.3%) were females and 92(30.66%) were males. The most common age group was 22-25 years 182(60.7%). Self-medication was found to be prevalent among 297(99%) subjects and 139(46.3%) respondents had practised self-medication in the preceding 6 months more than two times. Over-the-counter drugs were commonly used for the self-medication in 295(98.3%) cases. Overall, 285(95%) respondents had a positive attitude towards self-medication. Media was found to be the most common source of information for 93(31%) cases. CONCLUSIONS: High prevalence of self-medication was noticed, with over-the-counter drugs being the most commonly used. Proper educational awareness programmes about self-medication can control the issue.

Harassment of working women in the public health sector of Abbottabad in socio-legal perspective.

OBJECTIVE: To investigate the efficacy and impact of Protection Against Harassment of Women at Workplace Act 2010 in the public health sector in its socio-legal perspective. METHODS: This cross-sectional study was conducted from July to December 2014 in Abbottabad, Pakistan, and comprised subjects selected from 53 basic health units managed by the government. SPSS 20 was used for statistical analysis. RESULTS: Of the 450 questionnaires, 430(96.6%) were returned duly filled. Overall, 40% male (120 respondents) and 26% female (34 respondents) knew about the Act. Besides, 39% males (117 respondents) and 63% females (82 respondents) appeared unsatisfied with the complaint mechanism prescribed in the Act; all the respondents established that no case had been registered after the introduction of the Act. Overall, 31% males (93 respondents) and 57% females (74 respondents) thought that without the health governance commitment and social support structure the Act could not work. CONCLUSIONS: The Protection Against Harassment of Women at Workplace Act 2010 was considered ineffective by the respondents who were concerned about the lack of social support system for the Act.

EPICOCCUM SP., AN EMERGING SOURCE OF UNIQUE BIOACTIVE METABOLITES.

Fungi are playing a vital role for producing natural products, most productive source of lead compounds in far reaching endeavor of new drug discovery. Epicoccum fungus is known for its potential to produce diverse classes of biologically active secondary metabolites. The intent of this review is to provide detailed information about biology and chemistry of Epicoccum fungus. Most of the fungus metabolites showed cytotoxic, anticancer, antimicrobial and anti-diabetic activities. The literature given encompases the details of isolation of different unusual and unique secondary metabolites, their chemical nature and biological activities find out Epicoccum spp., a potential source of lead molecules.

Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients.

Drug-drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug-drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug-drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug-drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p < 0.001), hospital stay of 7 days or longer (p < 0.001) and taking 7 or more drugs (p < 0.001). We found a high prevalence for pDDIs in the Department of Cardiology, most of which were of moderate severity. Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs.

PERCEPTION OF ACADEMIC PHARMACISTS TOWARDS THEIR ROLE IN HEALTHCARE SYSTEM OF A DEVELOPING COUNTRY, PAKISTAN: A QUANTITATIVE SIGHT.

To investigate perception of academic pharmacists towards their role in healthcare system of a developing country, Pakistan, was the aim of this study. The study participants consisted of academic pharmacists from the government and private universities of Pakistan. Study was conducted for a period of three months, from January to March 2011, in Pakistan. Academic pharmacists were informed regarding the aim, objective and nature of the study. Verbal consent was given and execution of the study took place. Main sections of the questionnaire were comprised of series of statements pertaining to pharmacist perception and experience with the pharmacists. During the period, of January to April, the total number of questionnaires received from different government and private universities was 113. The response rate based on the 205 academic pharmacists working in universities during the study period was 63.9%. A majority (93.9%) of the respondents were satisfied working as academic pharmacist, 68.7% expressed that their interest in research is the reason to embark carrier as an academic pharmacist. Only half (55.7%) of the respondents agreed about pharmacy curriculum standard in Pakistan, and their satisfaction towards curriculum is less, as after the implementation of Pharm. D. (Doctor of Pharmacy). In the country, the curriculum is still focusing more towards theoretical knowledge rather than practical. In this case significant difference was noted with respect to university (p = 0.012). Academic pharmacists do have concern about the pharmacy profession in Pakistan. They ascertain the key issues facing the profession and its educators. Recommendations have been made to improve the current pharmacy curricula in order that future pharmacists in Pakistan practice effectively with the collaboration of other healthcare professionals.

SYNTHESIS, CHARACTERIZATION, ANTIMICROBIAL AND PHYTOTOXIC SCREENING OF 1-AROYL-3,5-DIARYLPYRAZOLINE DERIVATIVES.

Pyrazolines are biologically and pharmaceutically very active scaffolds. Derivatives of. (3,5-diphenyl-4,5-dihydro-1H-pyrazol-1-yl)(phenyl)methanone were synthesized by the cyclization of chalcones (1a-c) with substituted benzyl hydrazides (2a-e) using a few drops of piperidine as catalyst. Structures of all the synthesized compounds were confirmed by FTIR, 1H NMR, 13C NMR and mass spectrometric analysis. All the pyrazolines were subjected to antimicrobial and phytotoxic assays. Compound 3a and 3c showed maximum antimicrobial activities while all the synthesized compounds were active acc. to their phytotoxic assays.

EFFECT OF-GYMNEMA SYLVESTRE, CITRULLUS COLOCYNTHIS AND ARTEMISIA ABSINTHIUM ON BLOOD GLUCOSE AND LIPID PROFILE IN DIABETIC HUMAN.

The aim of this study was to manage diabetes with medicinal plants (Gymnema sylvestre, Artemisia absinthium and Citillus colocynthis) in human patients with type II diabetes. Thirty two patients of type II diabetes from both sexes of 30-60 years age were registered for this study and distributed them into four groups, each having 8 patients. Capsules of each, Gymnema sylvestre, Artemisia absinthium and Citrullus colocynthis were given to patients twice a day for 30 days in 1 g per day dosage and investigated for glucose, triglyceride (TGL) and cholesterol level. Gymnema sylvestre reduced 37% glucose, 5% TGL, 13% cholesterol and 19% low desity lipoproteins (LDL) level in diabetic individuals. Citrullus colocynth reduced glucose, cholesterol and TGL and HDL-cholesterol level by 35, 6, 6, and 5%, respectively. Artemisia absinthium reduced 3% high desity lipoproteins (HDL) and 6% LDL level. From results, it can be concluded that the powdered Gymnema sylvestre, Citrulus colocynthis, and Artemisia absinthium possess good anti-diabetic features, however these herbal products had no significant effect on lipid profiles of the diabetic human.

Perception and awareness of patients regarding ovarian cysts in Peshawar, Pakistan: a qualitative approach.

AIM OF THE STUDY: Women health is one of the key issues in developing countries including Pakistan. To improve the women's quality of life, awareness about health is necessary. The objective of this study is to evaluate the patient's perception regarding ovarian cyst and the awareness of the patients about the symptoms and health management in ovarian cyst. MATERIAL AND METHODS: A qualitative approach was used to conduct this study. An interview guide was prepared for the data collection. The interview guide had 29 questions which were asked from the patients. The duration of each interview was about 15-20 minutes and conducted in native language (Urdu) which was then translated to English language for the purpose of documentation. Snowball technique was adopted and the sample size was estimated from the point of saturation. RESULTS: All the interviews were conducted in the Gynecology ward of Hayatabad Medical Complex (HMC), Peshawar, Pakistan. Results were thematically analyzed. Thematic content analysis yielded 5 major themes: 1) Irregular menstrual cycle, 2) nausea and vomiting, 3) difficulty in emptying urinary bladder completely, 4) emergency due to severe pain, and 5) Physical works. CONCLUSIONS: There is a need of time that patients should be counseled at the time of discharge of the patient from the hospital. This is the right of the patient that they know about their disease and benefits of the successful treatment outcomes. Compliance can only be achieved through the counseling of the patients, resulting good quality of life and less economic burden over the patients.

Quantitative study evaluating perception of general public towards role of pharmacist in health care system of Pakistan.

To investigate general public perception towards the role of pharmacist in developing countries' healthcare system was the main aim of this study, which would be the basic foundation for researching the treatment pattern of cognitive disorder after stroke in communities. The study population (sample size = 385) consisted of general public from Islamabad, Faisalabad and Lahore, Pakistan. Main sections of the questionnaire comprised of series of statements pertaining to consumer's perception and experience with the pharmacists. The response rate of study was 77.1%. A majority (80.1%) of the consumers knows who is pharmacist; 49.8% (n = 148) of the respondents found the pharmacist working in the pharmacies; 74.1% (n = 220) believed that pharmacist can guide them regarding their medicine. With respect to government efforts to improve services provided by community pharmacies, less percentage (31.0%) of the consumers were satisfied. Half of the respondents (59.9%) were expecting from the pharmacists to be knowledgeable drug therapy experts, whereas 61.3% (n = 182) expect from the pharmacists to educate them regarding safe and appropriate use of medication. The findings of this study conclude that the quality of pharmaceutical services provided is very low in Pakistan. There is a gap between the public and the pharmacist, which can only be filled by creating awareness among public regarding the pharmacist's role in healthcare system and by focusing on how services provided by the pharmacists can add improvement to general public health.

Recent pharmacological advancements in schiff bases: a review.

Schiff bases are the biologically privileged scaffolds in organic chemistry, commonly synthesized from the condensation reaction of carbonyl functional group with amines. Naturally occurring and synthetically prepared Schiff bases are active molecules with many pharmacological activities like antibacterial, anti-cancer, anti-fungal, anti-malarial, antioxidant and many more. This review article summarizes pharmacological developments in the recent few years and gives a brief overview of their therapeutic potential.

Phospholipases A2: enzymatic assay for snake venom (Naja naja karachiensis) with their neutralization by medicinal plants of Pakistan.

Phospholipases A2 (PLA2) are the most lethal and noxious component of Naja naja karachiensis venom. They are engaged to induce severe toxicities after their penetration in victims. Present study was designed to highlight hydrolytic actions of PLA. in an egg yolk mixture and to encounter their deleterious effects via medicinal plants of Pakistan. PLA2 were found to produce free fatty acids in a dose dependent manner. Venom at concentration of 0.1 mg was found to liberate 26.6 pmoles of fatty acids with a decline in pH1 of 0.2 owing to the presence of PLA2 (133 Unit/mg). When quantity of venom was increased up to 8 mg, it caused to release 133 pmoles of free fatty acids with a decrease in 1.0 pH due to abundance in PLA, (665 Unit/mg). The rest of other doses of venom (0.3-4.0 mg) was found to liberate fatty acids between these two upper and lower limits. Twenty eight medicinal plants (0.1-0.6 mg) were tried to abort PLA, hydrolytic action, however, all were found useful (50-100%) against PLA,. Bauhinia variegate L., Citrus limon (L.). Burm.f. Enicostemnma hyssopifolium (Willd.) Verdoorn, Ocimum sanctum. Psoralea corylifolia L. and Stenolobium stans (L.) D. Don were found excellent in switching off 100% phospholipases A, at their lowest concentration (0.1 mg). Three plants extract were found useful only at lower concentration (0.1 mg), however, their higher doses were seemed to aggravate venom response. Eight medicinal plants failed to neutralize PLA, rather their higher doses were found effective. Standard antidote and rest of other plants extract were able to show maximum of 50% efficiencies. Therefore, it is necessary to identify and isolate bioactive constituent(s) from above cited six medicinal plants to eradicate the problem of snake bite in the future.

Mixed methodology approach in pharmacy practice research.

Healthcare providers play a major role in attending to all domains of health in a population. In terms of modem healthcare delivery, better health outcomes for population can be achieved by engaging multi-disciplinary expertise. In the last decade, pharmacy profession had transformed tremendously in terms of health and pharmaceutical service provision to both patients and general population. Within this practice transformation, pharmacists, especially those in developed countries, now occupy a respectable position within the healthcare system. In contrast, services and expertise offered by pharmacists in developing countries are still underutilized, and their role as healthcare professionals is not deemed to be important either by the community or by other healthcare providers, especially doctors and nurses. In order to explore the current perspectives regarding the role of pharmacists in the context of a developing country, a systematic research is needed. Mixed methodology research should be used for evidence generation. The philosophy of mixed method research came up decades ago. This approach is widely recommended for social and human sciences research. In recent existence, many researchers have begun to recommend mixed methods research as a separate methodology or design. Many factors have brought into the evolution of mixed methods research. A combination of both forms of data can provide the most complete analysis of the issues related to the pharmacy practice research. Numbers in quantitative and words in qualitative can be enclosed together to give the better understanding of research questions. Both forms of data are necessary for pharmacy practice research especially in case of developing countries where there is a need to generate the evidence for future health policy.

A study investigating the community pharmacist knowledge about the appropriate use of inhaler, Eastern Region AlAhsa, Saudi Arabia.

The current study aims to assess the community pharmacist's skills to make correct use of metered dose inhalers (MDIs). Seventy-four pharmacists were approached using six clusters from the most populous areas of Alahsa, Eastern region Saudi Arabia. Of whom n = 71, responses were taken in consideration to perform the statistical analysis. Scoring of pharmacist demonstration was done using a nine-step checklist for the appropriate use of inhaler. A simulated patient approach was used to assess pharmacist's skill. Majority, 98.6% of the pharmacists were Egyptian nationals with a mean age of 38.74 ± SD 4.52. Overall, pharmacists were found to have a poor recognition (mean score = 4.2 ± SD 2.08) with the steps considered while using an inhaler. However, significantly better knowledge differences were observed among the pharmacists aged 30-35 years (5.52 ± 2.14, t = 2.851, p = 0.009(∗)). In addition, job experience (3-4 years) was found significantly (p = 0.003(∗)) associated with a better knowledge toward the appropriate use of inhaler. It was seen that the young pharmacists working on chain pharmacies have comparatively better knowledge than the other groups.

Navigating Thyroid Dysfunction and Comorbidities Among University Students in Abbottabad, Pakistan - A Cross-Sectional Evaluation of Screening Tool for Thyroid Dysfunction.

Background: Thyroid dysfunction has a direct role in diagnosing, and assessment and indicates the development of thyroid carcinoma. This study aimed to assess thyroid dysfunction through medical camps in different age and sex groups in students of Comsats University Abbottabad Pakistan. Methods: In this study, a cross-sectional survey design was used. For data collection, a two-day medical camp was set in the Comsats University Abbottabad campus. The students were examined physically for symptoms of thyroid dysfunction using the survey questionnaire specifically designed for this study. Results: The current research revealed that 78 out of 1032 students, or 7.6% of the population, had thyroid disease. Although 39.3% (=406) were found to have low risk, followed by 36.7% (n=379) had moderate risk and 23.9% (n=247) had high risk of thyroid dysfunction. Altogether, 6.1% (n=63) of the students had high blood pressure (BP), 3.2% (n=33) had high cholesterolemia, 3.4% (n=33) had angina, and 0.9% (n=9) had diabetes mellitus (DM). In relation, students who exhibit signs and symptoms that last longer than five weeks include 42.2% (n=435) who felt the need for excessive sleep, 35.3% (n=364) who felt tired, 36.8% (n=380) who had trouble concentrating and 30.1% (n=311) who had palpitations. The high risk of thyroid being seen predominantly in students between the ages of 15-20 years (31.2%, n=148), as opposed to other age groups (p=0.001). Similar to this, women having a higher risk of thyroid disease (26.5%) than men (22.8%) (p =0.001). Conclusion: In conclusion, few students suffer with thyroid found to have high risk of thyroid disease. This method of questionnaire-based screening for thyroid dysfunction is cost-effective, with no additive risk of adverse effects from excessive screening, and could help in the early detection of thyroid and help avoid excess costs related to thyroid dysfunction and cancer screening.

A survey evaluating nurses' perception and expectations towards the role of pharmacist in Pakistan's healthcare system.

AIM: This paper is a report of a study of nurses' perception towards the role of pharmacist in Pakistan healthcare setup. BACKGROUND: Collaborative care by the healthcare professionals has the potential to improve patient care, enhance patient safety and to reduce workload issues that cause burn out among healthcare professionals. DESIGN: A quantitative (cross-sectional) study design was adopted. METHOD: A sample of 458 nurses was selected from government hospitals of three cities of Punjab, Pakistan. The study took place from 10 January 2009 to 15 March 2009. RESULTS: Two hundred and sixty-six questionnaires were returned, giving the response rate of (58·07%). Three-fifths of the nurses reported that they had once a day interaction with the pharmacist. Seven-tenths of the nurses expected the pharmacist to take personal responsibility for resolving any drug-related problems. Moreover they appear to have high expectations of the pharmacist, almost nine-tenths regarded pharmacists as knowledgeable drug therapy experts, and almost two-thirds of the nurses emphasized on counselling of patient by the pharmacist. CONCLUSION: Nurses in Pakistan showed negative perception towards the role of pharmacist in healthcare setting. Although nurses considered pharmacist as a drug information expert but their expectation did not match their experience. A possible factor for this behaviour could be due to nurses' belief that incorporating the role of pharmacist in patient care, may decrease their worth and can result in intrusion into their duties.

Awareness of Chronic Kidney Disease, Medication, and Laboratory Investigation among Nephrology and Urology Patients of Quetta, Pakistan.

Patients' awareness is critical in medical care, as it can serve as an input into the adjustment of interventions. The aim of study was to explore the level of awareness regarding chronic kidney disease (CKD), its medications, and laboratory investigations among nephrology and urology patients of Quetta. The cross-sectional study was used by adopting and culturally modifying a questionnaire. By convenient sampling technique, a total of 500 questionnaires were self-administered to inpatients, outpatients, and dialysis patients, and 468 responses (response rate 93.6%) were analyzed. Descriptive statistics, inferential statistics, and reliability analysis were performed on SPSS v25. A majority, 50.3% (n = 235), was unaware of symptoms that will develop due to worsening of disease, while 56.2% (n = 263) were unaware of what aggravates their kidney function. Almost half of the affected individuals, 47.4% (n = 222), have no understanding about the long-term prognosis of the disease. The majority of the respondents, 51.5% (n = 248), do not know about the names and usage of medications, and 62.4% (n = 292) were unaware of the medicines that may impair kidney function; more than half, 66.7% (n = 312), were unaware about the necessary laboratory investigations. A strong association between awareness and patient education level was found (p < 0.001). Awareness regarding disease condition, medications, and laboratory investigations of CKD among nephrology and urology patients of Quetta was found out to be low, which needs immediate educational intervention.

The role of pharmacists in developing countries: the current scenario in Pakistan.

During the past few years, the pharmacy profession has expanded significantly in terms of professional services delivery and now has been recognized as an important profession in the multidisciplinary provision of health care. In contrast to the situation in developed countries, pharmacists in developing countries are still underutilized and their role as health care professionals is not deemed important by either the community or other health care providers. The aim of this paper is to highlight the role of pharmacists in developing countries, particularly in Pakistan. The paper draws on the literature related to the socioeconomic and health status of Pakistan's population, along with background on the pharmacy profession in the country in the context of the current directions of health care. The paper highlights the current scenario and portrays the pharmacy profession in Pakistan. It concludes that although the pharmacy profession in Pakistan is continuously evolving, the health care system of Pakistan has yet to recognize the pharmacist's role. This lack of recognition is due to the limited interaction of pharmacists with the public. Pharmacists in Pakistan are concerned about their present professional role in the health care system. The main problem they are facing is the shortage of pharmacists in pharmacies. Moreover, their services are focused towards management more than towards customers. For these reasons, the pharmacist's role as a health care professional is not familiar to the public.

Corrigendum to "What Do the Hospital Pharmacists Think about the Quality of Pharmaceutical Care Services in a Pakistani Province? A Mixed Methodology Study".

[This corrects the article DOI: 10.1155/2015/756180.].