Exploring the Clinical Features, Management of Hypertension, and Predictors of Severity in Hospitalized Hypertensive COVID-19 Patients.

Background Hypertension significantly contributes to the severity, prolonged hospitalization, the need for intensive care, and mortality of COVID-19 patients. However, the data is still evolving. This study investigated the predictors of severity among hypertensive COVID-19 patients. Methodology This cohort study included 333 hospitalized hypertensive COVID-19 patients at the Indus Hospital, Karachi, Pakistan, from April 2021 to October 2021. The study evaluated the clinical features, antihypertensive therapy, and predictors of severity. A multivariable binary logistic regression model was used to determine severity predictors using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, NY, USA). Results The majority of hypertensive COVID-19 patients were females (54.7%), aged <65 years (55.8%), and coexisted with diabetes mellitus (56.5%). The independent predictors of severity were male (aOR 2.65, 95% CI, 1.08-6.51; p < 0.033), fever (aOR 3.52, 95% CI, 1.24-9.92; p = 0.017), shortness of breath (aOR 4.49, 95% CI, 1.73-11.63; p = 0.002), oxygen saturation (<90%) (aOR 87.39, 95% CI, 19.15-398.75; p < 0.001), and D-dimer (>0.5 mcg/ml) (aOR 3.03, 95% CI, 1.19-7.71; p = 0.020). Conclusions Our study concluded that males with fever before admission, shortness of breath, lower oxygen saturation, and elevated D-dimer are the predictors of severity among hypertensive COVID-19 patients.

Exploring Patient Safety Culture: A Study of Community Pharmacies in Karachi, Pakistan.

Background Community pharmacies are integral to the healthcare system, actively contributing to patient safety through accurate dispensing, education, collaboration, monitoring, and the implementation of safety protocols. Their accessibility and role as medication experts make them key partners in promoting positive health outcomes for individuals and communities. Objective The current study will evaluate the patient safety culture (PSC) among community pharmacies in Karachi, Pakistan. Additionally, this study will measure the association between patient safety culture in community pharmacies and the demographic characteristics of the pharmacy staff. Methods A cross-sectional survey of pharmacy staff was conducted using a survey instrument developed by the US Agency for Healthcare Research and Quality (AHRQ). Demographic variables and assessments of safety culture in pharmacies were studied. The data were analyzed using descriptive statistics. Results Among the 102 participants, positive responses ranged from 30% to 87.5%. The highest positive response was for the dimension "mistakes in communication" (86.3%), followed by "communication across shifts" (82.2%) and "communication openness" (81.7%). The dimensions "overall perceptions of patient safety" and "response to mistakes" had the lowest positive responses (56.0% and 60.9%, respectively). Furthermore, many staff did not regularly record the errors, even if they impacted the practices. Conclusion There was an overall unfavorable perception of patient safety culture among the surveyed pharmacies of Karachi, Pakistan. However, the communication dimensions showed the highest positive response. There is a strong need to improve the overall perception of patient safety among the staff and develop an optimistic response to mistakes.

Psychometric Properties and Assessment of Knowledge, Attitude, and Practice Towards ChatGPT in Pharmacy Practice and Education: a Study Protocol.

ChatGPT represents an advanced conversational artificial intelligence (AI), providing a powerful tool for generating human-like responses that could change pharmacy prospects. This protocol aims to describe the development, validation, and utilization of a tool to assess the knowledge, attitude, and practice towards ChatGPT (KAP-C) in pharmacy practice and education. The development and validation process of the KAP-C tool will include a comprehensive literature search to identify relevant constructs, content validation by a panel of experts for items relevancy using content validity index (CVI) and face validation by sample participants for items clarity using face validity index (FVI), readability and difficulty index using the Flesch-Kincaid Readability Test, Gunning Fog Index, or Simple Measure of Gobbledygook (SMOG), assessment of reliability using internal consistency (Cronbach's alpha), and exploratory factor analysis (EFA) to determine the underlying factor structures (eigenvalues, scree plot analysis, factor loadings, and varimax). The second phase will utilize the validated KAP-C tool to conduct KAP surveys among pharmacists and pharmacy students in selected low- and middle-income countries (LMICs) (Nigeria, Pakistan, and Yemen). The final data will be analyzed descriptively using frequencies, percentages, mean (standard deviation) or median (interquartile range), and inferential statistics like Chi-square or regression analyses using IBM SPSS version 28. A p<0.05 will be considered statistically significant. ChatGPT holds the potential to revolutionize pharmacy practice and education. This study will highlight the psychometric properties of the KAP-C tool that assesses the knowledge, attitude, and practice towards ChatGPT in pharmacy practice and education. The findings will contribute to the potential ethical integration of ChatGPT into pharmacy practice and education in LMICs, serve as a reference to other economies, and provide valuable evidence for leveraging AI advancements in pharmacy.

Treatment Outcomes of Childhood TB Patients in Four TB High Burden States of Malaysia: Results from a Multicenter Retrospective Cohort Study.

Data regarding treatment outcomes among childhood TB patients are lacking in Malaysia. The present study aimed to evaluate the treatment outcomes and predictors of unsuccessful treatment outcomes among childhood TB patients in four TB high-burden states of Malaysia. This was a retrospective cohort study conducted at 13 healthcare centers in four states of Malaysia, namely, Sabah, Sarawak, Selangor, and Penang. During the study period, a total of 8932 TB patients were enrolled for treatment at the study sites, of whom 206 (2.31%) were children. The majority of the childhood TB patients were female (52.9%) and belonged to the age group of 6-10 years (42.7%). Pulmonary TB accounted for 70.9% of childhood TB. Among childhood PTB patients, 50% were sputum smear negative. One hundred and seventy-eight patients (86.4%) were successfully treated (87 were cured and 91 completed treatment). Among 28 (13.6%) patients with unsuccessful treatment outcomes, 13 (6.3%) died, 3 (1.5%) failed treatment, 9 (4.4%) defaulted, and 3 (1.5%) were transferred out. Multivariate analysis revealed that patients' age (5-14 years) (OR = 0.279, p-value = 0.006) and male gender (OR = 0.390, p-value = 0.046) had a statistically significant negative association with unsuccessful treatment outcomes. The prevalence of childhood TB in the current study was comparable to the recently published national estimates. The study sites reached the WHO target of treatment success. Special attention to patients with identified risk factors can improve treatment outcomes.

Meloxicam loaded hydroxypropyl methylcellulose (HPMC) microparticulate: Fabrication, characterization and in vivo pharmacokinetic assessment.

Meloxicam (MEL) is an oxicam derivative with low water solubility that is useful in the treatment of colorectal cancer (CRC) as a COX-2 inhibitor. MEL-loaded HPMC micro particles were fabricated using an oil-in-oil (o/o) emulsion solvent evaporation (ESE) method. FTIR, XRD, particle size analysis, DSC, SEM and in vitro dissolution investigation were utilized to evaluate the produced micro particles physiochemically. Finally, rabbits were used as animal models in an in vivo pharmacokinetic study to assess the MEL concentration in the plasma of rabbits. Pure MEL, F1 and F2 were given to rabbits by a single dose for in vivo pharmacokinetic investigations. The XRD and DSC results confirmed the transformation of MEL from its crystalline nature to the amorphous state in micro particles. The formulations F1 and F2 particle sizes were determined 92.43µm and 163.26µm, respectively. The prepared micro particles had a smooth, non-porous and spherical surface. In comparison to the pure drug (22.4%), the F1 and F2 cumulative drug release (%) was 86.19% and 79.57%, respectively. Pure MEL, F1 and F2 have estimated Cmax values of 7.21, 25.41 and 22.38µg/mL, respectively. MEL had a half-life of 19.98 hours, which rose to 22.19 hours and 24.75 hours for F1 and F2, respectively. MEL, F1 and F2 had AUC0-α values of 116.034, 445.95 and 462.72µg/mL*h, respectively. Considering these aspects, MEL-loaded HPMC micro particles may have the potential to better the delivery and control the release of drug that is not easily dissolved in water which could lead to improved therapeutic efficacy and limited side effects.

Monkeypox Cross-Sectional Survey of Knowledge, Attitudes, Practices, and Willingness to Vaccinate among University Students in Pakistan.

This study aimed to explore knowledge, attitude, perceptions, and willingness regarding vaccination among university students in Pakistan. This cross-sectional study was carried out using an open online self-administered survey via Google Forms. The survey data were collected between the 15 to 30 of October 2022. A total of 946 respondents participated in the study, of which the majority were female (514, 54.3%). Most students belonged to a medical background, specifically pharmaceutical sciences. Most of the respondents did not know about monkeypox before 2022 (646, 68.3%). Regarding overall knowledge of monkeypox, most of the respondents had average knowledge (726, 76.7%), with very few having good knowledge (60, 6.3%). Regarding overall attitudes towards monkeypox, most of the respondents had neutral attitudes (648, 68.5%). There was a significant association between knowledge of Monkeypox with the type of academic degree (p < 0.001), type of discipline (p < 0.001), and region of respondents (p < 0.001). The willingness to vaccinate among the population was (67.7%). The current study pointed out that the overall knowledge of monkeypox was average in most respondents, with considerable knowledge gaps in most aspects. The overall attitude towards monkeypox was neutral. Further, the knowledge about monkeypox was strongly associated with academic degree, study discipline, and region of respondents. Our findings emphasize the need to raise public awareness by educating students on the monkeypox virus. This will improve adherence to preventative recommendations.

Availability, Affordability, Access, and Pricing of Anti-cancer Medicines in Low- and Middle-Income Countries: A Systematic Review of Literature.

Background: Cancer is the second leading cause of death globally accounting for more than half of deaths in Low- and Middle-Income Countries (LMICs). Cancer treatment is expensive and the high prices of cancer medicines have a huge impact on access in LMICs. Scarcity of pricing or affordability data is one of the major barriers in the development of effective and transparent pricing policies in LMICs. This study aimed to conduct a systematic review of the literature regarding pricing, availability, affordability, and access to anti-cancer medicines in LMICs. Method: A systematic search was conducted across six electronic databases: PubMed, Medline/CINAHL (EBSCO), Web of Science, Springer Links, Scopus, and Google Scholar. The literature (from 2015 to 2020) was reviewed to identify original research articles published in English. Results: A total of 13 studies were included in the review with some having multiple outcomes: five studies on pricing, four studies addressed affordability, five studies reported on availability, and four studies on access to anti-cancer medicines. The studies showed that in LMICs, there are wide variations in cancer prices and availability amongst the medicine brands and across different countries, with less affordability by patients with low-income levels, sometimes leading to treatment abandonment. Conclusion: Given the importance of medicine availability and prices in patient access and medicine buying capacity of governments, multi-pronged policy and program approaches by multiple stakeholders are needed to ensure access to cancer medicines.

Biodegradable and biocompatible polymeric nanoparticles for enhanced solubility and safe oral delivery of docetaxel: In vivo toxicity evaluation.

Docetaxel (DTX) is a chemotherapeutic drug with poor hydrophilicity and permeability. Its lipophilic properties decrease its absorption in systemic circulation which hinders its therapeutic efficacy & safety. Cyclodextrins (CDs) with their unique structural properties enhance solubility of chemotherapeutic drugs. The study was designed to formulate docetaxel-cyclodextrins inclusion complexes for enhancement of solubility with sulfobutyl ether ß-cyclodextrin (SBE7-ß-CD), hydroxypropyl ß-cyclodextrin (HP-ß-CD) and ß-cyclodextrin (ß-CD). Further, by using ionic gelation method polymeric nanoparticles of docetaxel-cyclodextrins were prepared with sodium tri poly phosphate (STPP) and chitosan (CS). Optimization is performed by varying CS and STPP mass ratios. Nanoparticles were analyzed for their physicochemical properties, drug-excipient compatibility, thermal stability and oral toxicity. CDs enhanced the solubility of DTX. Nanoparticles were found within 144.8 ± 65.19 - 372.0 ± 126.9 nm diameters with polydispersity ranging 0.117-0.375. The particles were found round & circular in shape with smooth and non-porous surface. Increased quantity of drug release was observed from DTX-CDs loaded nanoparticles than pure drug loaded nanoparticles. Oral toxicity in rabbits revealed biochemical, histopathological profile with no toxic effect on cellular structure of animals.

Novel multiparticulate pH triggered delayed release chronotherapeutic drug delivery of celecoxib-ß-cyclodextrin inclusion complexes by using Box-Behnken design.

This study aimed to prepare novel colon targeted celecoxib-ß-cyclodextrin (CXB-ß-CD) inclusion complex loaded eudragit S 100 (ES100) microparticles for chronotherapy of rheumatoid arthritis (RA) which is an innovative approach, never reported before, for the fabrication of CXB-ß-CD complex in the form of microparticles and its colon targeting. CXB was complexed with ß-cyclodextrin by kneading technique and we evaluated the effect of ß-CD on saturation solubility of CXB. Microparticles were developed by oil-in-oil emulsion solvent evaporation technique and formulation variables (polymer conc, surfactant conc and stirring speed) were optimized by using three-factor three-level Box-Behnken design (BBD). SEM imaging revealed smooth, uniform and spherical shape microparticles. There was 7.3 fold increases in saturation solubility of CXB-ß-CD inclusion complex in distilled water as compared to pure CXB. Particle size was in the range of 50.42 µm to 238.38 µm with entrapment efficiency of 68.47% to 91.65%. Biphasic drug release pattern was found i.e initially delayed release in stomach and small intestine followed by fast release at colonic pH. Response variable results achieved from optimized formulation were very close to the response values suggested by BBD signifying the actual reliability and robustness of BBD in the fabrication of colon targeted CXB-ß-CD microparticles. The comparison of CXB-ß-CD optimized formulation with optimized formulation containing pure CXB showed increase in drug release due to enhancement of water solubility of CXB-ß-CD inclusion complex. So, it can be concluded that CXB-ß-CD loaded ES100 microparticles can be successfully fabricated with enhanced solubility for the chronotherapy of rheumatoid arthritis.