Simultaneously Improving Mechanical, Formulation, and In Vivo Performance of Naproxen by Co-Crystallization.

Naproxen (NAP), an anti-inflammatory drug belonging to class II of Biopharmaceutic Classification System, has low aqueous solubility and dissolution rate which limit its oral bioavailability. The focus of this investigation was to assess the impact of co-crystallization in improving the physico-mechanical and in vivo performance of NAP. NAP was co-crystallized using nicotinamide as a co-former employing liquid-assisted grinding method and characterized by intrinsic dissolution rate, DSC, and PXRD. Prepared co-crystal exhibited improved physicochemical and mechanical properties. Mechanical behavior of NAP and developed co-crystal was analyzed by drawing tabletability curves. Over the entire range of used compaction pressure, NAP showed poor tensile strength (< 2 MPa) which resulted in lamination and capping in some tablets. In contrast, tensile strength of co-crystal gradually increased with pressure and was ~ 1.80 times that of NAP at 5000 psi. Intrinsic dissolution profile of co-crystal showed a more than five and twofold faster dissolution than NAP in 0.1 M HCl and phosphate buffer pH 7.4 at 37°C. In addition, formulation of co-crystal powder into tablets by direct compression demonstrated enhanced dissolution profiles (~ 43% in 0.1 M HCl and ~ 92% in phosphate buffer pH 7.4) in comparison to a marketed product, Neoprox (~ 25 and ~ 80%) after 60 min. In a single dose oral exposure study conducted in sheep, co-crystal showed more than 1.5-fold increase in AUC and Cmax. In conclusion, co-crystals of NAP illustrated better tabletability, in vitro and in vivo performance.

Prevalence of asthma and its management: A review.

Among respiratory problems, asthma is one of the most apidly growing disorder which has victimised about onethird of the world's population and almost 2.5 million patients die annually as a result of severe exacerbation. Asthmatic patients most of the time fail to receive maximum benefits from the therapy because of drugrelated problems, side effects of steroid medication and special skill required for the administration technique of drug inhalation. The current review was planned to highlight the most frequent problems of asthmatic patients and their possible management suggested during the last few years. The greatest challenge is to ensure adherence to medication along with appropriate inhalation technique among asthmatic Patients Proper selection of drug and Device. According to Global Initiative for Asthma Guidelines 2017, proper counselling, training sessions, dosage calendars, patient reminders and evaluation of inhalation technique are found to be very helpful in improving the quality of life of patients.

Prevalence of statin induced myopathy in Lahore, Pakistan.

Cardiovascular diseases are considered to be the leading cause of disability and deaths in the whole world. The major cause behind this disease is the formation of lipid plagues in the form of thrombus. The statins (HMG-CoA reductase inhibitors) are used for the treatment and prevention of hyperlipidemia. Myopathy is the major side effect caused by statins. The purpose of this study was to determine the prevalence of statin induced myopathy. A cross-sectional study design was adopted using convenient random sampling technique at Punjab Institute of Cardiology, Lahore Pakistan from November 2016 to February 2017. A total of 300 male and female patients were included having age range of 40-80 years. Data was collected directly from the patients and prevalence of myalgia was determined by the symptoms of the patients. Creatine Phospho Kinase levels were obtained of those patients showing symptoms. Data was analyzed by using SPSS version 21. The results showed that 51% patients were myalgic with mean±SEM, 1.49±0.29. Myalgia was more prevalent in age range 40-50, with females 57% and males 47%. Significant relation was found between myalgia and type of statin (p=0.05), duration of use of statin (p=0.036) and dose of statin (p=0.031). The study concludes that the prevalence of myalgia was not significant but females were more prone to myalgic symptoms as compared to males. It was further concluded that myalgic symptoms were directly related to dose and duration & type of statin use.

Impact of pharmacist's intervention on disease related knowledge, medication adherence, HRQoL and control of blood pressure among hypertensive patients.

The present study was aimed to evaluate the effect of educational intervention provided to the patients of hypertension through pharmacist with the goal to improve knowledge about hypertension, adherence to prescribed medicines, blood pressure control and HRQoL(Health Related Quality of Life).A total of 384 patients were assigned randomly into 2 groups including intervention and control groups each having 192 patients. Urdu versions of knowledge questionnaire regarding hypertension, medication adherence scale (MMAS-U) by Morisky and EuroQol scale (EQ-5D) were utilized. Each patient's blood pressure was measured. After educational intervention, an increase was found in mean knowledge score about hypertension (18.18 ± 4.00), adherence score (5.89 ± 1.90), HRQoL score (0.73 ± 0.12) and Visual Analogue Scale (VAS) score (69.39 ± 5.90) among the IG. The blood pressure control also improved and lower systolic (131.81 ± 10.98 mmHg) and diastolic blood pressures (83.75 ± 6.21 mmHg) were observed among the patients of IG. This study showed that educational programs are useful for patients in increasing patient's levels of knowledge about hypertension, improving adherence to prescribed medication and enhancing blood pressure control. This increase is in turn accountable to improve HRQoL.

KAP AMONG DOCTORS WORKING IN HOSPITALS, REGARDING HALAL PHARMACEUTICALS; A CROSS SECTIONAL ASSESSMENT.

There is a growing awareness amongst Muslims to avoid all items containing non-Halal ingredients. This sentiment has now progressed into the field of various medications. It therefore, required a study to assess the knowledge, attitude and perception (KAP) relating to pharmaceuticals containing non-Halal ingredients among doctors working in various hospitals of Malaysia. This was a cross sectional study, carried out in January 2013-February 2013 period, using a structured, self-administered questionnaires. Study settings included various government hospitals in Malaysia. Data were collected by distributing questionnaires through respective heads of the departments. Study was conducted on a sample of 243 participants. Inclusion criterion was a registered medical doctor working in a government hospital. Descriptive statistics (mean, standard deviation, frequency, percentage, median, inter quartile range) was applied to summarize the data, non-parametric tests were applied. χ2 Test and Fisher's Exact Test were applied to assess the association between demographic characteristics and knowledge, attitude and perception scores. Results revealed that the hospital doctors had a good and positive attitude and perception about Halal pharmaceuticals. Mean knowledge score out of maximum possible 9 score was 7.67 ± 1.68. Mean attitude score out of maximum possible 45 score was 34.10 ± 5.35 while mean perception score out of maximum possible 55 score was 45.73 ± 5.44. Mean overall KAP score out of maximum possible 109 was 87.60 ± 10.37. There was a significant, positive and weak correlation (0.20-0.29) between knowledge and attitude (r = 0.231, p < 0.001) as well as between knowledge and perception (r = 0.209, p = 0.001) while there was good correlation (0.5-0.75) between attitude and perception (r = 0.588, p < 0.001). It is concluded from the results that the better knowledge the respondents have on Halal pharmaceuticals the better is their perception and attitude towards Halal pharmaceuticals.

Patterns of Antimicrobial Use in Hospitalized Children: A Repeated Point Prevalence Survey From Pakistan.

Three repeated point prevalence surveys (PPSs) were conducted in pediatric wards of 5 hospitals using the methodology developed by Global-PPS to identify key targets for interventions and antibiotic stewardship programs. Out of the 916 hospitalized patients, 865 (94.6%) were treated with at least 1 antibiotic.

The burden of healthcare-associated infections among pediatrics: a repeated point prevalence survey from Pakistan.

BACKGROUND: Healthcare-associated infections (HAIs) are considered a major threat to public health resulting in significant morbidity, mortality, and additional costs. The present study aimed to assess the current patterns and risk factors of HAIs among hospitalized children. MATERIALS AND METHODS: Three repeated point prevalence surveys were conducted in the pediatric inpatients of four hospitals by using the methodology developed by the European Center for Disease Prevention and Control. All patients present in the ward at 8:00 AM on the survey day and not discharged from the hospital on the same day were included. A standardized data collection form containing information on the presence of HAIs and the associated risk factors was completed for the patients. FINDINGS: Out of 888 hospitalized patients, 116 (13.1%) had the symptoms of HAIs. Most common infections were bloodstream infections (BSIs) (32.8%), pneumonia (21.0%), ear, eyes, nose and throat infections (11.8%), and skin and soft tissue infections (SSTs) (19.0%). Factors significantly associated with infections were the length of hospital stay (p = 0.000), admission to the medicine ward (p = 0.034), and male gender (p = 0.010). BSIs were most common in children belonging to the age group of less than one month (78.9%), who were admitted to intensive care units (73.7%). SSTs including surgical site infections were more prevalent in surgery wards (78.3%). CONCLUSIONS: A high rate of HAIs among pediatrics was found in Pakistan. Infection control and prevention strategies are needed with a major focus on interventions to prevent the spread of most prevalent HAIs.

Polycystic Ovarian Syndrome-Related Depression in Adolescent Girls: A Review.

Polycystic ovarian syndrome (PCOS), a common endocrinal disorder of reproductive age characterized by heterogeneous complications, is nowadays prevailing among females at adolescent stage. Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity can occur in women with PCOS. In adolescents, infrequent or absence of menstruation may raise chances for this condition. The increased prevalence of PCOS among general population throughout the world is found to be 5%-10% in the women of reproductive age, and about 40% women with PCOS experience depression, particularly young girls. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications. Depression and anxiety are common in women with PCOS but are often overlooked and therefore left untreated. Along with the physical disturbances, many mental problems are also associated with PCOS. Therefore, PCOS not only has problems associated with reproduction but also has associated crucial metabolic and psychological health risks with increasing age of the patients. Because of the increased number of cases with PCOS around the world in present times, with prominent symptom of, specifically, depression at the adolescent stage, it is important to highlight the disease.

Ameliorating effect of Malva Neglecta on hyperglycemia and hyperlipidemia in diabetic rats

The plant, Malva neglecta wallr., is widely consumed for medicinal and nutritional purposes. The current study was carried out to assess the hypoglycemic and antihyperlipidemic potential of aqueous methanolic extract of M. neglecta. Chemical evaluation of the extract was performed by high pressure liquid chromatography. Oral glucose tolerance test (OGTT) was done in diabetic rats pre-exposed to 250, 500 and 750 mg/kg plant extract via the oral route. For hypoglycemic and biochemical study, the same therapy was administered to alloxan induced diabetic rats for 14 days. The standard control group received Glibenclamide (5 mg/kg). Ferulic acid, p-coumaric acid and other phenolic acids were detected and estimated in the extract. Administration of the plant extract significantly reduced blood glucose level in diabetic rats subjected to OGTT. The plant extract lowered the fasting blood glucose and alpha amylase, and prevented the damage to pancreas. It also corrected dyslipidemia in diabetic animals following 14 days therapy. Hence, this experimental study establishes the fact that M. neglecta exhibited significant antidiabetic and antihyperlipidemic activities in alloxan induced diabetic rats.

Association of hypertension and dyslipidaemia with increasing obesity in patients with Type 2 Diabetes Mellitus

The study was performed to estimate the association of hypertension and dyslipidaemia with increasing body weight and obesity in Type II diabetics of Lahore, Pakistan. An observational study was conducted by enrolling 2708 obese diabetics from four diabetes care centres of Lahore, Pakistan. Data was collected for a period of 7 months. Associations were estimated using chi-square, binary and multinomial logistic regression. Data suggested that blood pressure, systolic and diastolic, exhibited continual increase with increasing body weight and obesity class in diabetes patients with 41.8% increase in the prevalence of hypertension in obesity class III subjects (OR; 1.91, p=0.02). Likewise, triglycerides and total cholesterol exhibited continual increase in their mean values with increasing obesity, i-e., an overall increase in the prevalence of dyslipidaemia of 27.2% in obesity class 3 subjects (OR; 1.94, p=0.29). Taken together, this data suggested that hypertension is potentially associated with increasing obesity in diabetics, while dyslipidaemia demonstrated plausible association only with obesity class 3.