A prospective observational study of estimating drug related problems and clinical outcomes in subtypes of stroke patients.

BACKGROUND: Stroke is a neurological disease and a leading cause of mortality worldwide. Strokes mainly consist of two types: hemorrhage and ischemia. Stroke patients are being administered multiple drug therapy and are at risk of drug-related problems. AIM: To estimate drug-related problems (DRPs) and clinical end outcomes in hospitalized stroke patients. METHODS: Current study was a multicenter, cross-sectional prospective observational study including 250 stroke patients admitted to tertiary care hospitals in Karachi, Pakistan. The study included all clinical subtypes of stroke patients i.e. Stroke, Ischemic stroke, Hemorrhagic stroke, CVA, and TIA. Associations among patient-clinical end outcomes and drug therapy-related variables like DRPs, mortality, and morbidity rates were estimated using Pearson's chi-squared test. Statistical analysis was done by using SPSS software, version 25. RESULTS: A total of 250 patients participated in this study suffering from different clinical subtypes of stroke i.e. Ischemic stroke, hemorrhagic stroke, TIA, and CVA, including 46% male and 54% female patients. The majority of patients' stay at the hospital was between 1-10 days. The overall mortality rate in stroke patients was 51%. HAIs were observed in 70% of patients, HAIs faced by patients were SAP, CAP, UTI, sepsis, and VAP. Drugs were assessed according to NEML i.e. access group antibiotics, watch group antibiotics, reserve group antibiotics, statins, antiepileptics, and proton pump inhibitors. Majorly ceftriaxone was administered to 79% of patients, piperacillin-tazobactam to 52%, and cefixime to 48%, whereas meropenem was administered to 42% of patients along with vancomycin to 39% of total patients. A high mortality rate was observed in the case of Klebsiella pneumoniae and Staphylococcus aureus i.e. 78% and in the case of streptococcus pneumoniae 61% mortality rate was observed. Due to the presence of DRPs and various other clinical factors like comorbidities, DDIs, HAIs, administration of potentially nephrotoxic drugs, and administration of antibiotics without having CST, hospitalized stroke patients faced many problems. CONCLUSION: This study helped determine DRPs along with various clinical factors affecting the clinical end outcomes of patients suffering from any clinical subtype of stroke. Due to the enhancement in the evidence of the incidence of DRPs in tertiary care hospitals, pharmacist-led drug therapy review by interfering with doctors and other medical professionals at the patient bed site is needed and should be done to avoid any negative end outcomes and serious issues related to DRPs.

Assessment of potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients admitted to tertiary care hospitals.

Meningitis is an important cause of morbidity and mortality in children and adults. Its treatment strategy varies with age and gender. To assess potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients, a multicenter, clinical, descriptive, cross-sectional prospective observational study in 120 patients admitted to different tertiary care hospitals in Karachi was conducted. It includes both males 48% and females 52% belonging from all age groups i.e. peadiatrics (01 to 12 years), adults (18 to 65 years), and geriatrics (66 to 75 years). Out of these 72 patients were admitted in the public sector and 48 patients were admitted in private sector hospitals. Nosocomial infections were developed in 41% of patients during their stay at the hospital. Potentially nephrotoxic drugs were administered to all BM patients, these drugs should be administered carefully. Majorly Ceftriaxone was administered to 86% of patients, Vancomycin 71%, and meropenem 73% whereas 68% of patients were administered piperacillin-tazobactam. Organisms involved as causative agents in the majority of patients are Neisseria meningitides, Pseudomonas aeruginosa and, Streptococcus pneumoniae. DRPs impacted patient clinical outcomes in presence of many other factors like comorbidities, DDIs, Nis, administration of potentially nephrotoxic drugs, and administration of watch group and reserve group antibiotics without having culture sensitivity test, even after having CST no principles of de-escalation for antibiotics were done, which is a very important factor for hospitalized patients having IV antibiotics. The mortality rate among BM patients was 66%. The majority of patients (87%) stay at the hospital was 1-10 days. The present study helped in the identification of DRPs along with some other factors affecting the clinical outcomes in patients suffering from bacterial meningitis. Healthcare professionals should receive awareness and education on the importance of CST before initiating antibiotic therapy. Pharmacist-led medication review is necessary and should be followed to avoid negative outcomes and serious consequences related to DRPs.

Cervical Cancer Awareness and Attitude Towards Cervical Cancer Screening and Human Papillomavirus Vaccines Among Urban Women of Karachi, Pakistan.

Cervical cancer is the second most common cancer among women under 50 years of age in Pakistan. The current study was designed to assess the level of awareness through educational outreach presentations about cervical cancer, Papanicolaou (Pap) smear test, and human papillomavirus (HPV) vaccination in Karachi, Pakistan. Women from different urban hospitals were enrolled. Participants participated in a 45-minute presentation on cervical cancer awareness led by student pharmacists from Nazeer Hussain University, Karachi. A pre-and post-test was administered to assess the impact of the intervention. Descriptive statistics were used to summarize the findings, and a t-test was used for matched comparison, and a p-value <0.05 for statistical significance. A total of 150 women participated in the study. The study found that Pakistani women living in urban settings were less knowledgeable about the causes of cervical cancer and prevention. After the presentation, we observed a 45% increase in knowledge, and 31% of participants said they would obtain a Pap smear test in the next six months. Supervised pharmacy student-led presentations on cervical cancer educational awareness that significantly impacted women participants. Pharmacists can play a key role in reducing cervical cancer deaths through increased awareness, education, prevention, and immunization.

Comparative analysis of antioxidant, antidiabetic and analgesic activity of Callestemon viminalis L. and Alcea rosea L. leaves extracts.

High levels of reactive oxygen species (ROS) in the body and diabetes are key factors for the development of hypercholesteremia and related neuropathic pains. Current study aimed to compare the antioxidant, antidiabetic and analgesic activities of aqueous methanolic extracts of C. viminalis L. and A. rosea L. leaves. HPLC method was used for phenolic content evaluation. Antioxidant capacity was determined by DPPH and analgesic activity was performed via acetic acid induced writhing reflex test. Whereas the antidiabetic activity was performed on Alloxan induced diabetes model. HPLC analysis indicated the presence of phenols in both extracts. Based on DPPH radical scavenging activity, C. viminalis and A.rosea L. both leaves extracts showed strong scavenging activity (IC50, 11.96±0.64lg/mL) and (IC50, 10.11±0.74lg/mL) respectively. Antidiabetic effect of C. viminalis L and A. rosea L. were also significant (p<0.05). Further biochemical analysis showed both leaves extracts significantly (P<0.05) reduces glucose, Low density lipid (LDL), triglycerides (TG), total cholesterol (TC) and urea while high density lipid (HDL) were improved. In writhing reflex test both extracts exhibited significant (P<0.01) analgesic activity which was comparable to Aspirin. In conclusion both C. viminalis L. and A. rosea L. leaves extracts displayed significant antioxidant, analgesic and antidiabetic activity.

Assessing the Workplace Cyberloafing Behavior among Pharmacists in Pakistan.

Objective: After the commencement of the Internet and the popularity of various electronic devices, cyberloafing has become prevalent in the workplace regardless of professional type, demographic characteristics, and country. Individuals use the Internet for work-irrelevant purposes during work hours, which is believed to have a controversial role in work productivity. However, rare studies have paid attention to the prevalence of cyberloafing behavior among Pakistan pharmacists. Considering pharmacists' essential role in the health sector, this study investigates the prevalence of cyberloafing activities among workplace pharmacists in Pakistan. Methods: This cross-sectional survey was conducted among 242 registered pharmacists in Pakistan between October 2021 and February 2022 with a structured self-administered online questionnaire. The final sample consisted of 200 valid responses after screening. Data were processed through exploratory factor analysis and confirmatory factor analyses. Pearson Chi-square analysis was also used to test the correlation between factors. Findings: Descriptive analysis shows that pharmacists spend more time on sharing-related activities and least on gambling/gaming-related activities in the workplace. All the items' Cronbach's alpha values range from 0.923 to 0.927. The analysis indicates that (60%) pharmacists have intermediate Internet skills. The results also suggest that age, Internet usage, and work area have a strong relationship with cyberloafing behaviors which also, in turn, are linked with their perceived Internet skills. This study has important practical implications for pharmacy management in Pakistan. Conclusion: Cyberloafing behavior is prevalent among Pakistan pharmacists. Our findings could inspire how managers and all other relevant stakeholders could improve the pharmacy system in Pakistan.

Determining the release kinetics of risperidone controlled release matrices to treat schizophrenia.

Risperidone is an atypical antipsychotic agent clinically used to treat schizophrenia, bipolar diseases, and autism. Usually, the frequency of doses is twice daily. In the present study, risperidone controlled release matrices formulated using hydrophilic and hydrophobic polymers. The tablets were prepared by direct compression. The pre-compression and post-compression properties were assessed, along with swelling studies. The morphology of particles observed using scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). The stability study on the drug was performed using thermal gravimetric analysis (TGA) and differential thermal analysis (DTA). The optimized formulation was prepared with the help of hydrophilic polymer K100M (40% ratio). Furthermore, release kinetics had investigated. The release pattern of optimized formulation FT5 fitted best to zero-order kinetics and showed excellent release characteristics. The model-independent approach had been used, formulations FT6 and FT8 showed resemblance with FT5 in all three media, respectively. The once daily formulation of risperidone could be beneficial for schizophrenia patients and their caregivers and will improve patient compliance.