Exogenous application of salicylic acid ameliorates salinity stress in barley (Hordeum vulgare L.).

Barley (Hordeum vulgare L.) is a significant cereal crop belonging to Poaceae that is essential for human food and animal feeding. The production of barley grains was around 142.37 million tons in 2017/2018. However, the growth of barley was influenced by salinity which was enhanced by applying a foliar spray of salicylic acid. The current study investigated to evaluated the potential effect of SA on the barley (Hordeum vulgare L.) plants under salinity stress and its possible effects on physiological, biochemical, and growth responses. The experiment was conducted at Postgraduate Research Station (PARS), University of Agriculture; Faisalabad to assess the influence of salicylic acid on barley (Hordeum vulgare L.) under highly saline conditions. The experiment was conducted in a Completely Randomized Design (CRD) with 3 replicates. In plastic pots containing 8 kg of properly cleaned sand, two different types of barley (Sultan and Jau-17) were planted. The plants were then watered with a half-strength solution of Hoagland's nutritional solution. After the establishment of seedlings, two salt treatments (0 mM and 120 mM NaCl) were applied in combining three levels of exogenously applied salicylic acid (SA) (0, 0.5, and 1 mg L-1). Data about morphological, physiological, and biochemical attributes was recorded using standard procedure after three weeks of treatment. The morpho-physiological fresh weight of the shoot and root (48%), the dry mass of the shoot and root (66%), the plant height (18%), the chlorophyll a (30%), the chlorophyll b (22%), and the carotenoids (22%), all showed significant decreases. Salinity also decreased yield parameters and the chl. ratio (both at 29% and 26% of the total chl. leaf area index). Compared to the control parameters, the following data was recorded under salt stress: spike length, number of spikes, number of spikelets, number of tillers, biological yield, and harvest index. Salicylic acid was used as a foliar spray to lessen the effects of salinity stress, and 1 mg L-1 of salicylic acid proved more effective than 0.5 mg L-1. Both varieties show better growth by applying salicylic acid (0 mg L-1) as a control, showing normal growth. By increasing its level to (0.5 mg L-1), it shows better growth but maximized growth occurred at a higher level (1 mg L-1). Barley sultan (Hordeum vulgare L.) is the best variety as compared to Jau-17 performs more growth to mitigate salt stress (0mM and 120mM NaCl) by improving morpho-physiological parameters by enhancing plan height, Root and shoot fresh and dry weights, as well as root and shoot lengths, photosynthetic pigments, area of the leaves and their index, and yield attributes and reduce sodium ions.

Bi-polymeric Spongy Matrices Through Cross-linking Polymerization: Synthesized and Evaluated for Solubility Enhancement of Acyclovir.

In this study, two hydrophilic polymers hydroxypropyl methyl cellulose and beta-cyclodextrin (ß-CD) are used to synthesize highly responsive and spongy polymeric matrices. Porous and stimulus-responsive polymeric network was developed to improve the solubility of acyclovir (ACV) at significant level. Grafting was successfully carried out by free radical polymerization technique. Spongy matrices were characterized by percentage entrapment efficiency, drug loading, solubility studies, FTIR, powder X-ray diffraction, TGA, DSC, XRD, SEM, swelling studies, and in vitro studies. Acute oral toxicity studies were conducted to determine the safety of oral administration of prepared HPMC-ßCD-g-poly(AMPS) formulation. Porous and spongy structures were depicted in SEM images. Complex formation and thermal stability of constituents and drug (ACV) were analyzed by FTIR, TGA, and DSC spectra. XRD analysis revealed reduction in acyclovir crystallinity in spongy matrices. Particle size of optimized formulation was found in the range of 197 ± 2.55 nm. The momentous difference with reference product committed that drug solubility and release characteristics were markedly enhanced by the developed spongy matrices. Toxicity studies endorsed that developed spongy matrices were non-toxic and compatible to biological system. The efficient method of preparation, enhanced solubility, excellent physico-chemical characteristics, high dissolution, and non-toxic HPMC-ßCD-g-poly(AMPS) spongy matrices may be a promising approach for oral delivery of poorly soluble drugs.

Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study.

BACKGROUND: The unavailability of appropriate pediatric drug pack size is a global issue. Antibiotics are the lifesaving and most frequently prescribed therapeutic agents given to pediatrics. The objective of this study was to assess the compliance of pediatric antibiotic pack size with the standard dosage regimen. METHODS: A descriptive study design was employed. Data were collected from a community pharmacy in Bahawalpur, Pakistan, between August 1, 2017, and September 30, 2017. Five most commonly prescribed antibiotics were selected and calculations were made to check the appropriateness of packaging size by comparing the quantity of product in the available pack with the dosage regimen recommended by the British National Formulary for Children (BNFC). RESULTS: Only 16 clarithromycin, 9 amoxicillin, 1 cefotaxime, and 1 metronidazole packaging sizes were sufficient to meet the dosage regimen for treatment. None of the available pack sizes for gentamicin matched the recommended duration of treatment. The study findings revealed that the available pack sizes either had leftover or a shortfall of antibiotic formulation. Highly inappropriate dosage forms (containing either excess and less quantity) of antibiotics were intravenous infusions and oral suspensions. CONCLUSION: The study concluded that the packaging sizes of antibiotics failed to supply the recommended dosage regimen to pediatrics for common indications. This may contribute to development of antibiotic resistance among pediatric patients. Health policy makers should devise strict rules and regulations to ensure the availability of child-specific antibiotic pack sizes.

Factors associated with inappropriate dispensing of antibiotics among non-pharmacist pharmacy workers.

BACKGROUND: Pharmacies are a primary source of healthcare services in low and middle income countries, especially where patient to physician ratio is low. Due to the wide variability in the training of pharmacy workers, inappropriate antibiotic dispensing is common, which increases the risk of poor therapeutic outcomes and antibiotic resistance. OBJECTIVES: This study aims to understand the factors that drive the inappropriate dispensing of antibiotics among pharmacy workers in Bahawalpur, Pakistan. METHODS: In this qualitative study, the data were collected from the pharmacy workers through semi-structured interviews. A two-step sampling procedure, including purposive and convenient sampling techniques, was adopted to recruit the study participants. The sample size was determined by applying the saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analysed to draw conclusions using the inductive thematic analysis approach. RESULTS: A total of 16 in-depth interviews were conducted. Data analysis yielded four themes and 18 subthemes. Under-dispensing and dispensing of antibiotics without need were reported. Lack of knowledge of dispensers, false feeling of being qualified, social acceptance, customer demands, public beliefs, high consultation fees of doctors, expensive diagnostic tests, economic influences and profit maximization were the main factors associated with the inappropriate dispensing of antibiotics. CONCLUSIONS: Multiple pharmacy worker (non-pharmacist) level factors that may lead to the inappropriate dispensing of antibiotics were identified in this study. There is a dire need for the training of pharmacy workers and supervision of their dispensing practices. Strict enforcement of legislation is required to restrict the irrational use of antibiotics in Pakistan.

Community pharmacists as antibiotic stewards: A qualitative study exploring the current status of Antibiotic Stewardship Program in Bahawalpur, Pakistan.

BACKGROUND: The World Health Organization released a Global Action Plan to overcome the threatening concerns of antibacterial resistance. One of the cornerstones of this plan is the Antibiotic Stewardship Program (ASP). The study aimed to assess the community pharmacists' knowledge, perceptions and current practices regarding ASP. METHODS: A qualitative study was conducted in Bahawalpur, Pakistan, in which data were collected from the community pharmacists through in-depth, semi-structured interviews. The convenience sampling technique was used to recruit the study participants. Interview protocol was pilot tested and the sample size was limited by applying the saturation point criteria. All interviews were audio recorded and transcribed verbatim. The thematic analysis approach was used to analyze the data and draw conclusions based on study objectives. RESULTS: A total of fifteen community pharmacists were interviewed. Analysis of the data yielded five themes and 16 subthemes. All of the respondents had sound knowledge about the irrational use of antibiotics; however, they were oblivious about the ASP. After explaining the term, the respondents were of the opinion that these strategies could not be implemented in the current healthcare system of the country. According to the findings of the study, prescribing and dispensing practices were not followed. Only a few patients were educated about the antibiotics they were purchasing. CONCLUSION: Most of the study participants were unaware of any ASP being offered in the community pharmacy settings. The study participants agreed to be the antibiotic stewards, but a number of obstacles were reported. The training of pharmacists, medication reconciliation, the implementation of the good pharmacy practice guidelines and assurance of pharmacist availability at drug retail outlets were few suggestions given by the study participants to incorporate the ASP in the community settings.

Medicines shortages in Pakistan: a qualitative study to explore current situation, reasons and possible solutions to overcome the barriers.

OBJECTIVE: This study was conducted to assess current situation of medicines shortages in Pakistan and to identify its impact, reasons and possible solutions to overcome the barriers. DESIGN: A qualitative study. SETTING: The study was conducted between May 2018 and July 2018 in three cities of Pakistan including Islamabad, Karachi and Bahawalpur, depending on the availability of most relevant key informants. PARTICIPANTS: Health regulators, pharmaceutical manufacturers, pharmaceutical distributors and pharmacists. PRIMARY AND SECONDARY OUTCOME MEASURE: Study primarily explored current situation, reasons and potential solutions of medicines shortages in Pakistan. Secondary outcome was the issue of particular brand shortage. METHOD: Semistructured interviews were conducted. Sample size was determined by using saturation point criteria. Convenient sampling techniques were used to recruit the participants. The interviews were audiorecorded and transcribed verbatim. Data were analysed using inductive thematic analysis. RESULTS: A total of 41 stakeholders including 12 health regulators, 6 pharmaceutical manufacturers, 8 pharmaceutical distributors and 15 pharmacists participated in this study. Data analysis yielded 4 themes, 16 subthemes, 51 categories. Essential and life-saving medicines were in short supply. The major reasons of short supply of medicines were active pharmaceutical ingredient and raw material availability issues, lack of traditional distribution system and sudden demand fluctuation. Among proposed solutions, three most common were the facilitation and regulation of manufacturers, reasonable price fixation and improvements in the inventory control system. CONCLUSION: Medicines were short in supply, and this may have clinical and financial impact on the patients in Pakistan. There were multiple and complex reasons of medicines shortages. Mandatory government leadership is required to resolve the issue on priority basis for improving the access of medicines to the patients.

Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study.

BACKGROUND: The unavailability of appropriate pediatric drug pack size is a global issue. Antibiotics are the lifesaving and most frequently prescribed therapeutic agents given to pediatrics. The objective of this study was to assess the compliance of pediatric antibiotic pack size with the standard dosage regimen. METHODS: A descriptive study design was employed. Data were collected from a community pharmacy in Bahawalpur, Pakistan, between August 1, 2017, and September 30, 2017. Five most commonly prescribed antibiotics were selected and calculations were made to check the appropriateness of packaging size by comparing the quantity of product in the available pack with the dosage regimen recommended by the British National Formulary for Children (BNFC). RESULTS: Only 16 clarithromycin, 9 amoxicillin, 1 cefotaxime, and 1 metronidazole packaging sizes were sufficient to meet the dosage regimen for treatment. None of the available pack sizes for gentamicin matched the recommended duration of treatment. The study findings revealed that the available pack sizes either had leftover or a shortfall of antibiotic formulation. Highly inappropriate dosage forms (containing either excess and less quantity) of antibiotics were intravenous infusions and oral suspensions. CONCLUSION: The study concluded that the packaging sizes of antibiotics failed to supply the recommended dosage regimen to pediatrics for common indications. This may contribute to development of antibiotic resistance among pediatric patients. Health policy makers should devise strict rules and regulations to ensure the availability of child-specific antibiotic pack sizes.

What drives inappropriate use of antibiotics? A mixed methods study from Bahawalpur, Pakistan.

PURPOSE: This study investigates the knowledge, attitudes and practices of the general public regarding the use of antibiotics in community pharmacy, in Pakistan. METHODS: This is a mixed method study where data were collected through a validated questionnaire and semi-structured interviews. Convenience sampling techniques were used to recruit participants from the general public of Bahawalpur, Pakistan who visited pharmacies to purchase antibiotics between 1 June 2018 and 31 July 2018. Descriptive statistics and regression analyses were used to tabulate the results of quantitative data while inductive thematic analysis was used to identify themes and draw conclusions from the qualitative data. RESULTS: Over 60% of the 400 survey participants (n=246; 61.5%) had a moderate level of antibiotic knowledge; however, attitudes regarding antibiotics use were poor in half the sample (n=201; 50.3%). More than half (n=226; 56.6%) of the respondents stated that antibiotics could cure all types of infections. Just under one third (n=129; 32.3%) of respondents obtained the appropriate dosage regimen while the majority did not complete the course (n=369; 92.3%); stopping when they felt better. Inductive thematic analysis yielded four themes, 10 subthemes and 27 categories. Two subthemes were related to knowledge, one to attitude, three to practices and four subthemes were related to suggestions to improve the healthcare system. Inappropriate antibiotic practices included: lack of consultation with healthcare professionals, purchase of antibiotics without prescription or refilling of previous prescription, use of home supply of antibiotics, sharing of antibiotics with others, improper dosage regimens and early cessation of antibiotic therapy. CONCLUSION: Level of education, low health literacy, high consultation fees of private practitioners, inadequate health facilities in government hospitals and patient overload, busy schedules of people, poor healthcare infrastructure in rural areas and unrestricted supply of antibiotics were key factors associated with inappropriate use of antibiotics in Pakistan.

Extent and Predictors of Poor Glycaemic Control among Elderly Pakistani Patients with Type 2 Diabetes Mellitus: A Multi-Centre Cross-Sectional Study.

Objectives: This study aimed to explore the relationship between glycaemic control and factors that may influence this among elderly type 2 diabetes mellitus (T2DM) patients in Lahore, Pakistan. Methods: This descriptive, cross-sectional study was conducted at the Jinnah and Sir Ganga Ram Hospitals, Lahore using convenience sampling techniques between 1 December 2015 and 28 February 2016. The sample consisted of elderly (>65 years) T2DM patients. Glycaemic values and patient characteristics were obtained from medical charts. Consenting patients were interviewed to complete the Barthel Index, Lawton Instrumental Activities of Daily Living Scale, Clinical Frailty Scale, Iowa Pain Thermometer Scale, Geriatric Depression Scale, Montreal Cognitive Assessment tool, Mini Nutritional Assessment Scale-Short Form and Self Care Inventory-Revised Version. Multiple logistic regression analysis was carried out to determine the predictors of poor glycaemic control. Results: A total of 490 patients were approached and 400 agreed to participate. Overall, nearly one-third (32.2%, n = 129) of patients had glycated haemoglobin (HbA1c) at the target level. Fasting and random plasma glucose levels were within the target range to much the same extent; (36.8%, n = 147) and (27%, n = 108), respectively. HbA1c levels were also higher in patients with co-morbidities (67.4%, n = 229) with diabetes-related complications (73.5%, n = 227). Significant predictors of impaired glycaemic control (HbA1c) included poor diabetes self-care (adjusted odds ratio (AOR) 0.96; 95% confidence interval (CI) 0.95, 0.98), not being prescribed oral hypoglycaemic agents (OHA) (AOR 6.22; 95% CI 2.09, 18.46), regular hypoglycaemic attacks (AOR 2.53; 95% CI 1.34, 4.81) and falling tendency (AOR 0.19; 95% CI 0.10, 0.36). Conclusions: Poor glycaemic control prevailed among the majority of elderly Pakistani diabetic patients in this study. Triggering factors of poor glycaemic control should be taken into consideration by the healthcare professionals in targeting multifaceted interventions to achieve good glycaemic control.

Analysis of tuberculosis treatment outcomes among pulmonary tuberculosis patients in Bahawalpur, Pakistan.

OBJECTIVE: Monitoring tuberculosis treatment outcomes and understanding the reasons for unsuccessful treatment are important indicators for evaluating the performance of the national tuberculosis control program. The aim of this study was to evaluate the treatment outcomes among pulmonary TB (PTB) patients and identify the predictors of unsuccessful treatment outcome. RESULTS: Treatment success rate of 67.8% among new and retreatment PTB patients and 69% in new smear positive PTB patients was observed. Close to 21% (20.9%) and 15.7% PTB and new smear positive PTB patients had loss to follow-up during treatment. Overall, older patients (AOR 1.02; 95% CI 1.01-1.0), smokers (AOR 1.65; 95% CI 1.02-2.67) and retreatment cases of TB (AOR 2.34; 95% CI 1.43-3.84) were at greater risk of having unsuccessful treatment outcomes. Moreover, sputum positivity at 2 months (AOR 13.78; 95% CI 5.09-37.26) was a significant predictor of poor treatment outcomes in new smear positive PTB patients. The treatment success rate among PTB patients was lower than the recommended 85% success rate. TB patients at higher risk of unsuccessful treatment outcomes should be provided with enhanced supervision and treatment monitoring to improve the success rate of TB management in Pakistan.