Trastuzumab deruxtecan in human epidermal growth factor receptor 2-positive breast cancer brain metastases: a systematic review and meta-analysis

BACKGROUND

Trastuzumab deruxtecan (T-DXd) has shown promising results in patients with breast cancer brain metastases (BCBMs). We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of T-DXd in the human epidermal growth factor receptor 2 (HER2)-positive BCBM population.

PATIENTS AND METHODS

We searched PubMed, Embase, and Cochrane Library databases as well as American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and San Antonio Breast Cancer Symposium (SABCS) websites for clinical trials (CTs) and observational studies evaluating T-DXd in patients with HER2-positive BCBM. Heterogeneity was assessed with I2 statistics. Random effects models were used for all statistical analyses, which were carried out using R software (version 4.2.2).

RESULTS

Ten studies were included, six CTs (n = 189) and four observational studies (n = 130), with a total of 319 patients. The median progression-free survival was 15 months [95% confidence interval (CI) 13.9-16.1 months]. The objective response rate (ORR) was 61% (95% CI 52% to 70%), and the intracranial (IC)-ORR was 61% (95% CI 54% to 69%). No significant differences in ORR and IC-ORR were observed between CTs and observational studies (P = 0.31 and 0.58, respectively). The clinical benefit rate (CBR) was 80% (95% CI 52% to 94%), and the IC-CBR was 70% (95% CI 54% to 82%). The ORR was 68% (95% CI 57% to 77%) in the subgroup of patients with stable BMs and 60% (95% CI 48%-72%) in patients with active BM, with no significant difference between groups (P = 0.35).

CONCLUSIONS

Our systematic review and meta-analysis supports the IC activity of T-DXd in patients with stable BM and active BM.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) under the protocol number CRD42023422589.

Morpho-physiological and phytohormonal changes during the induction of adventitious root development stimulated by exogenous IBA application in Magnolia biondii Pamp

Abstract Magnolia biondii Pamp is an important ornamental tree species widely grown and used as a rootstock in the propagation of different Magnolia varieties. In the current studies, anatomical, physiological and endogenous hormones were studied to check the effect of IBA 750 mg/L on the adventitious rooting and to provide theoretical and technical support for the propagation of Magnolia biondii Pamp through stem cuttings. Two thousand stem cuttings were prepared and divided into two groups i.e., IBA treated cuttings and water control. For the evaluation of antioxidant enzyme activities, and endogenous hormones levels, samples were collected on the day of planting and each 5th day and further steps were carried out in the laboratory according to the protocols and proper precautions. For the anatomical observations, samples were collected on the 13th, 15th, and 17th day for IBA treated cuttings while 21st, 23rd, and 25th day for control. Collected samples were preserved in the FAA solution and further observations were carried out in the laboratory. Anatomical observations showed that it took 13 days for the differentiation of root primordia to the appearance of young adventitious roots in IBA treated cuttings, while it took 21 days to develop primordia in the control. Antioxidant enzyme activities involved in ROS were significantly higher in the IBA treated cuttings compared to control. POD showed a peak on the 13th day before the emergence of roots in IBA treated cuttings while it showed a peak on the 21st day in the control. PPO showed a peak on the 21st day in the IBA treated cuttings while it showed a peak on the 29th day in the control. SOD showed a peak on the 17th day in IBA treated cuttings, while it showed a peak on the 25th day in the control. Exogenous application of IBA enhanced the endogenous IAA and GA3 levels compared to CK, while it reduced the levels of ABA continuously at the time of rooting and then increased gradually. Inclusively, our study suggests that IBA 750 mg/L is efficient for the rooting of Magnolia biondii Pamp cuttings, as it enhanced the process of antioxidant enzyme activities, endogenous hormones levels and reduced the time of root formation which is evident from the anatomical observations.

Screening of IL-22 first and second introns and FOXP3 second exon for SNPs and mutations with potential role in the susceptibility of SLE in selected population

OBJECTIVE

The main objective of performing this study was the mutational analysis of Forkhead box family member (FoxP3) and Interleukin-22 (IL-22) genes and their associations with systemic lupus erythematosus (SLE).

MATERIALS AND METHODS

A total of sixty blood samples were collected from SLE patients from different hospitals in Lahore. Proforma was based on American College of Rheumatology (ACR) criteria. The total time for this research was one year (2018-2019). DNA was extracted, and FoxP3 and IL-22 genes were polymerized through PCR and further sequenced through the Sanger Sequencing method. Chromas version 2.6.6 was used for the similarity index of sequences. NG_060763 and NG_007392.1 were used as Reference Sequences of IL-22 and FoxP3 genes, respectively.

RESULTS

Three already identified Single Nucleotide Polymorphisms (SNPs) in the IL-22 gene i.e., rs2227491, rs2227485, and rs2227513, were confirmed in the sequencing results of SLE patients. Results showed that there were nine novel mutations (27.27%) in the case of the IL-22 gene in the studied genotyped samples. These SNPs had remarkably increased allele T frequency in rs2227485 and allele C frequency in rs2227491 and rs2227513. On the other hand, in the case of FoxP3 gene exon 2, there was an addition of T at position 10 in the intronic portion, thus not involved in the progression of the disease.

CONCLUSIONS

The importance of cytokine-mediated signaling pathways, such as the IL-22 gene, is thus established. Novel variants in the IL-22 gene likely contributed significantly to the development of this autoimmune disorder. The current study found that the dysregulation of the inflammatory markers in SLE is not related to the FoxP3 gene, even though FoxP3 is implicated in the tolerance process.

Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications

Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR.

Determinants of anxiety and depression among university teachers during third wave of COVID-19

BACKGROUND

To estimate the determinants of anxiety and depression among university teachers in Lahore, Pakistan, during COVID-19.

METHODS

A cross-sectional study was conducted by enrolling 668 teachers from the universities of Lahore, Pakistan. Data were collected using a questionnaire. Chi-square for significance and logistic regression for the association were used.

RESULTS

Majorly, the university teachers, with an average age of 35.29 years, had regular jobs (72.8%), job experience of > 6 years (51.2%) and good self-reported health (55.4%). The majority of the teachers were working as lecturers (59.6%), lecturing in arts (33.5%) or general science (42.5%) departments, having MPhil (37.9%) or master (28.9%) degrees, and teaching via synchronous video (59.3%) mode. Anxiety and depression, severe and extremely severe, were higher among lecturers, MPhil or master degree holders, teachers lecturing arts and general science subjects, and in those on contract employment. Anxiety was significantly associated with academic departments; arts (OR;2.5, p = 0.001) and general science (OR;2.9, p = 0.001), poor health status (OR;4.4, p = 0.018), and contractual employment (OR;1.8, p = 0.003). Depression was associated with academic departments; arts (OR;2.7, p = 0.001) and general science (OR;2.5, p = 0.001), and health status (OR;2.3, p = 0.001).

CONCLUSION

Among university teachers, anxiety and depression, severe and extremely severe, were prevalent among lecturers having MPhil or master degrees, belonging to arts and general science departments, and among contract employees. Anxiety and depression were significantly associated with academic disciplines, lower cadre, and poor health status.

Structural and functional insight into thiazolidinone derivatives as novel candidates for anticancer drug design: in vitro biological and in-silico strategies

The compounds 2a-2h containing a thiazolidinone pharmacophore were synthesized via hetrerocylization of thiosemicarbazones with dimethyl acetylenedicarboxylate. The hybrid molecules were evaluated for anticancer activity against the human cell lines MCF-7, T47D (human breast adenocarcinoma) and HeLa (cervical cancer). Compounds 2c showed effective cytotoxicity on MCF-7 and HeLa (GI₅₀ 6.40 ± 0.10 μM/mL and GI₅₀10.30 ± 1.09 μM/mL), and compound 2d also showed effective cytotoxicity against MCF-7 and HeLa cell lines i.e., (GI₅₀ 16.60 ± 0.21 μM/mL and GI₅₀ 15.02 ± 0.14 μM/mL). These findings were comparable to cisplatin (azane;dichloroplatinum) the standard drug (GI₅₀ 13.20 ± μM/mL and 15.10 μM/mL respectively) and consequently nominated for determination of the mode of cell death. The results revealed the cytotoxic effects of 2c and 2d by induction of apoptosis in MCF-7 and HeLa cell lines. Moreover the results were further supported by the Molecular Docking which predicts the binding interactions of the best anticancer ligands with Ribonucleotide reductase (RNR), which is essential enzyme required for de-novo synthesis of DNA precursors. Molecular dynamic simulations were also performed to determine the stability of protein-ligand complex under different simulated conditions. In addition, the computational studies including DFTs, ADMET properties suggested these compounds can act as lead molecules, for the synthesis of novel drug candidates for the treatment of specific cancer and its associated malignancies.

Knowledge, Attitudes, Perceptions, and Acceptance of COVID-19 Vaccination among Pharmacy and Non-Pharmacy Students

University students are a sub-group of the population at high risk of COVID-19 infection, and their judgments on vaccination affect the public attitudes towards vaccination. Thus, the present study aimed to assess the knowledge, attitudes, perceptions, and acceptance of the COVID-19 vaccine among pharmacy and non-pharmacy students. A cross-sectional study was conducted by enrolling pharmacy (375) and non-pharmacy (225) students from the universities in Lahore. Chi-square analysis was used for significant frequency distributions and a 5-point Likert scale was used to score attitude, perception, and acceptance. The majority of the students were aged between 19-24 years, hailing from urban and middle-class families with good self-reported health. The preferred vaccine was Pfizer, followed by Sinopharm and Sinovac. The major source of information was social media, followed by government campaigns and family members. The pharmacy students demonstrated better knowledge and positive attitudes toward COVID-19 vaccination. The non-pharmacy students scored higher for the questions based on scientific leads, myths, and baffling conspiracies. The non-pharmacy students showed higher hesitancy/barrier total scores related to their trust in the health system, COVID-19 vaccine storage, and efficacy. Data suggested that pharmacy students exhibited better knowledge, positive attitudes, and perceptions about COVID-19 vaccination. Overall, vaccine efficacy and safety were mutual concerns. Nonetheless, non-pharmacy students were hesitant due to mistrust in the health system of Pakistan.

Pilot drug and therapeutic committee programme in Sierra Leone: A descriptive mixed method study

AIMS

Irrational medicine use is a global crisis, but incidences are proportionately higher in low- and middle-income countries such as Sierra Leone. This study explores the structure, functions and challenges of drug and therapeutics committees (DTCs), an intervention towards irrational medicine use recently piloted in Sierra Leone.

METHODS

A 2-phase mixed-method study design was used in this study. Firstly, a cross-sectional survey was conducted on all pharmacists who have worked for at least 1 year in DTC-piloted hospitals, using an online questionnaire to assess DTCs' structure, indicators and challenges. In phase 2, all eligible pharmacists were invited for a semistructured online interview using the WhatsApp messaging application to get deeper insights into the key issues that emerged from the survey; however, only 5 of the 7 consented to participate. MS Excel 2019 and NVivo version 12 were respectively used for data management and analysis.

RESULTS

A total of 6 survey responses and 5 interviews were included in the analysis. Participants are pharmacists from the 7 hospitals in Sierra Leone where DTC was piloted. Most DTCs are comprised of a minimum of 10 members consisting of both medical and hospital administrative staff. The main functions of DTCs are ensuring rational medicines use, monitoring and reporting adverse drug reactions. All 7 hospitals with established pilot DTCs have different subcommittees operating at varying functionality levels, ranging from effective to nonfunctional. The main challenges in DTC functions and maintenance are funding (n = 6), DTC decision implementation (n = 4), and unmotivated members (n = 4). Strategies suggested to improve DTCs at public hospitals and nationwide include resource allocation, monitoring and evaluating DTC functions and its members' capacity building.

CONCLUSION

DTCs present a compelling opportunity towards achieving rational medicines use at the hospital level in Sierra Leone. Nonetheless, the lack of funding and operational resources are significant limitations that must be noted by policymakers before expanding DTC programmes to other hospitals in Sierra Leone.

Artificial Intelligence (AI) in Pharmacy: An Overview of Innovations

Artificial Intelligence (AI) emerged as an intervention for data and number-related problems. This breakthrough has led to several technological advancements in virtually all fields from engineering to architecture, education, accounting, business, health, and so on. AI has come a long way in healthcare, having played significant roles in data and information storage and management - such as patient medical histories, medicine stocks, sale records, and so on; automated machines; software and computer applications like diagnostic tools such as MRI radiation technology, CT diagnosis and many more have all been created to aid and simplify healthcare measures. Inarguably, AI has revolutionized healthcare to be more effective and efficient and the pharmacy sector is not left out. During the past few years, a considerable amount of increasing interest in the uses of AI technology has been identified for analyzing as well as interpreting some important fields of pharmacy like drug discovery, dosage form designing, polypharmacology, and hospital pharmacy. Given the growing importance of AI, we wanted to create a comprehensive report which helps every practicing pharmacist understand the biggest breakthroughs which are assisted by the deployment of this field.

In-silico Investigations of quinine and quinidine as potential Inhibitors of AKR1B1 and AKR1B10: Functional and structural characterization

The aberrant expression of aldo keto reductases (AKR1B1 & AKR1B10) has been extensively studied in different types of cancer especially the colon cancer but a very few studies have yet been reported regarding the discovery of inhibitors for the treatment of colon cancer by targeting these isozymes. Therefore, there is a need of selective inhibitors of both targets for the eradication of colon cancer. Currently, the study is focused on the exploration of two quinolone compounds i.e., (S)-(6-Methoxyquinolin-4-yl)[(1S,2R,4S,5R)-5-vinylquinuclidin-2-yl]methanol (Quinidine) and (R)-(6-Methoxyquinolin-4-yl)[(1S,2S,4S,5R)-5-vinylquinuclidin-2-yl]methanol (Quinine) as the potential inhibitors of AKR1B1 and AKR1B10 via detailed in-silico approach. The structural properties including vibrational frequencies, dipole moment, polarizability and the optimization energies were estimated using density functional theory (DFT) calculations; where both compounds were found chemically reactive. After that, the optimized structures were used for the molecular docking studies and here quinidine was found more selective towards AKR1B1 and quinine exhibited maximum inhibition of AKR1B10. The results of molecular docking studies were validated by molecular dynamics simulations which provided the deep insight of stability of protein ligand complex. At the end, the ADMET properties were determined to demonstrate the druglikeness properties of both selected compounds. These findings suggested further exploration of both compounds at molecular level using different in-vivo and in-vitro approaches that will lead to the designing of potential inhibitor of AKR1B1/AKR1B10 for curing colon cancer and related malignancies.

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Background

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.

Methods

This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.

Results

Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.

Conclusion

The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

Discovery of Phenylcarbamoylazinane-1,2,4-Triazole Amides Derivatives as the Potential Inhibitors of Aldo-Keto Reductases (AKR1B1 & AKRB10): Potential Lead Molecules for Treatment of Colon Cancer

Both members of the aldo-keto reductases (AKRs) family, AKR1B1 and AKR1B10, are over-expressed in various type of cancer, making them potential targets for inflammation-mediated cancers such as colon, lung, breast, and prostate cancers. This is the first comprehensive study which focused on the identification of phenylcarbamoylazinane-1, 2,4-triazole amides (7a−o) as the inhibitors of aldo-keto reductases (AKR1B1, AKR1B10) via detailed computational analysis. Firstly, the stability and reactivity of compounds were determined by using the Guassian09 programme in which the density functional theory (DFT) calculations were performed by using the B3LYP/SVP level. Among all the derivatives, the 7d, 7e, 7f, 7h, 7j, 7k, and 7m were found chemically reactive. Then the binding interactions of the optimized compounds within the active pocket of the selected targets were carried out by using molecular docking software: AutoDock tools and Molecular operation environment (MOE) software, and during analysis, the Autodock (academic software) results were found to be reproducible, suggesting this software is best over the MOE (commercial software). The results were found in correlation with the DFT results, suggesting 7d as the best inhibitor of AKR1B1 with the energy value of −49.40 kJ/mol and 7f as the best inhibitor of AKR1B10 with the energy value of −52.84 kJ/mol. The other potent compounds also showed comparable binding energies. The best inhibitors of both targets were validated by the molecular dynamics simulation studies where the root mean square value of <2 along with the other physicochemical properties, hydrogen bond interactions, and binding energies were observed. Furthermore, the anticancer potential of the potent compounds was confirmed by cell viability (MTT) assay. The studied compounds fall into the category of drug-like properties and also supported by physicochemical and pharmacological ADMET properties. It can be suggested that the further synthesis of derivatives of 7d and 7f may lead to the potential drug-like molecules for the treatment of colon cancer associated with the aberrant expression of either AKR1B1 or AKR1B10 and other associated malignancies.

Views of Pharmacists and Government Representatives Toward the Pilot Chief Pharmacist System in Chinese Hospitals: A Multicenter Exploratory Qualitative Study

Background

In China, the pharmacy departments of most hospitals have changed their main focus from drug procurement and distribution to providing pharmaceutical care services. Various regions of China have successively implemented the pilot Chief Pharmacist System (CPS) to help improve pharmaceutical care services and rational drug use in hospitals. This study was designed to explore the perspectives of pharmacists and government officials on CPS, including the advantages and barriers to the successful implementation of CPS.

Methods

A qualitative study, based on semi-structured interviews, was conducted from October 1, 2018 to March 1, 2019. The interview data were gathered from 18 pharmacy staff and government representatives working in five distinct regions of China using purposive sampling. A thematic analysis approach and NVivo version 12 Plus was utilized to code and analysis of all interviews.

Results

Five broad themes were identified: the role of the chief pharmacist; their attitudes toward the CPS; the advantages and results of the CPS; the barriers toward CPS; and their suggestions toward CPS. Most of the participants believed that the chief pharmacist played a vital role in a hospital. Under CPS, the hospital pharmacy department pays more attention to prescription review, medication monitoring, and pharmaceutical consultation. However, an insufficient number of pharmacy personnel, unclear authority, and inadequate salaries were the main barriers to the implementation of the CPS.

Conclusion

The attitudes of most of the participants were found to be positive toward CPS in China. The CPS can enhance the prestige of the hospital pharmacy department, improve the quality of hospital pharmaceutical care services, and promote rational drug use. Nevertheless, certain barriers highlighted in this study should be addressed promptly.

4-Chlorophenyl-N-furfuryl-1,2,4-triazole Methylacetamides as Significant 15-Lipoxygenase Inhibitors: an Efficient Approach for Finding Lead Anti-inflammatory Compounds

Lipoxygenases (LOXs) are a class of enzymes that catalyze the production of pro-inflammatory mediators, such as leukotrienes and lipoxins, via an arachidonic acid cascade as soon as they are released from the membrane phospholipids after tissue injury. In continuation of our efforts in search for new LOX inhibitors, a series of chlorophenyl-furfuryl-based 1,2,4-triazole derivatives were prepared and evaluated for their 15-LOX inhibitory activities. A simple precursor, 4-chlorobenzoic acid (a), was consecutively transformed into benzoate (1), hydrazide (2), semicarbazide (3), and N-furfuryl 5-(4-chlorobenzyl)-4H-1,2,4-triazole (4), which when further merged with electrophiles (6a-o) resulted in end products (7a-o). The structural elucidations of the newly synthesized compounds (7a-o) were carried out by Fourier transform infrared, 1H-, 13C NMR spectroscopy, EI-MS, and HR-EI-MS spectrometry. The inhibitive capability of compounds (7a-o) on soybean 15-LOX was performed in vitro using the chemiluminescence method. The compounds 7k, 7o, 7m, 7b, and 7i demonstrated potent activities (IC50 17.43 ± 0.38, 19.35 ± 0.71, 23.59 ± 0.68, 26.35 ± 0.62, and 27.53 ± 0.82 μM, respectively). These compounds revealed 79.5 to 98.8% cellular viability as measured by the MTT assay at 0.25 mM concentration. The structure-activity relationship (SAR) studies showed that the positions and the nature of substituents bonded to the phenyl ring are important in the determination of 15-LOX inhibitory activities. ADME, in silico, and density functional theory studies supported the evidence as yet another class of triazoles with potential lead properties in search for anti-LOX compounds with a safe gastrointestinal safety profile for various inflammatory diseases. Further work is in progress on the synthesis of more derivatives in search for anti-inflammatory agents.

Structure and surface analyses of a newly synthesized acyl thiourea derivative along with its in silico and in vitro investigations for RNR, DNA binding, urease inhibition and radical scavenging activities

N-((4-Acetylphenyl)carbamothioyl)-2,4-dichlorobenzamide (4) was synthesized by the treatment of 2,4-dichlorobenzoyl chloride with potassium thiocyanate in a 1 : 1 molar ratio in dry acetone to afford the 2,4-dichlorobenzoyl isothiocyanate in situ which on reaction with acetyl aniline furnished (4) in good yield and high purity. The compound was confirmed by FTIR, ¹H-NMR, and ¹³C-NMR and single crystal X-ray diffraction studies. The planar rings were situated at a dihedral angle of 33.32(6)°. The molecules, forming S(6) ring motifs with the intramolecular N–H⋯O hydrogen bonds, were linked through intermolecular C–H⋯O and N–H⋯S hydrogen bonds, enclosing R₂²(8) ring motifs, into infinite double chains along [101]. C–H⋯π and π⋯π interactions with an inter-centroid distance of 3.694 (1) Å helped to consolidate a three-dimensional architecture. Hirshfeld surface (HS) analysis further indicated that the most important contributions for the crystal packing were from H⋯C/C⋯H (20.9%), H⋯H (20.5%), H⋯Cl/Cl⋯H (19.4%), H⋯O/O⋯H (13.8%) and H⋯S/S⋯H (8.9%) interactions. Thus C–H⋯π (ring), π⋯π, van der Waals interactions and hydrogen bonding played the major roles in the crystal packing. The electronic structure and computed DFT (density functional theory) parameters identified the reactivity profile of compound (4). In silico binding of (4) with RNA indicated the formation of a stable protein–ligand complex via hydrogen bonding, while DNA docking studies inferred (4) as a potent groove binder. The experimentally observed hypochromic change (57.2%) in the UV-visible spectrum of (4) in the presence of varying DNA concentrations together with the evaluated binding parameters (K_b; 7.9 × 10⁴ M⁻¹, ΔG; −28.42 kJ mol⁻¹) indicated spontaneous interaction of (4) with DNA via groove binding and hence supported the findings obtained through docking analysis. This compound also showed excellent urease inhibition activity in both in silico and vitro studies with an IC₅₀ value of 0.0389 ± 0.0017 μM. However, the radical scavenging efficiency of (4) was found to be modest in comparison to vitamin C.

A new acyl thiourea derivative was explored for its binding interaction with RNR and DNA and for excellent urease inhibition activity.

Exploring ibuprofen derivatives as α-glucosidase and lipoxygenase inhibitors: Cytotoxicity and in silico studies

This study reports the synthesis of a series of ibuprofen derivatives, including thiosemicarbazides 4a-f, 1,3,4-oxadiazoles 5a-f, 1,3,4-thiadiazoles 6a-f, 1,2,4-triazoles 7a-f, and their S-alkylated derivatives 8a-d. All of the newly synthesized derivatives were analyzed using ¹ H NMR, ¹³ C NMR spectroscopy, and high-resolution mass spectra (electron ionization) spectrometry. These synthetic molecules were examined for their in vitro baking yeast α-glucosidase and soybean 15-lipoxygenase (15-LOX) inhibition and cell viability studies. The results revealed that the compounds N-(3,4-dichlorophenyl)-5-[1-(4-isobutylphenyl)ethyl]-1,3,4-oxadiazol-2-amine 5f (IC₅₀ 3.05 ± 1.23 µM) and N-(3-fluorophenyl)-5-[1-(4-isobutylphenyl)ethyl]-1,3,4-oxadiazol-2-amine 5b (IC₅₀ 3.12 ± 1.21 µM) were the most potent with respect to the α-glucosidase enzyme while in case of 15-LOX, the compound 4-(2,4-dichlorophenyl)-1-[2-(4-isobutylphenyl)propanoyl]thiosemicarbazide 4e showed potent inhibition with an IC₅₀ value of 55.41 ± 0.41 µM. All these compounds were found least toxic by displaying a blood mononuclear cell viability value of 69.2%-97.8% by the MTT assay compared to the standards when assayed at 0.25 mM concentration. Molecular docking analyses were conducted to evaluate the inhibition profiles of these derivatives against the said enzymes and the data supported the in vitro profiles.

Access to Insulin Products in Pakistan: A National Scale Cross-Sectional Survey on Prices, Availability, and Affordability

Background: Diabetes is among the top ten most prevalent diseases in Pakistan, and the availability of medicines to treat the disease is vital for a great percentage of the country’s population. Insulin was discovered a century ago; however, its access in several parts of the globe remains an issue. This study aims to evaluate prices, availability, and affordability (access components) of insulin and five comparator medicine access in Pakistan.

Methods: A nationwide cross-sectional survey was conducted to evaluate the access to insulin and some comparator medicines in eight cities of Pakistan, using a modified WHO/HAI methodology. The survey included 80 medicine outlets, i.e., 40 private pharmacies and 40 public hospitals. Data for every unique insulin product available in the Pakistani market were obtained, including five comparator medicines. Percentage availability, median unit prices (MUPs), and affordability (the number of days’ wages (NDWs) required for a month’s course by the lowest-paid unskilled government worker) of all products were calculated, including originator brands (OBs) and biosimilar (BS) products.

Results: Of all insulin products surveyed (n = 320), 87.5% were manufactured by foreign multinational companies (MNCs). None of the insulin products had an ideal availability of 80% in any of the surveyed health facilities. In the public sector, none of the insulin products had an availability of more than 50%. In the public sector, the overall availability of human insulin was 70% (including OB and BS). While in the private sector, the overall availability of human insulin was 90% and that of analog insulin was 62.5%. The analog insulin products were 72.8% costlier than the human insulin products. The median prices of BS insulin were 25.4% lower than the OB products, indicating that almost one-fourth of the cost could be saved by switching to BS human insulin from OB human insulin. All oral anti-diabetic medicines were found to be affordable, whereas none of the insulin was affordable. The NDWs for human and analog insulin were 1.38 and 5.06.

Conclusion: In Pakistan, the insulin availability falls short of the WHO’s benchmark of 80%. Insulin continues to be unaffordable in both private and government sectors. To increase insulin access, the government should optimize insulin procurement at all levels, promote local production, enforce biosimilar prescribing, and provide financial subsidies for these products.

Phytochemical screening and evaluation of antioxidant, total phenolic and flavonoid contents in various weed plants associated with wheat crops

This study explores the antioxidant activity, phytochemical screening, total phenolic and flavonoids contents in the extracts of four locally available weeds plants namely Convolvulus arvensis, Chenopodium murale, Avena fatua and Phalaris minor with different solvents. The antioxidant activities of these extracts were determined via various in-vitro methods such as total antioxidant activity (TAA), reducing power (RP), DPPH (2,2-Diphenyl-1-Picrylhydrazyl) free radical scavenging and hydrogen peroxide scavenging assays. Phytochemical screening was performed both qualitatively as well as quantitatively. Total phenolic content (TPC) and total flavonoid content (TFC) were determined through Folin- Ciocalteu reagent and aluminium chloride methods respectively. Methanol-chloroform solvent showed the presence of a high amount of TPC in milligram of gallic acid equivalent per gram of dry weight (mg of GAE/g of DW) in the extracts of all weeds. Their descending sequence was Avena fatua (74.09) ˃ Phalaris minor (65.66) ˃ Chenopodium murale (64.04) ˃ Convolvulus arvensis (61.905), while, chloroform solvent found to be best solvent for the extraction of TFC. Methanol-chloroform solvent was also found to be best solvent for TAA (Total antioxidant activity assay) which showed values in milligram of ascorbic acid equivalent per gram of dry weight (mg of AAE /g of DW), for DPPH scavenging activity, reducing power (antioxidant activity) and hydrogen peroxide scavenging activity. Phytochemical screening indicated the presence of polyphenols, flavonoids, tannins, saponins, alkaloids and glycosides in these weeds.

Community pharmacists' perception and exposure to drug promotion in Pakistan: a cross-sectional study

OBJECTIVE

Drug promotion is a factor that promotes the irrational use of drugs and sometimes negatively influences the prescribing/dispensing pattern. So there was a need to assess the views about accepting gifts and attitudes/influence towards drug promotion among community pharmacists in Punjab, Pakistan.

SETTING

Adopting a preused questionnaire, we conducted a cross-sectional multiple-site survey study. We distributed questionnaires to pharmacists in the community pharmacies to investigate the exposure, scepticism and acceptance to drug promotion as well as their perception about the appropriateness of gifts and to check if they had been taught about dealing with medical representatives. Data were analysed in simple percentages, and the χ² test was used to evaluate association with demographics. All the analysis was done using SPSS V.23.0.

RESULTS

A total 86.9% (463/533) pharmacists completed the survey. One out of four pharmacists reported being taught about the ethics of drug promotion (26.8%) and about how to interpret drug promotional material (25.0%) and were significantly associated with higher age (age 31%-35 years, 81.9%; p<0.05). More than two-thirds of the respondents found it appropriate to accept stationery (73.4%) and textbooks (70.6%) as gifts, and only 17.5% felt it was appropriate to accept direct money. Less than half of the pharmacists (47.3%) perceived drug companies were useful for gaining knowledge about new drugs. Majority (76.2%) thought these drug promotions play a role in the irrational prescribing of antibiotics and 18.6% dispensed antibiotics due to these promotions.

CONCLUSION

The majority of pharmacists participating in this study felt it was appropriate to receive small value gifts from pharmaceutical companies. Only a small proportion of the respondents was given ethical training and education about drug promotion. Improving the syllabus and updating the pharmacist's knowledge after graduation, as part of continued pharmacy education, will eventually improve the healthcare professionals' capability to act for the patients' welfare.

Sublethal toxicity of carbofuran in cattle egret (Bubulcus ibis coromandus): hematological, biochemical, and histopathological alterations

This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Awareness and Attitudes of the Pakistani Population With Regard to Physician-Pharmaceutical Company Interaction: A Cross-Sectional Study

Objective: To determine the awareness and attitudes of the Pakistani population regarding physician-pharmaceutical company interactions. Methods: The data were collected from primary health care clinics and pharmacy outlets located within cities of six randomly selected districts of the Punjab Province. Those individuals (age ≥18 years) who have just completed their visit to the physician and well understand Urdu language were approached. Descriptive analysis was performed for all variables by using SPSS (IBM version 26). Results: A total of 3,852 participants fully completed the study out of 4,301 (response rate 89.5%). Of those, 30.9% were female; two-thirds (66.7%) were aware of drug representatives' visits to clinics. The majority were aware of pharmaceutical company material presence (or absence) in the physicians' rooms (56.6%), company items with logos (66.8%), patient education materials (73.4%), and 60.8% thought that receiving gifts from companies was "wrong/unethical" practice for physicians, which was lower in comparison to other professions such as judges to accept gifts from lawyers (65.6%) and professional sports umpires to acknowledge gifts (64.3%). A minority said that they have lower trust on physicians for using drug company notepads or pens (16.7%), going on trips sponsored by the company (16.7%), accepting gifts <15,000 PKR (90.3 US$) (26.7%), and accepting gifts >15,000 PKR (90.3 US$) (40.0%). Conclusion: Survey participants were well aware of physician-pharmaceutical company interactions. Participants were more knowledgeable regarding the pharmaceutical company presence (or absence) in physicians' offices than about gift-related practices of physicians. Trust on the physician was not affected by small gifts but by the large gifts.

Prediction of soil seed bank of piedmont and alluvial environments of Dera Ghazi Khan, Punjab, Pakistan

The current focus is on the overall pattern of seed storage present in the fragments of the soil of piedmont and alluvial landscapes of the environment. The present study predicted the seed banks of both soils of alluvial and piedmont zones in different ecological conditions and evaluate the potential of seeds in the restoration of both environments. The composition of the seed bank of soil is mainly affected by the alluvial environment and the structure of cleared area shows that more species of germinating annual grasses and growable seeds with the higher total number. Extant vegetation structures have an important role in the diversity of soil seed reservoirs, whose composition corresponded with the openness of the site. When in situ soil seed bank is recruited, it helps to restore only some components of the plant community in an alluvial environment. In our current research, it was confirmed that seed richness was higher in number at lower elevation (alluvial) than that at high elevation (piedmont). Seed richness showed a significant negative correlation with anions, cations, while significantly positive with altitude that suggests the richness pattern of the overall seed bank of the area is influenced by various environmental factors.

Assessment of anthropogenic-causing-agents act on waterbirds-diversity in the vicinity of Tarbela Dam, Indus River, Pakistan

Birds are among the best bio-indicators, which can guide us to recognize some of the main conservation concerns in ecosystems. Anthropogenic impacts such as deforestation, habitat degradation, modification of landscapes, and decreased quality of habitats are major threats to bird diversity. The present study was designed to detect anthropogenic causative agents that act on waterbird diversity in Tarbella Dam, Indus River, Pakistan. Waterbird censuses were carried out from March 2019 to February 2020 in multiple areas around the dam. A total of 2990 waterbirds representing 63 species were recorded. We detected the highest waterbird richness and diversity at Pehure whereas the highest density was recorded at Kabbal. Human activity impacts seemed to be the main factor determining the waterbird communities as waterbirds were negatively correlated with the greatest anthropogenic impacts. Waterbirds seem to respond rapidly to human disturbance.

Progress on the national action plan of Pakistan on antimicrobial resistance (AMR): a narrative review and the implications

Introduction: The emergence of antimicrobial resistance (AMR) is a threat to public health. In 2015, the World Health Organization (WHO) introduced a global action plan to tackle AMR in the World Health Assembly. Pakistan's national action plan (NAP) for AMR was released in May 2017 by the Ministry of National Health Services. Based on the NAP, strategies have been initiated on a national and provincial scale in Pakistan.Areas covered: This narrative review of the five components of the Pakistan NAP has been undertaken to discuss some of the challenges in implementation of the NAP for AMR in Pakistan including different opinions and views of key stakeholders, combined with suggestions on potential ways to reduce the burden of the AMR.Expert opinion: Going forward, healthcare authorities should focus on screening and monitoring of all the objectives of the NAP by establishing proper policies as well as promoting antimicrobial stewardship interventions and Infection prevention and control (IPC) practices. Overall, the comprehensive strengthening of the healthcare system is required to adequately implement the NAP, tackle continued inappropriate antimicrobial use and high AMR rates in Pakistan.

Drug Shortage: Causes, Impact, and Mitigation Strategies

Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.

Graphene Oxide-Doped MgO Nanostructures for Highly Efficient Dye Degradation and Bactericidal Action

Various concentrations (0.01, 0.03 and 0.05 wt ratios) of graphene oxide (GO) nanosheets were doped into magnesium oxide (MgO) nanostructures using chemical precipitation technique. The objective was to study the effect of GO dopant concentrations on the catalytic and antibacterial behavior of fixed amount of MgO. XRD technique revealed cubic phase of MgO, while its crystalline nature was confirmed through SAED profiles. Functional groups presence and Mg-O (443 cm-1) in fingerprint region was evident with FTIR spectroscopy. Optical properties were recorded via UV-visible spectroscopy with redshift pointing to a decrease in band gap energy from 5.0 to 4.8 eV upon doping. Electron-hole recombination behavior was examined through photoluminescence (PL) spectroscopy. Raman spectra exhibited D band (1338 cm-1) and G band (1598 cm-1) evident to GO doping. Formation of nanostructure with cubic and hexagon morphology was confirmed with TEM, whereas interlayer average d-spacing of 0.23 nm was assessed using HR-TEM. Dopants existence and evaluation of elemental constitution Mg, O were corroborated using EDS technique. Catalytic activity against methyl blue ciprofloxacin (MBCF) was significantly reduced (45%) for higher GO dopant concentration (0.05), whereas bactericidal activity of MgO against E. coli was improved significantly (4.85 mm inhibition zone) upon doping with higher concentration (0.05) of GO, owing to the formation of nanorods.

WHO key access antibiotics price, availability and affordability in private sector pharmacies in Pakistan

BACKGROUND

Poor availability and unaffordability of key access antibiotics may increase antimicrobial resistance in the community by promoting inappropriate antibiotic selection and abridged therapy compliance.

OBJECTIVE

To check the prices, availability, and affordability of the World Health Organization (WHO) key access antibiotics in private sector pharmacies of Lahore, Pakistan.

METHODOLOGY

A survey of WHO key access antibiotics from WHO essential medicine list 2017 was conducted in private sector pharmacies of 4 different regions of Lahore employing adapted WHO/HAI methodology. The comparison of prices and availability between originator brands (OB) and lowest price generics (LPG) were conducted followed by the effect of medicine price differences on patient's affordability. The data were analyzed using a preprogrammed WHO Microsoft excel workbook.

RESULTS

The mean availability of OB products was 45.20% and the availability of LPGs was 40.40%. The OBs of co-amoxiclav, clarithromycin and metronidazole and LPGs of azithromycin and ciprofloxacin were easily available (100%) in all private sector pharmacies. Whereas, antibiotics like chloramphenicol, cloxacillin, nitrofurantoin, spectinomycin, and cefazolin were totally unavailable in all the surveyed pharmacies. The OBs and LPGs with high MPRs were ceftriaxone (OB; 15.31, LPG; 6.38) and ciprofloxacin (OB; 12.42, LPG; 5.77). The median of brand premium obtained was 38.7%, which varied between the lowest brand premium of 3.97% for metronidazole and highest for ceftriaxone i.e. 140%. The cost of standard treatment was 0.5 day's wage (median) if using OB and 0.4 day's wage (median) for LPG, for a lowest paid unskilled government worker. Treatment with OB and LPG was unaffordable for ciprofloxacin (OB; 2.4, LPG; 1.1) & cefotaxime (OB; 12.7, LPG; 8.1).

CONCLUSION

There is dire need to properly implement price control policies to better regulate fragile antibiotic supply system so that the availability of both OB and LPG of key access antibiotics should be increased. The prices could be reduced by improving purchasing efficiency, excluding taxes and regulating mark-ups. This could increase the affordability of patients to complete their antibiotic therapy with subsequent reduction in antimicrobial resistance.

Access to Essential Cardiovascular Medicines in Pakistan: A National Survey on the Availability, Price, and Affordability, Using WHO/HAI Methodology

Objective: This national survey was aimed at measuring the access to cardiovascular disease (CVD) medicines in terms of their availability, price, and affordability in Pakistan. This was done by using the standard WHO/Health Action International (HAI) methodology.

Methods: The price and availability data for 18 CVD medicines were collected from public sector hospitals (n = 40) and private sector retail pharmacies (n = 40) in eight cities of Pakistan. The outcome measures were availability (calculated as percentage of health facilities stocked with listed medicines), medicine price to the international reference price ratio (i.e., median price ratio (MPR)), and affordability (calculated as number of days’ wages (NDWs) of the lowest paid unskilled government worker required to afford one-month treatment of a chronic disease). The affordability of standard treatment in Pakistan with four CVD drugs was compared with data from six other low and middle income countries (LMICs) using HAI database.

Findings: The mean percent availability of CVD medicines was significantly low (p < 0.001) in the public sector as compared to the private sector, that is, 25.5% vs. 54.6% for originator brands (OBs) and 30.4% vs. 34.9% for lowest price generics (LPGs), respectively. For all OBs and LPGs, the inflation-adjusted mean MPR was 2.72 and 1, respectively. CVD medicines were found to be unaffordable with average NDWs of 6.4 and 2.2 for OBs and LPGs, respectively, that is, NDWs of more than 1. In international comparison with countries such as Sudan, Lebanon, Egypt, India, Afghanistan, and China, the affordability of standard treatment with selected CVD medicines (atenolol, amlodipine, captopril, and simvastatin) in Pakistan was found to be low. Overall, all four OBs and three out of four LPGs of selected CVD drugs were found unaffordable in Pakistan.

Conclusion: This data indicated that the availability of selected CVD medicines was low in both public and private sector medicine outlets. Both OBs and LPGs were found unaffordable in the private sector, necessitating the redressal of pricing policies, structuring, and their implementation.

Prognostic indicators and outcomes following surgical management of metastatic cutaneous squamous cell carcinoma of the head and neck

Metastatic cutaneous SCC carries a poor prognosis with five-year survival of 25%-57%. The aim of this study is to examine the outcomes following surgery with adjuvant therapy for management of metastatic cSCC in a UK-based population. This is a retrospective review of patients with metastatic cSCC of the head and neck who underwent primary surgery at a regional center during a six-year period. Overall and disease specific survival were calculated using Kaplan-Meier and log-rank tests. Results were reported as hazard ratios (HR) with 95% confidence intervals. Forty-five patients met the inclusion criteria. The mean time to discovery of metastases was 9.3 months (range, 0-40 months). Only two patients (4%) had discovery of metastases after two years, with none after 3.3 years. The overall five5-year survival was 31% (95% CI 15%to 48%) with two-year survival at 48% (95% CI 31%to 63%). The median OS survival was 722 days (95% CI 607to 1359). Patients aged >80 years had a decreased OS. This is the largest UK based study documenting the overall and disease specific survival associated with metastatic cutaneous SCC of the head and neck. Our overall survival is comparable to similar studies, but remains poor. Total number of involved nodes, and lymph node ratio were not statistically significant.

The influence of environmental factors on seed germination of Xanthium strumarium L.: Implications for management

Xanthium strumarium L. (Common cocklebur) is a noxious weed prevailing in different ecosystems around the world. It incurs significant yield and economic losses in different cropping systems globally. Successful management of any weed species depends on sound knowledge of seed germination biology. However, detailed knowledge on seed germination biology of the species is missing. Therefore, we investigated the impact of different environmental factors on seed germination and seed burial depths on seedling emergence of two X. strumarium populations. The impact of different sorghum mulch doses (0-10 t ha-1) on seedling emergence of the tested populations was also explored. Seed germination was evaluated under different photoperiods (0, 12 and 24), constant temperatures (0-50°C with 5°C stepwise rise), and different levels of pH (3-12), salinity (0-600 mM) and osmotic potential (0 to -1.6 MPa). Seedling emergence was observed for seeds buried at different depths (0-15 cm). Seeds of both populations proved non-photoblastic; however, higher germination was recorded under 12-hour photoperiod. The seeds germinated under a wide range of constant temperatures (10-45°C), pH (4-10), osmotic potentials (0 to -0.8 MPa) and salinity levels (0-400 mM NaCl). However, the highest germination was observed under 30-31°C temperature and neutral pH (7.51-7.52). Seeds were able to withstand 400 mM salinity and -1.00 MPa osmotic potential. Seedling emergence was initially improved with increasing burial depth and then a sharp decline was noted for the seeds buried >3 cm depth. Most of the seeds of both populations did not emerge from >8 cm depth. Different sorghum mulch doses linearly suppressed seedling emergence of tested populations, and 5.83-5.89 t ha-1 mulch application suppressed 50% of seedling emergence. Seedling emergence was completely retarded with 8 t ha-1 sorghum mulch. The tested populations germinated under diverse environmental circumstances indicating that the species can become troublesome in marginal habitats and cropped lands. Deep burial of seeds and application of sorghum mulches suppressed seedling emergence. Thus, deep burial followed by shallow tillage and application of sorghum mulches could be used as a successful strategy to manage the species in agricultural fields. Nonetheless, management strategies must be developed to control the species in other habitats.

Public knowledge, attitude, and practice regarding antibiotics use in Punjab, Pakistan: a cross-sectional study

OBJECTIVES

Public awareness about antibiotics use is critical in antimicrobial resistance. We evaluated knowledge, attitudes, and practices among the general population of Punjab, Pakistan in this cross-sectional study.

METHODS

We used a 50-item questionnaire to collect information on participant demographics, knowledge, and attitudes about antibiotics use and to evaluate the practices of taking antibiotics without a doctor's prescription.

RESULTS

Of the 2106 participants who completed surveys, 35.4% thought antibiotics could cure viral infections; 47.5% believed they are effective against cold and flu. Nearly 60% percent of respondents had self-medicated with antibiotics. Married people (adjusted odds ratio (AOR) = 1.285, 95% confidence interval (CI): 1.004-1.643 p = 0.046), higher antibiotics use knowledge (AOR = 0.818, 95% CI: 0.674-0.993 p = 0.042), ever purchased antibiotics without a physician's prescription (AOR = 2.024 95% CI: 1.674-2.457 p ≤ 0.001) and storing antibiotics at home (AOR = 0.801 95% CI: 0.652-0.985 p = 0.035) were significantly associated with self-medication practices.

CONCLUSIONS

A high proportion of inappropriate antibiotics use exists among the general population of Punjab. Interventions are needed to improve health literacy and supervise antibiotics sales in retail pharmacies.

Impact of National Drug Pricing Policy 2018 on access to medicines in Lahore division, Pakistan: a pre-post survey study using WHO/HAI methodology

OBJECTIVE

To evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability.

DESIGN

Two cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology.

SETTING

Four districts of Lahore division, Pakistan.

PARTICIPANTS

16 public sector hospitals and 16 private sector retail pharmacies.

MEASURES

The pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days' wages required to get a standard treatment by the lowest paid unskilled government worker.

RESULTS

The overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%-58.3% and 20.3%-32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019.

CONCLUSIONS

The availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, the drug pricing policy must be reviewed to ensure access to essential medicines.

Prices, Availability and Affordability of Medicines with Value-Added Tax Exemption: A Cross-Sectional Survey in the Philippines

BACKGROUND

Developing countries, such as the Philippines, started implementing policies to improve access to medicines, which is a vital step toward universal healthcare coverage. This study aimed to evaluate the prices, availability and affordability of prescribed medicines for diabetes, hypercholesterolemia and hypertension with the exemption of 12% value-added tax in the Philippines.

METHODS

The prices and availability of 50 medicines were collected in August 2019 from 36 public and 42 private medicine outlets in six regions of the Philippines, following a modified methodology developed by the World Health Organization and Health Action International. Availability is reported as the percentage of outlets in which the surveyed medicine was found at the time of visit. Medicine prices are expressed as median unit prices (MUPs) in Philippine Peso. Affordability is calculated based on the number of days' wages required for the lowest-paid unskilled government worker to purchase a monthly treatment.

RESULTS

The mean availability of surveyed medicines was low in both public and private sectors, with 1.3% for originator brands (OBs) and 25.0% for lowest-priced generics (LPGs) in public outlets, and 34.7% and 35.4% in private outlets, respectively. The MUP of medicines were higher in private outlets, and OBs have higher unit price compared to the generic equivalents. Treatments with OBs were unaffordable, except for gliclazide, but the affordability of most LPGs is generally good.

CONCLUSION

Access to medicines in both sectors was affected by low availability. High prices of OBs influenced the affordability of medicines even with tax exemption. A review of policies and regulations should be initiated for a better access to medicines in the Philippines.

Knowledge, attitude and practices among consumers toward antibiotics use and antibiotic resistance in Swat, Khyber-Pakhtunkhwa, Pakistan

Objective: Inappropriate use of antibiotics is one of the main causes of antibiotic resistance around the globe. The present study was aimed to assess the knowledge, attitude, and practices toward antibiotics and antibiotic resistance among consumers. Methods: A cross-sectional study was conducted from April 2019 to September 2019. The participants visiting community pharmacies to buy the antibiotics were approached by data collectors. The descriptive analysis, Kruskal Wallis, and Mann-Whitney statistical tests were used for data analysis through SPSS. Results: 399 participants at three pharmacies with male (n = 352, 88.2%), age (years) group between 34 to 41(n = 138, 34.6%), uneducated (n = 128, 32.1%), and higher education (n = 76, 19.0%) level of the participants were noted. Poor to moderate knowledge were observed; participants were unaware of the risk and misuse of antibiotics at all three pharmacies. By some means, a positive attitude noted, but the storage of antibiotics at home (Median = 2, IQR = 2) was preferred to use when needed. Most of the respondents didn't follow the actual dosage regimen as prescribed (n = 266, 66.7%, p < 0.05). Conclusion: A lack of knowledge and malpractices toward antibiotics use among consumers were observed. Education and awareness of the public about antibiotic resistance is the need of the hour.

TiO2 Co-doped with Zr and Ag shows highly efficient visible light photocatalytic behavior suitable for treatment of polluted water

The objective of this study is to analyze the effects of zirconium (Zr) and silver (Ag) doping on the photoactivity of titania (TiO₂). Zr–Ag (ZA) co-doped TiO₂ products were fabricated via sol–gel technique and their properties (structural and chemical) were characterized. The weight ratio of TiO₂ was fixed, while weight ratios of Zr and Ag were varied from 2 to 4, 6 and 8 wt% while synthesized samples were calcined at 400 °C for 3 h. The XRD results demonstrated that the incorporation of metal doping agents failed to alter the host material's lattice structure, however, its crystallite size was reduced from 13.54 to 5.05 nm with increasing Zr⁴⁺ and Ag⁺ concentrations. FTIR spectroscopy was used to examine various functional groups. In the attained spectra, an ample absorption peak between 500 and 1000 cm⁻¹ was recorded, which was ascribed to Ti–O–Ti linkage vibration mode present within TiO₂. Surface morphology, microstructure, SAED patterns and elemental composition were examined with FE-SEM, HR-TEM and EDX, which served to confirm the ZA-doped TiO₂ product. Band gap energy of the co-doped material was significantly reduced as indicated by a higher wavelength redshift in the spectra. The photoactivity and kinetics of photo-products were investigated by observing photo-decolorization of methylene blue (MB) under a radiation source. Photodecomposition of MB was dramatically enhanced when titania co-doped with Zr and Ag was employed compared to un-doped or mono-doped TiO₂. The ZA (8 wt%) co-doped TiO₂ photocatalyst depicted the maximum MB removal efficiency (∼93%) within 90 min under a light source.

The objective of this study is to analyze the effects of zirconium (Zr) and silver (Ag) doping on the photoactivity of titania (TiO₂).

Association of Estimated GFR (By MDRD) with the Carotid Intima Media Thickness (CIMT) in Different Stages of CKD among Patients with Type 2 Diabetes Mellitus

Most of the mortalities among Diabetic Nephropathy patients are cardiovascular, if we identify the risk factor, measures can be taken to prevent it. Hence an objective was set to evaluate the association between carotid artery intima media thickness (CIMT) with eGFR in patients of CKD stage III, IV and V among patients with type 2 diabetes mellitus; also, correlation with age, BMI, lipid profile. This cross-sectional, observational study was performed in 70 patients in different stages of CKD in Diabetic Patients selected by Inclusion Criteria (Diabetic nephropathy patients with stages III, IV, V and exclusion Criteria (Acute kidney injury, History of carotid surgery, Patients of MI and stroke). This study was performed in Department of Nephrology, Dhaka Medical College in collaboration with the Department of Radiology and Imaging, laboratory of Department of Biochemistry and Department of Microbiology at Dhaka Medical College Hospital (By standard method in laboratory) from 1st January 2016 to 31st December 2016. eGFR was measured by MDRD formula and the CIMT was measured using an ultrasonographic examination. The mean CIMT was 0.9±0.21mm, and 62.9% of the subjects showed IMT thickening (≥1mm). The carotid IMT elevated significantly with the stage progression of CKD (Overall eGFR mean 28.8±14.5mL/min/1.73m² in CIMT<1mm with range from 6 to 54 and 9.1±9.0mL/min/1.73m² in CIMT ≥1mm with range from 3 to 32 (p=0.001). The eGFR was significantly lower in the patients with CIMT thickening than those without CIMT thickening. eGFR was also significantly associated with CKD stages (p=0.001), serum creatinine (p=0.001), BMI (r = -0.330, p=0.005), and negatively associated with age group, duration of hypertension, smoking. However, the CIMT was not significantly different among the patients at different stages of diabetic nephropathy (r = -0.172, p=156) and age group. It has been concluded that the mean CIMT was markedly high in patients with CKD compared to normal expected value. This study showed a relationship between the CIMT and the renal parameters as eGFR and the stages of diabetic nephropathy with a confirm association between the CIMT and diabetic macroangiopathy.