Assessment of Knowledge, Attitude and Practices towards the Disposal of Unused and Expired Medications among Students of Private Medical Universities in Lusaka, Zambia

Background: The disposal of unused and expired medications has been a concern in many countries in that, the pharmaceutical waste enters the ecosystem and eventually causes a negative impact on human health and environment. Aim: To assess the knowledge, attitude and disposal practices of unused and expired medicines by students in the private medical universities in Lusaka of Zambia. Method: A cross-sectional survey was conducted over a period of 8 weeks among 391 respondents from three private universities in Lusaka. Respondents were polled using semi structured questions that focused on their knowledge, attitudes, and disposal practices for unused and expired drugs. In order to analyze data, the statistical package for social sciences (SPSS) version 20 was utilized. Results: The mean age of the participants was 23 years (SD: ±3). Out of the 391 participants, 320 (81.8%) knew about medicine waste and 391 (100.0%) responded that unsafe disposal of unused and expired medicine poses a threat to human health and can harm the environment. The drug-take-back system was unknown to a vast percentage of the respondent 371 (94.9%). The majority 274 (70.1%) of respondents had unused medicine stored at home, with antibiotics 215 (56.0%) and analgesia 111 (28.4%) being the most prevalent types of drugs kept in the households. The most commonly used disposal practice for unused 126 (32.2%) and expired medicines 274 (70.1%) was throwing them in household garbage. Only 27 (6.9%) and 30 (7.7%) reported returning unused and expired medicines to the nearest pharmacy respectively. The majority of respondents believed the risk stemmed from the presence of an undesired drug in the home, the potential for harm to children, a lack of proper information on safe disposal practices, and the necessity for a take-back program. Conclusions: The majority of the study participants used unsafe methods to dispose of unused and expired medicine. However, most of the participants acknowledged that unsafe disposal of unused and expired medicines is a public health problem and proposed the need to introduce drug take-back programs in the communities.

The Screening of Diabetes, Obesity and Hypertension Risks Associated with Hepatitis C Within the Egyptian Population in a Community Pharmacy Setting

Background:Diabetes and hypertension have been identified as risk factors for HCV complications in previous studies.This has sparked the interest in the field of prevention by identifying at-risk individuals and increasing investments for screening among pharmacists.The aim of this study was to screen for risk factors,including age,gender,BMI,hypertension,diabetes,and obesity,in Egyptian patients with HCV Methods:A prospective cross-sectional study was carried out from September 2018 to February 2019,with a total of 1,959 medical records collected.By comparing the patients'characteristics,variables related to metabolic risk,and body composition measurements,regression models have been established to determine any confounding factors.Results:The prevalence of HCV antibody was 41.0%in men and 59.0%in women.Among the variables included in the regression analysis,age,BMI,and uncontrolled hypertension were found to have statistically significant associations with diabetes in HCV positive cases(p<0.001).HCV patients>40 years old with high BMI were found to have significant associations with both,diabetes and hypertension(p<0.001).Hypertensive HCV patients were found to have significant associations with gender,age>40,and DM(p<0.001).Conclusion:HCV infection and metabolic disorders have a closed cycle relationship.Reducing the complications of DM has a promising prospective of limiting the complications of HCV .

Phytochemical Analysis and Antibacterial Activity of <i>Azadirachta indica</i>Leaf Extracts against <i>Escherichia coli</i>

Background: Traditional medicine has employed Azadirachta indica to treat a variety of ailments. However, there is little information on the use of this plant in Zambia. Objective: To evaluate the phytochemicals and antibacterial activity of Azadirachta indica leaf extracts against Escherichia coli. Materials and Methods: This was a laboratory-based experimental study in which ethanol and water were used for extraction by maceration. Phytochemical analysis was then done on the leaf extract. Using the disc diffusion method, varying concentrations of A. indica aqueous and ethanolic extracts were used to test the antibacterial activity of A. indica against Escherichia coli. The sensitivity of the tested microorganisms to aqueous and ethanolic leaf extracts was shown by zones of inhibition after incubation. Results: The phytochemical screening of the A. indica leaves revealed the presence of phenolics and tannins in both the ethanol and aqueous extract. Saponins, flavonoids and alkaloids were only present in the aqueous extract. While steroids were only present in the ethanol extract. The antibacterial activity of A. indica leaves extract was determined by zones of inhibition which showed that both aqueous and ethanol extracts had activity against E. coli. The Minimum Inhibitory Concentration was determined at 10 mg/mL for the aqueous extract and 20 mg/mL for the ethanol extract. The zones of inhibition increased with concentration. Conclusion: The extracts of A. indica displayed antibacterial activity against E. coli in a dose-dependent manner. Comparatively, the aqueous extract produced better antibacterial properties against E. coli than the ethanolic extract.

Antibacterial, Antioxidant Activities and GC-MS Analysis of Dichrostachys cinera (L.) Ethanolic Leaves Extract

Traditional medicinal plants are one of the potential sources of antimicrobial drugs and there is a great concern in the use and development of herbal medicine for the treatment of various infections. This study aimed to evaluate the antibacterial, and antioxidant activities of Dichrostachys cinera ethanolic leaves extract and to determine the components of the crude extract. D. cinera extract was evaluated against Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, and Pseudomonas aeruginosa ATCC 27853. The antibacterial, antioxidant activities and active constituents were determined using standard methods. Antibacterial activity of the crude extract findings showed that all bacterial candidates were susceptible where S. aureus represent MIC at 12.5 mg/ml and MBC at 25 mg/ml, E. coli and P. aeruginosa both showed MIC 25 mg/ml and MBC 50 mg/ml. In the free radical scavenging assay of the extract and the standard quercetin at concentrations of 250 μg/ml, 125 μg/ml, 50 μg/ml, 10 μg/ml, and 5 μg/ml. The radical scavenging activity for the extract was about 92%, 89.6%, 86.8%, 82.8% and 37.8% respectively, compared to quercetin which gave 89.7%, 85.8%, 62.1%, 55.5%, and 45% radical scavenging activity. The GC-Ms analysis of the total constituents demonstrated that 1,6-Anhydro-2,4-dideoxy-.beta.-D-ribo-hexo (21.26%) with different peaks, followed by Glycerin (11.56%), 1,2,3-Cyclopentanetriol (10.18%), 8,11,14-Eicosatrienoic acid, (Z,Z,Z)-(6.18%), 1H-Pyrrole, 1-methyl-(6.08%), Phytol (5.91%) and 7-Bromo-6-(2-diethylaminoethoxy)-2,3-dihyd (5.44%) as major components in the extract. Finally, this study provided useful information on the therapeutic potential of D. cinera as an antibacterial agent and recommended to be evaluated against a wide range of Bacterial and fungal strains using different solvents and different parts from the plant.

In <i>Vitro</i>Anthelmintic Activity of Leaf Extracts of <i>Celosia</i>laxa Schum. &Thonn

Background: Celosia laxa (Amaranthaceae) is mainly a west African plant species used in Traditional Medicine as an anthelmintic, anticancer, antibacterial and analgesic agent. The seeming prevalence of worm infection in Gwandu community of Gwandu Local Government Area of Kebbi State-Nigeria prompted this study. Methods: Whole plant of C. laxa extracts obtained through maceration in aqueous (AE), methanol (ME) and hexane (HE) solvents were investigated for their anthelmintic activity against Indian earthworms (Pheretima posthuman) at four different (gradient) concentrations of 10, 20, 40 and 80 (mg/ml) for each extract. The study involved the determination of time of paralysis (P) and time of death (D) of the worms. Results: Both the aqueous and ethanolic extracts exhibited significant anthelmintic activity at the highest concentration of 80 mg/ml as compared to the standard drug, praziquantel (10 mg/ml). Consequently, the aqueous extract showed a higher activity at 80 mg/ml compared to standard praziquantel at 10 mg/ml (with no significant value of p < 0.05). The time of paralysis and death observed for AE was 13.0 ± 1.8 and 16.8 ± 1.5 while the ME was less bioactive with 15.7 ± 0.5 and 23.0 ± 0.0 respectively. However, on the other hand, the hexane extract recorded no-activity on all the test sample concentrations, compared to the standard drug (with a significant difference of p-value, p > 0.05). Conclusion: It was concluded that the leaves of C. laxa are likely to yield a potent anthelminthic drug owing to soluble phytoconstituent which are largely hydrophilicity extracted by the polar solvents. Also, considering that the plants’ mode of preparation for use by the locals was aqueous decoction before administration, the folkloric therapeutic claims can be said to have been justified.

Phytotherapy in diabetes: Review on potential mechanistic perspectives

Diabetes mellitus(DM) is a widely spread epidemic dis ease that results from the absence of insulin, decreased secretion and/or impaired function. Since DM is a multi factorial disease, the available pharmaceuticals, despite their sensible treatment, target mostly one pathway to control hyperglycemia and encounter several side effects. Therefore, new therapeutic paradigms aim to hit several pathways using only one agent. Tradition ally, antidiabetic plants and/or their active constituents may fulfill this need. More than 200 species of plants possess antidiabetic properties which were evaluated mostly by screening tests without digging far for the exact mode of action. Searching among the differen literature resources and various database and in view o the above aspects, the present article provides a com prehensive review on the available antidiabetic plants that have been approved by pharmacological and clini cal evaluations, and which their mechanism(s) of ac tion is assured. These plants are categorized according to their proved mode of action and are classified into those that act by inhibiting glucose absorption from in testine, increasing insulin secretion from the pancreasinhibiting glucose production from hepatocytes, or enhancing glucose uptake by adipose and muscle tissues. The current review also highlights those that mimic in their action the new peptide analogs, such as exenatide, liraglutide and dipeptidylpeptidase-4 inhibitors that increase glucagon-like peptide-1 serum concentration and slow down the gastric emptying.

Review of pharmacologic and immunologic agents in the management of COVID-19

The novel coronavirus disease 2019(COVID-19)is the third coronavirus outbreak in the last two decades.Emerging and re-emerging infections like COVID-19 pose serious challenges of the paucity of information and lack of specific cure or vaccines.This leaves utilisation of existing scientific data on related viral infections and repurposing relevant aetiologic and supportive therapies as the best control approach while novel strategies are developed and trialled.Many promising antiviral agents including lopinavir,ritonavir,remdesivir,umifenovir,darunavir,and oseltamivir have been repurposed and are currently trialled for the care for COVID-19 patients.Adjunct therapies for the management of symptoms and to provide support especially in severe and critically ill patients have also been identified.This review provides an appraisal of the current evidence for the rational use of frontline therapeutics in the management of COVID-19.It also includes updates regarding COVID-19 immunotherapy and vaccine development.

Asthma Patient Care: The Pharmacist’s Perspective

Aim of the Study: To compare effect of asthma care by pharmacist intervention versus routine care on asthma control. Patients and Methods: A 2-month randomised, controlled trial was conducted in outpatient clinics of Ain Shams University Hospitals, Cairo, Egypt. Patients were randomly assigned to receive routine care or a pre-defined pharmacist intervention. This intervention was mainly focused on patient education, improving inhalation technique and medication assessment. Primary outcome was the level of asthma control, as assessed by the Asthma Control Questionnaire (ACQ). Results: By the end of the study, intervention patients who received a written action plan significantly improved their ACQ results than routine care group who did not receive a plan (p < 0.0001). Inhalation technique and adherence to controller medication were significantly better in the intervention group. Conclusion: The present study results provide supportive evidence concerning pharmacists’ favourable effects on asthma patient care and support pharmacists as valuable members of the health care team.

Pharmacist-Managed Anticoagulation Services for Warfarin Management in Tertiary Hospitals:The Egyptian Experience

Background:Warfarin is widely regarded as the main anticoagulant in lowering the risk of thromboembolism.This study used indicators to compare pharmacist-managed anticoagulation services,using a well-prepared protocol,with physician-managed anticoagulation services・Methods:A retrospective prospective pilot study was conducted to compare patient outcomes before and after transitioning patients to phannacist-managed anticoagulation services,comparing the proportion of those with therapeutic international normalized ratio(INK),subtherapeutic INK,and supratherapeutic INR,as well as their bleeding occurrences as indicators of assuring quality care.Results:A significant improvement in anticoagulation management was noted in the transition to pharmacist-managed anticoagulation services.The proportion of those with subtherapeutic INR decreased from 61.8%to 11.8%(p<0.001),those with supratherapeutic INR decreased from 20.6%to 2.9%(p<0.001),those with therapeutic INR increased from 17.6%to 85.3%(p<0.001),and the occurrence of bleeding decreased from 11.8%to 0.0%,without significant difference in warfarin doses(median from 4 before the transition to 5 after);in addition,the time to reach therapeutic INR decreased from 12-24 weeks to 2-8 weeks after transitioning to pharmacist-managed anticoagulation services.Conclusion:Pharmacist-managed anticoagulation services are considered safer and more effective than physician-managed anticoagulation services alone in terms of patientsJ adherence and satisfaction,which provide an excellent opportunity for quality assurance care.

Herbal compounds as promising therapeutic agents in precision medicine strategies for cancer:A systematic review

Background:The field of personalized medicine has gained increasing attention in cancer care,with the aim of tailoring treatment strategies to individual patients for improved outcomes.Herbal medicine,with its long-standing historical use and extensive bioactive compounds,offers a rich source of potential treatments for various diseases,including cancer.Objective:To provide an overview of the current knowledge and evidence associated with incorporating herbal compounds into precision medicine strategies for cancer diseases.Additionally,to explore the general characteristics of the studies included in the analysis,focusing on their key features and trends.Search strategy:A comprehensive literature search was conducted from multiple online databases,including Pub Med,Scopus,Web of Science,and CINAHL-EBSCO.The search strategy was designed to identify studies related to personalized cancer medicine and herbal interventions.Inclusion criteria:Publications pertaining to cancer research conducted through in vitro,in vivo,and clinical studies,employing natural products were included in this review.Data extraction and analysis:Two review authors independently applied inclusion and inclusion criteria,data extraction,and assessments of methodological quality.The quality assessment and biases of the studies were evaluated based on modified Jadad scales.A detailed quantitative summary of the included studies is presented,providing a comprehensive description of their key features and findings.Results:A total of 121 studies were included in this review for analysis.Some of them were considered as comprehensive experimental investigations both in vitro and in vivo.The majority(n=85)of the studies included in this review were conducted in vitro,with 44 of them specifically investigating the effects of herbal medicine on animal models.Additionally,7 articles with a combined sample size of 31,271 patients,examined the impact of herbal medicine in clinical settings.Conclusion:Personalized medication can optimize the use of herbal medicine in cancer treatment by considering individual patient factors such as genetics,medical history,and other treatments.Additionally,active phytochemicals found in herbs have shown potential for inhibiting cancer cell growth and inducing apoptosis,making them a promising area of research in preclinical and clinical investigations.