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Ambient ionisation has recently become an attractive addition to toxicology workflows, as it provides rapid analysis of drugs of abuse compared with traditional chromatographic techniques such as LC-MS. Based on electrospray ionisation mechanisms, paper spray ionisation (PSI) generates ions directly from a sample spotted onto a paper substrate, minimising the cost and time of analysis. PSI uses dried matrix spots (DMS), a well-established but evolving trend in toxicology providing an alternative to collection of venous blood samples. DMS also offer improved matrix and analyte stability due to fewer enzymatic processes taking place as a result of matrix dehydration. Using DMS and PSI combined introduces the possibility of less invasive sample collection for the patient, no sample extraction or chromatography required facilitating lower cost per analysis, and quicker turnaround with earlier results available to clinicians. Emergency department (ED) presentations due to acute drug toxicity can be life-threatening; currently clinicians rely on self-report and clinical patterns of toxicity to determine the drug(s) likely to be involved. The use of PSI for identification and quantitation of NPS/other drugs can provide results on drugs present to inform patient care early in the patients’ ED presentation. With the NPS market continually expanding, PSI coupled to MS has the potential for a wide-reaching benefit to ED care, ultimately enabling clinicians to tailor patient care based on analytically confirmed NPS use. This presentation will illustrate our preliminary work using a VeriSpray PSI-MS.

Introduction: Many fentanyl analogs are developed and mixed with other illicit drugs, such as cocaine and heroin. Detecting fentanyl and fentanyl analogs in these illicit drug mixtures gains more importance. Most confirmatory procedures require time-consuming and expensive, highly sophisticated laboratory equipment and experimental procedures, which can delay critical information that might save a victim or identify a suspect. In this project, we propose miniaturizing and accelerating this process by combining SERS analysis and mass spectrometry on a single microfluidic device. This procedure, known as paper spray mass spectrometry (PS-MS), can isolate fentanyl analogs from even complex drug mixtures. Thus, we propose to develop a novel device capable of simultaneously detecting fentanyl and fentanyl analogs in illicit drug mixtures. Methods: For this aim, first, a dual-purpose plasmonic paper substrate will be developed and optimized by soaking the filter papers into the synthesized bimetallic (Au-Ag) nanostars. The various images will be taken to define the characteristics of these paper substrates. Then, a procedure for drug screening by Raman will be combined with paper spray mass spectrometry (PS-MS) confirmation. Finally, this newly developed method will be used in seized drug samples. Results: The soaking time of the filter paper is affecting the enhancement. As the papers stay in the nanostar solutions more (up to 6 days), the enhancement of the peaks gets better. Different illicit drugs such as fentanyl, fentanyl analogs, cocaine, heroin, and methamphetamine can be detected on these filter papers by portable Raman spectroscopy. Optimizing the PSI-MS method is still in process. Conclusions: Coupling portable SERS and PSI-MS methods will provide strong confirmatory results for real-world samples and drug mixtures. The experimental results obtained in this project can be readily implemented in field applications and in smaller laboratories, where inexpensive portable Raman spectrometers are often present and are used in drug analysis.

The colorimetric paper-based device using lipase inhibition assay was developed for rapid and visual detection of orlistat in weight loss supplements. The paper device with five circular detection zones was simply fabricated from filter paper No 1 using a low-cost paper craft puncher with a design of a flower-like shape. The enzymatic reaction on the detection zone employed a small volume of a substrate, a-naphthyl acetate, a sample, and a lipase enzyme. After incubation, the Fast Blue B solution was used as a chromogenic reagent. The decrease in purple color can be observed by the naked eye, in the presence of orlistat. Under optimized conditions, the paper device showed satisfactory sensitivity and selectivity. The device was applied for rapid screening of orlistat in weight loss supplements and the results agreed with those obtained from TLC analysis.

(1) Background: Many drugs possess poor bioavailability, and many strategies are available to overcome this issue. In this study, smartFilm technology, i.e., a porous cellulose matrix (paper), in which the active compound can be loaded onto in an amorphous state was utilised for oral administration to improve the solubility and bioactivity of a poorly soluble BSC class IV antibiotic. (2) Methods: Norfloxacin was used as the model drug and loaded into commercially available paper. The resulting norfloxacin-loaded smartFilms were transformed into smartFilm granules via wet granulation and the resulting norfloxacin-loaded smartFilm granules were transformed into norfloxacin-loaded tablets made from paper, i.e., smartFilm tablets. The crystalline state of norfloxacin was investigated, as well as the pharmaceutical properties of the granules and the tablets. The bioactivity of the smartFilm tablets was assessed in vitro and ex vivo to determine the antibacterial activity of norfloxacin. The results were compared to a physical mixture tablet that contained non-loaded paper granules and equal amounts of norfloxacin as a crystalline powder. (3) Results: Norfloxacin-loaded smartFilm granules and norfloxacin-loaded smartFilm tablets contained norfloxacin in an amorphous state, which resulted in an improved and faster release of norfloxacin when compared to the physical mixture tablet. The bioactivity was up to three times higher when compared to the physical mixture tablet. The ex vivo model was demonstrated to be a useful tool that allows for a fast and cost-effective discrimination between “good” and “bad” formulations. It provides realistic physiological conditions and can therefore yield meaningful, additional biopharmaceutical information that cannot be assessed in classical in vitro experiments. (4) Conclusions: smartFilm tablets are a promising, universal, industrially feasible and cost-effective formulation strategy for improved solubility and enhanced bioactivity of poorly soluble drugs.

Many orally administrated drugs exhibit poor bioavailability due to their limited solubility. The smartFilm technology is an innovative approach to improve the drug aqueous solubility, where the drug is embedded within the matrix of cellulose-based paper in an amorphous state, hence increasing its solubility. Despite its proven effectiveness, smartFilms, i.e., pieces of paper, exhibit limited flowability and are not easy to swallow, and thus oral administration is not convenient. In addition, there is a lack of knowledge of their mechanical behavior under compression. This study aimed to transform unloaded smartFilms, i.e., paper, into a flowable physical form and investigated its mechanical behavior when compressed. Granules made of paper were prepared via wet granulation and were compressed into tablets. The influence of using different amounts and forms of sucrose, as a binder, on the pharmaceutical properties of the produced granules and tablets was studied and the most suitable composition was identified by using instrumented die experiments. For this, the Poisson’s ratio and Young’s modulus were determined for different compaction force levels and the deformation behavior was estimated with the Heckel mathematical model. All granule batches showed good flowability with angle of repose values between 25–35°. Granule batches with ≤30% dry sucrose content produced tablets that fulfilled the European Pharmacopeia requirements, and the compaction behavior of the granules was found to be comparable to the behavior of classical binders and compression enhancers. Paper can be transferred into granules. These granules can be used as suitable intermediate products for the production of tablets made of paper in large, industrial scale.

Routine vaccination activities, such as detection, reporting, and management of adverse events following immunization (AEFIs), are generally handled by healthcare providers (HCPs). Safe vaccines against severe acute respiratory syndrome coronavirus (SARS-CoV-2) were introduced to control the Coronavirus Disease-19 (COVID-19) pandemic. The study aimed to assess the knowledge, perceptions, and practice of HCPs in Iraq about reporting adverse events following COVID-19 vaccination, and their association with sociodemographic variables. The study was a cross-sectional study that was carried out between August and September 2021 at the COVID-19 vaccination centers in Iraq. This study used an online and paper-based questionnaire, which was distributed among HCPs (physicians and pharmacists) in COVID-19 vaccination centers. A total of 117 pharmacists and physicians responded to the survey. Two-thirds of respondents were pharmacists. The majority of the respondents (49.6%) had fair knowledge levels on AEFIs. The perception of 43% of the participants was very good, whereas the perception of 28%, 23%, and 6% of the participants was fair, good, and poor, respectively. The reporting practice of HCPs was inadequate in 53% of respondents. The number of pharmacists who had good knowledge of AEFIs was significantly higher than that of the physicians. The age group (30-39) years of HCPs was significantly associated with more positive perception towards AEFIs. The number of pharmacists that had good perception was significantly higher than that of the physicians. Furthermore, HCPs aged 30 to 39 years had significantly higher reporting practices than other age groups. The study highlighted that the HCPs working at the COVID-19 vaccination centers have low knowledge of AEFIs. On the other hand, HCPs had more positive perception towards reporting AEFIs. Education programs and reference materials are needed to increase their awareness about AEFIs.

Emergency contraceptives (ECs) are indicated for preventing the chance of unintended pregnancy that follows unprotected sexual intercourse in cases of incorrectly used regular contraceptives and in sexual assault. It is considered a safe choice to prevent pregnancy than abortion which is considered life threating. The aim of this study was to assess knowledge, attitude, and practices (KAP) of community pharmacists towards emergency contraceptives and their association with sociodemographic variables. This study was a cross sectional study conducted between August and September 2021 on a convenient sample of community pharmacists from Iraq. The survey tool was an online, self-administered questionnaire, in English language and a paper-based copy of the questionnaire was delivered face-to-face to some of the study participants. The questionnaire consisted of four parts, sociodemographic characteristics, knowledge, attitude and practices of community pharmacists toward emergency contraceptives. A total of 212 community pharmacists participated in the study. Of the study participants, 67.9% were in the age range of (24-29) years, 61.8% were females,60% had less than 5 years of experience, the majority (73.1%) were from Baghdad. This study showed that the majority of community pharmacists (74%) had good knowledge and 95% of them had a very positive attitude. However, 51% of the participants had poor practice where 62.5% of the pharmacists did not make counselling during dispending on mechanism of action. This study results have shown no significant relationship between demographic characteristics and KAP of participants towards emergency contraceptives. The majority of the study participants had good knowledge and very positive attitude too, whereas poor practice was observed in more than half of the participants. Educational programs and training sessions are required to raise knowledge about the importance of emergency contraceptives and also to improve the dispensing practice of these products.

Background: Package leaflet provides information about medicinal product to the user. Printed leaflet is familiar and available, however poorly legible, especially when containing multiple languages. It is resourceful to update, has potential to go missing or get damaged, and is environmentally burdensome. The pharmaceutical manufacturers in the Baltic countries have been granted permission to market selected hospital medicinal products without printed package leaflet. The industrial pilot project is expected to promote availability of medicinal products and patient safety via increased access to medicinal information. Objective: Only few countries in Europe have derogated from Article 58 of Directive 2001/83/EC. Knowledge about the effects of removal of paper package leaflet from the medicinal product is limited, and related publications are scarce. Current interview study is identifying the obstacles during the implementation of the industrial project, investigating the potential environmental impact, and searching for further opportunities for the package leaflet in development of medicinal products. Methods: Real-time person-to-person semi-structured interviews with relevant stakeholders were conducted, and transcripts were analysed by content analysis to identify themes. Results: Results demonstrated general support for removing package leaflet from selected hospital products. Main difficulties of the industrial project regarded the need for clear communication and practical disadvantages of project setup. Main benefits included educational aspect of increasing awareness about product information and strengthened collaboration. Majority of participants felt doubtful about the impact of the industrial project on people's awareness of ecological issues and they admittedly lacked sufficient information on the environmental impact of pharmaceutical packaging. Conclusion: The removal of paper leaflet could be extended to more products based on the positive feedback for the industrial pilot project. However, it is paramount that the format of electronic product information would need to be enhanced first to improve readability.

Abstract Objective: the idea of this study to improve transdermal permeability of Methotrexate using eucalyptus oil, olive oil and peppermint oil as enhancers. Method: eucalyptus oil (2% and 4%), peppermint oil (2% and 4%) and olive oil (2% and 4%) all used as natural enhancers to develop transdermal permeability of Methotrexate via gel formulation. The gel was subjected to many physiochemical properties tests. In-vitro release and permeability studies for the drug were done by Franz cell diffusion across synthetic membrane, kinetic model was studied via korsmeyer- peppas equation. Result: the results demonstrate that safe, nonirritant or cause necrosis to rats' skin and stable till 60 days gel was successfully formulated. Methotrexate penetration alone without enhancer is only about 20%, while using enhancers reach to 85%, 99% and 90% with eucalyptus oil 4%, peppermint oil 4% and olive oil 4% respectively after 24 hours. Conclusion: Methotrexate transdermal gel was prepared and evaluated fruitfully in-vitro with a good permeation across semipermeable membrane. The results indicated that using of peppermint oil as enhancer have superiority to enhance the transdermal permeation of the Methotrexate.

High intraocular pressure (IOP) is a recognized risk factor for glaucoma and optic nerve injury, and it is one of the primary causes of vision loss globally. Anabasis articulata (AA) is a desert plant found in Iraq. The extract of AA is used to cure diabetes, fever, eczema, and kidney infections. The aim of the study is to evaluate the antioxidant effect of methanol extract of AA on intraocular pressure in the glaucoma rat model. Forty-two rats were allocated into seven groups, each with six animals:: group 1 (normal), group 2 (control), in which animals were induced to have elevated IOP by betamethasone suspension injection, groups 3,4 and 5 for evaluating the effect of 50,100 and 150 mg/kg/day of the tested extract, respectively, and the remaining two groups (group 6 and 7) for evaluating oral acetazolamide and topical timolol 0.5% respectively. Betamethasone was used for the induction. Measure the IOP every 2 days for 2 weeks. The daily dose of AA extract (50 mg/kg/day) for 6 days significantly reduces intraocular pressure (p ? 0.05), from (34.23± 0.58) to (32.83± 1.38) mmHg when compared with the control group. In group 4, IOP decreased significantly from (35.5±1.37) to (31.35±0.40) mmHg (p ? 0.05) after 1 week of treatment. In group 5, the significant (p? 0.001) IOP reduction from (35.66±0.39) to (31.88±0.74) mmHg started on day 6 and continued until the end of the experiment, reaching (24.53±0.53) mmHg (p? 0.001). The antioxidant and anti-angiogenic properties of AA make it a promising adjuvant treatment for glaucoma.

The rheological behavior among factors that are present in Stokes law can be used to control the stability of the colloidal dispersion system. The felodipine lipid polymer hybrid nanocarriers (LPHNs) is an interesting colloidal dispersion system that is used for rheological characteristic analysis. The LPHNs compose of polymeric components and lipids. This research aims to prepare oral felodipine LPHNs to investigate the effect of independent variables on the rheological behavior of the nanosystem. The microwave-based technique was used to prepare felodipine LPHNs (H1-H9) successfully. All the formulations enter the characterization process for particle size and PDI to ascertain the colloidal properties of the prepared nanosystem then use coaxial rotational digital rheometer for rheological evaluation. The outcomes show that all felodipine LPHNs formulations (H1-H9) had a nanosize and homogenous structure that ascertain colloidal features of the nanodispersion system. The rheogram chart indicates that all of the felodipine LPHNs formulations (H1-H9) show pseudoplastic flow (non-Newtonian flow) that have shear-thinning property. The microwave-based method prepares felodipine LPHNs formulations (H1-H9) that show excellent physical texture that ascertains its ability as a technique for the preparation of nanoparticles. All of the felodipine LPHNs formulations (H1-H9) show pseudoplastic flow that supports the physical stability of the nanosystem.

Abstract Background: The novel coronavirus 2 (SARS?CoV?2) pandemic is a pulmonary disease, which leads to cardiac, hematologic, and renal complications. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis. The world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions. Objective: compare the clinical outcome and the costs of two anticoagulants (heparin and (enoxaparin)) used to treat hospitalized patients with COVID-19 infection. Patients and method: The study was a retrospective review of medical records of adult, non-pregnant, COVID-19 infected hospitalized patients who had baseline and last outcome measurements at Alamal Epidemiology Center, Al-Najaf city from (Augast 2020 to June 2021). The outcome measures included D-dimer, length of stay (LOS), and mortality rate. Only the cost of the medical treatment was considered in the analysis. The pharmacoeconomics analysis was done in three different cost-effectiveness analysis methods. Microsoft Excel spreadsheet and Statistical Package for the Social Sciences software (SPSS), was used to conduct statistical analysis. Kaplan Meier test was used to compare the mortality rate. T-TEST was used to compare the outcomes of the two groups. Results and discussion: two groups were compared, the first group consists of 72 patients who received heparin, and the second group consists of 72 patients who received enoxaparin. COVID-19 infected patients had a higher abnormal average D-dimer (2534.675 ng/dl). No significant differences between both genders with regards to the basal average D-dimer (males= 2649.95 ng/dl, females= 2374.1mg/dl, P-value>0.05). There was a significant difference between patient's ages 60 years and patients 0.05). Concerning the cost, treatment with heparin cost less than enoxaparin (2.08 U.S $, 9.44 U.S $)/per patient/per day. Conclusion: Originator heparin was a more cost-effective anticoagulant therapy compared to originator enoxaparin, it was associated with a lower cost and better effect, treatment with Heparin resulted in positive INB= 11.3, where a positive result means that heparin is more cost-effective than Enoxaparin. All three methods of pharmacoeconomic analysis decide that heparin was more cost-effective than enoxaparin in treating COVID-19 infected patients.

Breast cancer is the most common cancer among women over the world. To reducing reoccurrence and mortality rates, adjuvant hormonal therapy (AHT) is used for a long period. The major barrier to the effectiveness of the treatment is adherence. Adherence to medicines among patients is challenging. Patient beliefs in medications can be positively or negatively correlated to adherence. Objectives: To investigate the extent of adherence and factors affecting adherence, as well as to investigate the association between beliefs and adherence in women with breast cancer taking AHT. Method: A cross-sectional study included 124 Iraqi women with breast cancer recruited from Middle Euphrates Cancer Center. Morisky medication adherence scale (MMAS) and beliefs about medication questionnaires (BMQ) are used to assess adherence and beliefs respectively. Result: 25% of women were fully adherent (MMAS = 8). 83.06% of all women developed side effects from medications received. Side effects and unemployed women were significantly associated with non-adherence. Additionally, there is no significant association between beliefs in medications and adherence. conclusion The enormous percent of poor adherence caused by side effects suggests the need for interventions by educating patients about the importance of their treatment and how to overcome side effects.

Asthma is one of the most common chronic, non-communicable diseases affecting children worldwide. The estimated prevalence of pediatric asthma in Iraq is 15.8%. Physiologic, inflammatory and structural factors contribute to the development of asthma. Assessment and monitoring of asthma control can be done by a validated children asthma control test (CACT). Management of asthma must address three components which are an appropriate management plan, the most appropriate medication if necessary, and the use of safe and effective medication. The management plan should consider patient counseling and education about the definition of asthma, signs, and symptoms, the pathophysiology of asthma, common triggers for asthma and how can avoid them, what are the rescue medication and the controller one, proper inhaler techniques, and how to monitor asthma control. Patient education accounts for 90% of success and this can be achieved by an active collaboration among health care providers. This is a prospective interventional study that aims at evaluating pharmacist counseling for asthmatic children. The study involved 105 participants whose consent was taken and underwent a face-to-face interview about asthma counseling and inhaler technique for those who use it. Ninety-two eligible participants remained. Their CACT was recorded at the first visit and then followed up weekly for one month either by phone or physical to assess asthma control. In the fourth week, a CACT was recorded and compared to the first one before intervention. There was a significant improvement in CACT after providing the counselling and weekly follow up.

Fluoxetine (FX) is an antidepressant drug administered only orally in humans. Despite the wide use of FX, until now, there is only limited literature concerning the pharmacokinetics (PK) of FX and the effect of food on its PK. Thus, the objective of this investigation was to study the PK of FX in Arabic healthy male adult volunteers under fasting and fed conditions. In the fasting study, FX 20 mg capsules (Prozac®, Eli Lilly, Canada) were administered to 41 volunteers after overnight fasting of 12 hours, followed by blood sampling from each volunteer immediately before dosing (zero time) and then at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 24, 36, 48, 60, 72, 96, 120, and eventually at 144 hours after FX dosing. The fed study was conducted after 90 days wash-out period following the completion of the fasting study. The same subjects who received FX in the fasting study were administered the drug directly after a fatty breakfast (fed study), followed by blood sampling intervals similar to the schedule mentioned above for the fasting study. The current investigation demonstrated no statistical differences in the FX pharmacokinetic parameters Cmax, AUC0–t, AUC0–∞, Kel, T1/2, MRT, Cl/F, and Vd/F after fasting compared to the fed conditions, whereas there was statistically significant elongation in the Tmax values after food intake. Therefore, this study concludes the absence of food effect on the PK of FX (except Tmax) in the Arabic population and confirms the method of administration mentioned in the product information but also concludes high interindividual variation in FX exposure (AUC), which suggest that therapeutic drug monitoring (TDM) might be advisable when feasible.

High percentage of the Iraqi population profoundly rely on folk medicine to meet their health needs which makes their safety questionable. This study aims to evaluate Iraqi herbalists' knowledge and practice to ensure the public's safety. This study was conducted in a cross-sectional design between October 2021 and March 2022, using a pretested questionnaire administered to Iraqi herbalists practicing in Middle Euphrates Area. Through face-to-face meetings, participants completed a multicomponent questionnaire comprising 15 items in four sections. The data obtained were analyzed using a statistical package for social sciences; Chi-square was used to correlate some variables, and P-values of

Some new norms need to be adapted due to COVID-19 pandemic period where people need to wear masks, wash their hands frequently, maintain social distancing, and avoid going out unless necessary. Therefore, educational institutions were closed to minimize the spread of COVID-19. As a result of this, online education was adapted to substitute face-to-face learning. Therefore, this study aimed to assess the Malaysian university students’ adaptation to the new norms, knowledge and practices toward COVID-19, besides, their attitudes toward online learning. A convenient sampling technique was used to recruit 500 Malaysian university students from January to February 2021 through social media. For data collection, all students were asked to fill in a questionnaire that was developed based on previous literature, using Google Forms. 498 students completed the questionnaire (response rate 99.6%). Malaysian Ministry of Health was the main source (83.73%) that students refer to when looking for information on COVID-19. Only 40% of the participants had good overall knowledge about COVID-19; such knowledge was influenced by the students' field of study. The current practice towards COVID-19 was good only by 26.1% of participating students; such practice was influenced by the ethnic groups. Additionally, 60% of participated students agreed that COVID-19 can be successfully controlled. About one-third of participants had positive attitudes toward online learning. The major challenges facing students during online learning include distraction of the learning environment (80%), unstable internet connectivity (75%), lack of motivation (70%), limited technical skills (41%), and limited broadband data (34%). In conclusion, the knowledge and practice toward COVID-19 was good in less than half of Malaysian university students. Attitudes to the controlling of COVID-19 were positive, while the attitudes toward online learning were neutral among most of the Malaysian university students. Challenges toward online learning are diverse and include both technical and student-related problems.

Cupressus sempervirens L., Cupressaceae, that is known as evergreen cypress, Mediterranean cypress and in Arabic called “al -Sarw. It is an evergreen, medium sized, longevity, and wide distributed over all the world. The plant represents an important member of conifer plants which characterized with aromatic leaves and cones. Cupressus sempervirens have been ethnobotanical uses as an antiseptic, relief of cough, astringent, antispasmodic, wound healing and anti-inflammatory. Aims of this work are phytochemical analysis, isolation and structural identification of Quercitroside (quercitrin) and essential oil in Iraqi C. sempervirens. Isolation of quercitrin was performed by preparative HPLC from n-butanol fraction that prepared and extracted from Cupressus sempervirens leaves using ultrasound probe extraction, the structural identification of isolated quercitrin done by FT-IR characterized by bands at varies of frequency ranges. Moreover, LCMSMS; molecular ion at 448 m/z and base peak m/z 301. Furthermore, isolation of essential oil using hydro-distillation and estimated by GC-MS, the results show a good essential oil yield 0.9% with an interesting concentration of alpha-pinene 44%, carene10%, cedrol 4.86%, and β- myrcene 3.67%. A new Quercetin-glycoside in Cupressus Semperviren species in addition, 0.9% essential oil yield considered important phytochemicals with good concentration in Iraqi cypress plant.

Until today, one of the leading predominant infections is Urinary tract infection (UTI). It exerts a huge burden on health systems worldwide each year. Treating UTIs empirically with antimicrobials improves morbidity rates. This study aims to assess the prevalence of UTI-associated bacteria in adult patients and to determine their antibiotic susceptibility profile. A retrospective study was conducted for adult outpatients who visited Al-Diwaniya tertiary hospitals from January 2020 till February 2022 to review their medical and lab records in addition to sociodemographic data. A total of 256 patients’ records were included of which 204 (79.7%) belong to females and 52 (20.3%) were males with an average age of 39.22±17.10 years. The predominant organisms’ isolates were Staphylococcus spp. found in 100 records (39.1%), Escherichia coli (E. coli) demonstrated in 90 records (35.2%), and Klebsiella spp. (K. spp.) revealed in 23 records (9%). Staphylococcus spp. (Staph. spp.) showed high resistance to ampicillin (92.9%) followed by ceftazidime (87.5%), and were highly sensitive to vancomycin. The higher resistance profile of E. coli was to ampicillin (97.9%) and ceftriaxone (81.3%) while was highly susceptible to meropenem (97.9%) and amikacin (97.6%). Additionally, Klebsiella spp. was highly susceptible to nitrofurantoin (78.6%), while was completely resistant to ampicillin. This study presents Staphylococcus spp. as the most prevalent gram-positive uropathogen and E. coli as the most prevalent gram-negative bacteria with a multidrug resistance profile to commonly used antimicrobials which is an alarming situation to implement an immediate effective stewardship program.

There were several goals in this study, the most important of which was to create an oral liquid preparation (Ion sensitive floating oral in situ gel system for sustained delivery of Montelukast Sodium for pediatric patients) that would make administration easier, provide the correct therapeutic dose, and allow the drug to be released more slowly into the digestive tract (GIT) for better control. Montelukast Sodium in situ gels at different concentration (w/v) of natural polysaccharides (Gellan gum and sodium alginate) and natural polymer (Pectin) were prepared and characterized in the terms of preparation, viscosity and In vitro release. As the concentrations of ion-sensitive gel-forming components (Gellan gum, sodium alginate, and pectin) and gas-generating ingredients increased, the viscosity of formulations in solution (CaCO3). In vitro release study showed that the release of Montelukast Sodium from these gels was characterized by an initial phase of high release (burst effect), followed by a more gradual release in the second phase. The oral distribution of Montelukast Sodium using the in situ gel system manufactured by Montelukast Sodium can be seen as a viable strategy for the improvement of therapeutic effects.

The study objective was to conduct Pharmacoeconomics study (cost-effective analysis) between infliximab reference (Remicade) and its biosimilar (Remsima) in patients with rheumatoid arthritis (RA) in Iraqi hospitals. This is a retrospective multicenter pharmacoeconomic analysis conducted at two large teaching governmental hospitals in Baghdad, Iraq which provided infliximab to patients with RA. Data were collected from patient’s medical records and face-to-face interviews with the patients from December 2021 to April 2022. The study included 57 patients with rheumatoid arthritis (RA). The patients were categorized into two groups according to the type of infliximab they received over 30 weeks: 27 patients received reference infliximab (Remicade) and 30 patients received biosimilar infliximab (Remsima). The two groups had comparable demographic and baseline disease parameters, with a mean age of 49.6 years and a BMI of 30.0. The vast majority of participants were women (82.5%) with low level of formal education (65%). Overall, both infliximab biopharmaceuticals had good effectiveness to reduce the RA disease activity (CDAI) and improve patient quality of life. They both had comparable adverse reactions including UTI, fatigue, and headache. There was no significant difference (P-value >0.05) in disease activity between the two groups according to RA clinical disease activity index (CDAI) score across all three-time measures: before biological therapy, 14 weeks post-therapy and 30 weeks post-therapy. In 2019, Remicade was slightly more effective and provide better quality of life, but costlier ($41,896 per QALY) compared to Remsima. It was not clear whether the reference biologic (Remicade) or its biosimilar (Remsima) was more cost effective. In 2021, Remicade was more cost effective compared to Remsima because Remicade was less expensive and relatively more effective according to CDAI and EQ-5D-5L scores. Registering and purchasing both reference infliximab and its biosimilar was good idea to keep the competition in the price and maintain infliximab for RA patients.

The aim of study was to explore pharmacist insights toward the impact of prospective implementation of the national health insurance program on patients, providers and Iraqi health system. This was a qualitative study including semi-structured face-to-face (mostly) interviews with experienced pharmacists. The interview guide included open-ended questions about the impact of the national health insurance program on patients and healthcare providers at three levels: quality of services, costs, and frequency of visits. Potential challenges were also discussed. Interviews were conducted in four provinces from March to May 2022. Thematic analysis was used to analyze the interview findings and generate themes and subthemes. The study recruited 21 pharmacists till the saturation point has been reached. Most of the participants were aware of the new health insurance law. Most participants believed that the program can enhance patient health and would increase the income of healthcare providers (HCPs) in the private sector. They also expected that patients would use private-sector services more frequently. Additionally, the implementation of the health insurance can improve the quality of healthcare services and reduce the financial burden regarding private sector fees. The potential challenges of the program include people's resistance to paying a monthly premium, difficulties in claims processing, potential delays in the reimbursement of HCPs, potential patient misuse of the insurance program, and the absence of an electronic system and database. There are not an adequate number of priced and tested medications. The health insurance program has several potential advantages, but at the same time it can face several technical challenges. The program should be well studied before implementing and it needs to be piloted at small scale before national implementation. The electronic system must be implemented by healthcare settings to facilitate transferring of the information/bills to the health authority. It is recommended to hire international team of experts to supervise the management this new system.

Combination of natural poly-phenolic compounds with chemotherapeutic agents is recently being a novel strategy in cancer therapy researches owing to their potential antioxidant and anti-inflammatory properties that modulate several intracellular signaling pathways. Resveratrol and Baicalein are well known poly-phenolic compounds that belong to stilbene and flavone subclasses, respectively. This study aims to investigate the possible enhancement effect of resveratrol and Baicalein when combined with doxorubicin using a different combination ratio and applied on two cancer cell lines: HCT116 (colorectal cancer cells) and HepG2 (hepatocellular cancer cells). It also investigates the possibility of such natural compounds to provide a protection effect on cardiocytes (H9C2) when resveratrol and Baicalein treatment followed by doxorubicin is used. The two cancer cell lines were treated with different combination groups, including the combination between doxorubicin and Baicalein or resveratrol and the combination between the three compounds using a different combination ratio for both treatment groups (i.e., two drugs or three drugs combination). Treatment applied on cells, using cell density of 7000 cells /well and incubation time was 48 hrs. MTT test was performed to assay the cell viability. The results obtained showed that the cytotoxicity of doxorubicin in the two cancer cell lines has increased when combined with Baicalein and resveratrol. Doxorubicin IC50 decreased from 4.99 µg/ml to 0.3657 µg/ml and from 7.3 µg/ml to 0.676 µg/ml on HCT116 and HepG2 cells, respectively, using constant combination ratio (1:1:1). The combination of doxorubicin, Baicalein, and resveratrol has resulted in a less cardiotoxic effect compared to treatment with doxorubicin alone. This decrease was obviously seen when the three compounds were combined using a low concentration range and with a constant combination ratio. Conclusion: combinations of Baicalein and resveratrol with doxorubicin chemotherapeutic drug In Vitro had enhanced the cytotoxic activity of such a chemotherapeutic drug, while simultaneously eliminating its cardio-toxicity side effect.

Abstract Drug information resources are the information that is used in medications discovery, utilization, and management. Little information about different types of resources used by Iraqi community pharmacists is known. Therefore, the objectives were to determine drug information resources' type do the pharmacists used and the common drug information questions they faced during their work in community pharmacy. A cross-sectional descriptive study was conducted in different Iraqi provinces and online self-reported survey was introduced through Google Form Software to an appropriate sample of graduated pharmacists who were working in a private community pharmacy and having at least one year of experience between February 27 and May 15, 2021. The researchers received 201 usable surveys. British National Formulary was used by 47% of the surveyed pharmacists to find specific information, followed by "Pharmacotherapy(s) and Applied Therapeutics" (16.9% for both). On the other hand, internet was used by 93% of the surveyed pharmacists and Google search engine (65%) and Medscape application (62%) were frequently surfed to find specific drug information and 81% of pharmacists trusted in this information and passed them to consumers. Safety of drugs during pregnancy and lactation periods was the most frequently question received from the patients (60.7%). In conclusion pharmacists prefer to surf specific internet websites to collect specific information about medicines and they referred to pharmaceutical textbooks if available at their pharmacies to get such information. The pharmacist is the person who is more often accessed by patients and the patients follow pharmacist's instruction for specific drug related questions.

One of these plants utilized in traditional medicine is Lactuca seriolla Linn., which belongs to the Asteraceae family. It goes by a variety of common names in the world, including prickly lettuce, wild lettuce, jagged lettuce, and Kahu and khas. The work aimed to isolate and characterize some bioactive constituent(s) from the aerial part of Lactuca serriola utilizing Combiflash NEXTGEN and high-performance liquid chromatography (HPLC). Lactuca serriola (aerial part) was extracted with 80% ethanol, then fractionated with hexane. Then 250 mg of hexane extract was mixed with 4 g of silica gel and loaded in cartilage, then bounded to the gold column of combi flash using a solvent system comprised of ethyl acetate: n-hexane (10% ethyl acetate 90% hexane v/v) to elute the column. The fractions resulting were analyzed by thin layer chromatography and high-performance liquid chromatography (HPLC). white needle-like crystalline substances were isolated via combi flash column chromatography. The isolated product was analyzed by thin layer chromatography and high-performance liquid chromatography (HPLC). β-sitosterol (11 mg) and stigmasterol (7 mg) were obtained from 250 mg of hexane fraction.

Abstract Lack of safe available non-resistant treatment for visceral leishmaniasis (Kala-azar) keeps limiting the complete cure of this disease ,drugs that have toxic side effects or lack of effectiveness have led to disease relapse ,all these factors have lightened the way to the search for imperative drugs from natural resources that have been shown to have antileishmanial activity through literature survey . In the present study, the comparative in vitro anti-leishmania activity of various fractions of Osteospermum ecklonis aerial parts fractions have been evaluated. Extracts were prepared through maceration and Soxhlet apparatus using 85% methanol and fractionation was done by separating the active constituents according to the differences in their polarities using petroleum ether and n-butanol respectively. The resultant fractions( petroleum ether as well as n-butanol fractions )were chosen for effective inhibition of Leishmania donovani, The results prove with no doubt that the petroleum ether fraction of the maceration aerial parts in a concentration of 2.5 mg/ml had better antileishmanial activity than other concentrations of tested samples and the result coincided with the anti-leishmaniasis activity of official treatment (pentostam®) ,This finding can be attributed to the terpene nature of the materials used to be existed in such fraction. This observation have paved the road to step in for extended studies in relation to the conventional herbal medicines for better and safe alternatives to available synthetic chemical drugs.

Nefopam (N.F.) HCl is a non-narcotic centrally-acting, non-opioid benzoxazocine analgesic to relieve acute and chronic pain. It exhibits low bioavailability (about 36%) due to its first-pass degradation in the liver. Intranasal administration has been used as a new route for targeting active brain sites and enhancing the bioavailability of N.F. HCl bypassing hepatic metabolism. In situ gel of N.F. HCl was prepared by the cold method using different concentrations of Poloxamer 407, Poloxamer 188, HPMC K4M, Carbapol 934, and Hyaluronic acid polymers. The results show that identification tests are superimposed with references, solubility study shows that N.F. HCl is suitable to be administered intranasally; Compatibility studies reveal incompatibility of Nefopam HCl with HPMC K4M and Carbapol 934; meanwhile, no interaction with Methylcellulose and Hyaluronic acid. In conclusion, the obtained results revealed the incredible ability of the produced N.F. HCl intranasal in situ gel is intended to enhance drug bioavailability bypassing the metabolizing effect of the liver that N.F. HCl is facing when given orally.

Abstract This work is considered the first study for the components of the Iraqi Leucaena leucocephala plant, where the different phytochemical compounds that present in the aerial parts were identified by using the gas chromatography/mass spectrometry technique (GC/MS). The type of the components and their concentration will differ according to the part of the plant used and the method of extraction (hot and cold). This study made a comparison in lupeol concentration that was identified and isolated from petroleum ether fractions of Leucaena leucocephala by using Gas Chromatography/Mass Spectrometry (GC/MS), High-performance thin-layer chromatography (HPTLC), and Preparative High-Performance Liquid Chromatography (P-HPLC). The plant leaves and stems were collected in September, dried under shade, and powdered (separately), then extracted by two extraction methods: hot Soxhlet and cold maceration method using 85% ethanol, then the result crude extract was fractionation with petroleum ether by using a separator funnel. The results of GC/MS, HPTLC, and PHPLC indicated that the leaves contain a higher concentration of lupeol than the stems and the cold maceration method is more efficient than the hot Soxhlet extraction method. Lupeol has many pharmacological activities applied in alternative medicine such as anti-inflammatory, antimicrobial, anti-arthritic, anticancer, antidiabetic, and antioxidant activities with wide future applications.

The use of antibiotics without prescription (self-medication) is growing globally and is associated with increased bacterial resistance, ineffective treatment and adverse reactions. This study aimed at assessing the practice of antibiotic self-medication in the Iraqi population. A cross-sectional study design was adopted in this work. The sample was comprised of 303 staff members from the non-medical colleges in Iraq. An online questionnaire was distributed between the 29th of June to the 14th of September 2021 to collect data including socio-demographic characteristics and questions about antibiotic self-medication. Most of the participants had a university degree and a moderate monthly income. The majority (88%) have practiced self-medication at least once before. A “simple” condition and convenience were the main motivators behind self-medication, which was mainly used for sore throat, fever and cough. Own experience was the most reported determining factor for selecting an antibiotic, and community pharmacies were the main source for obtaining the antibiotics. About 40% of the participants admitted to switching the antibiotic or changing its dose during the treatment course. Self-medication with antibiotics is a major issue in our community and measures have to be taken to reduce its impact on public health through the development of bacterial resistance.

This study aimed to develop an oral drug delivery system for gastro-retentive sustained drug release of baclofen by using a 3D printed capsular device since baclofen has a short half-life of 2.5 to 4 hours and has a narrow absorption window. Firstly sustained-release tablets of baclofen were formulated through the hot-melt extrusion of various thermoplastic polymers and direct compression of the extrudate, then a capsular device was designed and 3D printed to contain two air pockets to enable floating of the device and has four windows for drug release. 3D printing of the capsular device was done by an FDM printer using biodegradable PLA filament, and the sustained release tablets were inserted into the device to allow the medicine to be released into the stomach over a longer period. An in vitro buoyance test and an in vitro dissolution test were used to examine the buoyancy and sustained-release features of the formulated gastro-floating system. Five sustained release formulas were developed using different thermoplastic polymers in hot-melt extrusion. Produced tablets were assayed for drug content, hardness, and friability while a DSC study was done on the selected formula. F 5 which contains 20% baclofen, 55% Eudragit RS-100, 20% ethylcellulose, and 5% PEG 4000 showed sustained release where the complete dissolution of the drug occurred in 12 hours, and the gastro-floating device remained floating all the time. This method has a great potential for developing various floating drug delivery systems with the required release profile.

This research concentrate on cultivated Iraqi Agave attenuata dried leaves and roots, because of little studies on this plant especially on the root that lead to the eager of study and comparison of phytochemical constituents between leaves and root. Extraction of bioactive constituents was carried out using several solvents with increasing polarity (n-hexane, ethyl acetate and methanol) by soxhlet apparatus. Steroidal saponins in Agave genus is well documented in many species, lightening the minds in this research on extraction method which is specific for steroidal saponins. Phytochemical screening was done by GC/MS for n-hexane fraction, qualitative and quantitative estimation of several bioactive constituents (caffeic acid, p-coumaric acid, and quercetin) for ethyl acetate and methanol fractions while for steroidal saponins (sarsasapogenin, hecogenin and tigogenin) in both leaves and root by using reverse phase-high performance liquid chromatography (RP-HPLC). Among those identified phytochemical constituents, several constituents have not been detected in Agave attenuata leaves and roots before. This study is the first to describe the results in which the highest concentration of caffeic acid was found in leaves ethyl acetate fraction, p-coumaric acid and quercetin in root ethyl acetate fractions. While for steroidal saponins, the hecogenin, tigogenin and sarsasapogenin highest concentrations were found in leaves.

Type 2 diabetes mellitus (T2DM) is a chronic disorder that is a serious health concern all over the globe, it is linked to Interleukin-10 (IL-10) single nucleotide polymorphisms (SNPs) at the promoter region. On the other hand, diabetes influences the cellular and humoral immunity predisposing the patient to a variety of opportunistic parasites one of them is Toxoplasma gondii (T. gondii), which may infect any nucleated cell, including pancreatic cells. The purpose of this research was to explore the association of IL-10 genetic polymorphisms with T2DM and latent toxoplasmosis among Iraqi patients with T2DM. Fifty-five and fifty-eight venous blood samples were taken from T2DM patients and age-matched non-diabetic persons, respectively. Sera from all samples had been tested for the presence of anti-toxoplasma antibodies using the Enzyme-Linked Immunosorbent Assay (ELISA). Polymerase chain reaction (PCR) was performed by specific primers and the products were sequenced at Macrogen /Korea. A higher percentage of T. gondii infection was found in T2DM patients (52.1%) and 31.5% of non-diabetic persons. The high frequency of the SNP at position -3952 among T2DM patients, and this is a novel finding. An interesting result, an increased risk of T2DM was observed in carriers of -1082 A/G variants, which was high frequency among studied subjects. The carriers of both -1082 AG+GG and -3952 AG+GG genotypes had a synergistic effect on the risk of type 2 diabetes mellitus significantly. A significant association between T2DM and polymorphisms at positions -1082 A/G and -3952 A/G of the IL-10 gene.

(1) Background: Amorphous drug systems are an intensively studied approach to overcome the insufficient bioavailability of poorly soluble drugs. Here, paper tablets were studied, which were made from cellulose-based paper matrices loaded with norfloxacin. Moreover, wet granulation was introduced as an additional processing step for improving the flowability of the solids, which is necessary when considering production on an industrial scale. (2) Methods: The possible impact of the wet granulation on the crystallinity of norfloxacin was studied by examining granulated and non-granulated samples. Crystallinity investigations were performed using X-ray powder diffraction (XRD) and terahertz time-domain spectroscopy (THz TDS). (3) Results: THz TDS allowed for a more straightforward crystallinity assessment than XRD. Moreover, using THz TDS, it was possible to detect minor changes in the crystallinity of the API after the granulation, whereas this was not possible with the XRD analysis. (4) Conclusions: THz TDS results indicate a partial crystallization of norfloxacin due to the wet granulation. Depending on the formulation, THz TDS can serve as a beneficial and advantageous tool to determine the crystallinity of an API.

Borax is a dangerous material if it is contained in food so its use is prohibited. Borax contained in wet noodles is used as a preservative to keep the noodles supple and durable. There are reports in several areas in Tangerang about the content of borax in food, but no research has been conducted in the Sepatan Market, Tangerang Regency. Identification of borax by qualitative test using flame test method and curcumin paper color test, while quantitative test using UV-Vis Spectrophotometry method with a wavelength of 536.40 nm. Two of the total samples tested using ultraviolet visible spectrophotometric instruments showed negative borax content when compared to the flame test and curcumin paper color test. Wet noodle samples sold at Pasar Sepatan, Tangerang Regency, showed a positive content of Borax at 85.71% of the total sample.

In a developing country like India, with limited resources and access to healthcare facilities, dealing with massive hemorrhage is a major challenge. This challenge gets compounded by pre-existing anemia, hemostatic disorders, and logistic issues of timely transfer of such patients from peripheral hospitals to centers with adequate resources and management expertise. Despite the awareness amongst healthcare providers regarding management modalities of bleeding patients, no uniform Patient Blood Management (PBM) or perioperative bleeding management protocols have been implemented in India, yet. In light of this, an interdisciplinary expert group came together, comprising of experts working in transfusion medicine, hematology, obstetrics, anesthesiology and intensive care, to review current practices in management of bleeding in Indian healthcare institutions and evaluating the feasibility of implementing uniform PBM guidelines. The specific intent was to perform a gap analysis between the ideal and the current status in terms of practices and resources. The expert group identified interdisciplinary education in PBM and bleeding management, bleeding history, viscoelastic and platelet function testing, and the implementation of validated, setting-specific bleeding management protocols (algorithms) as important tools in PBM and perioperative bleeding management. Here, trauma, major surgery, postpartum hemorrhage, cardiac and liver surgery are the most common clinical settings associated with massive blood loss. Accordingly, PBM should be implemented as a multidisciplinary and practically applicable concept in India in a timely manner in order to optimize the use the precious resource blood and to increase patients' safety.

Like most of the pharmacy colleges in developing countries with high population growth, public pharmacy colleges in Egypt are experiencing a significant increase in students’ enrollment annually due to the large youth population, accompanied with the keenness of students to join pharmacy colleges as a step to a better future career. In this context, large lectures represent a popular approach for teaching the students as economic and logistic constraints prevent splitting them into smaller groups. Nevertheless, the impact of large lectures in relation to student learning has been widely questioned due to their educational limitations, which are related to the passive role the students maintain in lectures. Despite the reported feebleness underlying large lectures and lecturing in general, large lectures will likely continue to be taught in the same format in these countries. Accordingly, to soften the negative impacts of large lectures, this article describes a simple and feasible 5-step paper-based model to transform lectures from a passive information delivery space into an active learning environment. This model mainly suits educational establishments with financial constraints, nevertheless, it can be applied in lectures presented in any educational environment to improve active participation of students. The components and the expected advantages of employing the 5-step paper-based model in large lectures as well as its limitations and ways to overcome them are presented briefly. The impact of applying this model on students’ engagement and learning is currently being investigated.

Pharmaceutics [...]

Biological medicines nowadays have a great impact, as they offer treatment for diverse diseases and suppose a high cost for health system. Biosimilar medicines contain a version of an active substance already authorized as an original biotechnological medicine, whose patent has expired, and they comply with the guidelines published by the European Medicines Agency. These guidelines, where biosimilarity criteria are established, guarantee comparability between biosimilar product and reference one. Biosimilars’ authorization is carried out through a centralized procedure based on clinical, non-clinical and quality studies. These studies allow the extrapolation of indications, frequently, without carrying out additional analyses. In several European countries, switching between original and biosimilar medicine is considered safe. In Spain, Pharmacy and Therapeutic Committee of hospitals, as consensus bodies among health professionals, are the most suitable bodies to establish the interchangeability criteria in each center. Biosimilar drugs contribute to sustainability and to improvement of the accessibility to medicines. Faced with this situation, Spanish Society of Hospital Pharmacy considers interesting to express its position about biosimilar medicines’ strategies. Spanish Society of Hospital Pharmacy, in September 2015, published an information note about biosimilar medicines, in which its role as medicines similar in quality, safety and efficacy to the originals, but at lower cost, was highlighted. Likewise, it was stressed the role of hospital pharmacists within the Pharmacy and Therapeutic Committee of hospitals, where their knowledge for the selection, evaluation and use of medicines could be useful, in coordination and permanent collaboration with other units or clinical services of hospitals.

E-prescribing is now widespread and, in some countries, has completely replaced paper prescriptions. In Norway, almost all prescribing is electronic, except for multidose drug dispensing (MDD), which is still sent to the pharmacy by fax or ordinary mail. MDD is an adherence aid used by one-third of all patients receiving home care services. In this paper, we present results from a qualitative study evaluating the introduction of e-prescribing for MDD in a community health care setting. The focus is on the work and workflow for the pharmacists and nurses involved in the medication-handling process. We used the pragmatic process evaluation framework and the systematic text condensation method to analyse the data. We conducted 12 interviews with 34 nurses and pharmacists. This study shows that the e-prescribing of MDD led to greater integration between systems, both within the existing MDD system and across care levels, potentially improving patient safety. However, the structured prescriptions increased the need for clarifications, resulting in an increased overall workload. A greater understanding of the roles and responsibilities of the different professionals in the medication management chain and their needs would improve the workflow of the nurses and pharmacists involved.

This is the first question one should consider before submitting a paper to an international journal. The answer is simple: If researchers or practitioners from another country can learn something from your paper that can influence a practice or a research they are involved in, then your paper is relevant for an international audience. There are many elements that can influence in this cross-border transferability. One could think that having a big “n”, or performing complex statistical calculations, or using complicated study designs makes the paper more attractive to colleagues from other countries. These elements can help, but they are not sufficient. On the other hand, one could think that a study performed in a small hospital in a given country will never be of interest for these foreign colleagues. That is not necessarily correct. Let’s burst some myths.

The inclusion of pharmacists in the healthcare system of a developing country like Pakistan has always been a subject of debate among the healthcare professionals (HCPs), especially physicians, who have long ruled the healthcare system alone and who have had a long-held position of supremacy. The common argument against the inclusion of pharmacists is the dynamics of the healthcare system, and patients being physician oriented, hence, consider the inclusion of pharmacists as no good. Although the trend of defiance is changing, it is worthwhile mentioning here that the concept of the inclusion of pharmacist was implemented in developed countries by an evidence-based approach, i.e., to actually involve pharmacists in the disease state management of a patient and conducting a trial. This opinion calls for the same to be implemented in a developing country like Pakistan to evaluate its significance.

Aim: Pharmaceutical promotion is the principal aspect of the healthcare system. In this study, we aimed to portray the opinion of doctors and medical representatives (MRs) on conventional pharmaceutical ways (usage of promotional or educational paper materials and physician drug samples) for pharmaceutical promotion. Materials and Methods: In this cross-sectional observational study, data were collected from doctors and MRs across India using self-administered Google forms. Data were analyzed, and results were drawn. Results: A total of 314 doctors and 272 MRs participated in the study. As per 95.5% of doctors, continuing medical education (CME)/books/online information is the most common and convenient method to update medical knowledge, whereas 67.9% of MRs also think the same. Only 5.5% of doctors prefer paper material provided by pharmaceutical companies to update their knowledge. Most doctors say paper materials provided by pharmaceutical companies contribute less than 25% to product information, rather CME, books, and online information contribute significantly. MRs also think similarly. 66.2% of MRs agree that more than 25% of paper material gets wasted due to non-distribution. 73.2% of doctors and 75.4% of MRs agree that the use of paper materials for product promotion is not cost-effective, even if it contributes to deforestation. Only 51% of doctors use more than 50% of medical samples in patient care and only half of doctors and MRs think expired medical samples are disposed of correctly. 56.1% of doctors and 71.4% of MRs think a significant amount of medical samples are wasted and are hazardous to the environment. Conclusions: Both doctors and MRs are of the opinion that the conventional method of paper promotion, that is, paper material and drug samples, is not cost-effective and also not eco-friendly. Hence, need to rethink – is there a need to change with time?

It is always a difficult task for a jury to classify articles from a selection of outstanding manuscripts. [...]

Type: Invitation

This is the first article of its type to describe the advances taking place in clinical pharmacy education in Pakistan. The Pharmacy Council of Pakistan has developed a five-year Pharm.D program to replace the four-year B.Pharm degree. Completing clinical pharmacy clerkships is a prerequisite for receiving the Pharm.D degree. To meet this requirement, Ziauddin College of Pharmacy has developed a specialized clerkship program for its 4th and 5th year students. The College is fortunate to be linked with well developed tertiary care hospitals at three prime locations in the in the metropolitan city of Karachi, which provides opportunity for the students to gain exposure to real life situations and work with patients. The article presents an account of the efforts taken for development of the clinical pharmacy clerkship program, the problems encountered during its development, and the main outcomes of a clerkship program. Type: Note

Type: Pharmacy Practice

Type: Invitation

Interrogating the literature is among the first steps a researcher undertakes when actuating a research project or also when any scholar might seek to know what has been done in an area, best practices for conducting a certain activity, or simply to seek answers for a question ranging from one's own personal curiosity to those that might affect departmental or institutional guidance. Decisions on the type of review process to undertake is one that is not taken lightly. This methods commentary outlines the reasons for conducting a scoping review versus a systematic review for topics related to pharmacy education. Considerations for conducting the scoping review are outlined including considerations for writing a protocol prior to conducting a scoping review, to potential platforms to use for transparency of sharing data, processes related to guidelines for data extraction and types of search strategies utilized.