Shujaat Ali Khan

Nasal and perirectal colonization of vancomycin sensitive and resistant enterococci in patients of paediatrics ICU (PICU) of tertiary health care facilities

BackgroundEnterococci normally inhabit the intestinal tract of humans and are also a potential pathogen in causing nosocomial infections. The increase in antibiotic resistance and transfer of antibiotic resistance gene to Staphylococcus aureus (S. aureus) due to co-colonization has increased its importance in research. The aim of the study was to evaluate local epidemiology of nasal and rectal colonization with Enterococcus faecalis (E. faecalis) and Enterococcus faecium (E. faecium) in patients of Paediatrics Intensive Care Unit (PICU) and correlation with clinical and socioeconomic factors.MethodsThe nasal and perirectal swab samples were collected from 110 patients admitted in PICUs of three tertiary care hospitals of Rawalpindi Medical College, Pakistan. The identification of enterococci was done by biochemical tests and by PCR for ddl, vanA and vanB genes. Antibiotic susceptibility testing was performed by disc diffusion and MICs were determined for vancomycin, tetracycline, ciprofloxacin and oxacillin only.ResultsOut of 220 nasal and perirectal samples, 09 vancomycin-resistant enterococci (VRE) and 76 vancomycin-susceptible enterococci (VSE), consisting of 40 E. faecalis and 45 E. faecium were isolated. PCR successfully identified both species with ddl primers and VRE with vanA primer. With disc diffusion method, all isolates were resistant to most of the antibiotics tested except linezolid, quinupristin/dalfopristin, teicoplanin and vancomycin. VRE showed resistance to teicoplanin and vancomycin both and none was resistant to linezolid and quinupristin/dalfopristin. Generally, E. faecium isolates were more resistant than E. faecalis. MICs of vancomycin for nasal and perirectal VRE were 512u2009mg/L and 64 to 512u2009mg/L respectively. VRE were more in patients with prolonged hospitalization, from urban localities and those having pneumonia.ConclusionPresent study reveals high colonization and antibiotic resistance in enterococcal isolates from nasal and perirectal area. Nasal colonization by enterococci in PICU is more alarming as VRE may cause infection and can transfer this resistance gene to other microorganisms like S. aureus.

Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients.

Drug–drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug–drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug–drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug–drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p < 0.001), hospital stay of 7 days or longer (p < 0.001) and taking 7 or more drugs (p < 0.001). We found a high prevalence for pDDIs in the Department of Cardiology, most of which were of moderate severity. Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs.

Randomized controlled trials covering pharmaceutical care and medicines management: A systematic review of literature

Objective To review the effects of pharmaceutical care on hospitalizations, mortality and clinical outcomes in patients. Methods Systematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases to identify studies that were published between 2004 and January 2017. Studies included in this review were randomized controlled trials (RCTs) that spanned across both community and hospital settings. Using strict inclusion/exclusion criteria studies were included if they reported level 1 or 2 outcomes in the hierarchy of outcome measure i.e. clinical and surrogate outcomes (e.g. blood pressure (BP) control, blood glucose level, cholesterol BMI). Each study was assessed for quality using the Jadad scoring system. Results Fifty‐four RCTs were included in the present review. Forty‐six of these studies ranked high quality according to the Jadad scoring system. Studies were categorized into their general condition groups. Interventions in patients with diabetes, depression, respiratory disorders, cardiovascular disorders, epilepsy, osteoporosis, and interventions in older adults were identified. In the majority of studies pharmaceutical care was found to lead to significant improvements in clinical outcomes and/or hospitalizations when compared to the non‐intervention group. Some conditions had a large number of RCTs, for example for cardiovascular conditions and in diabetes. Statistically significant improvements were seen in the majority of the studies included for both of these conditions, with studies indicating positive clinical outcomes and/or hospitalizations rates. Within the cardiovascular condition, a subset of studies, focusing on cardiac heart failure and coronary heart disease, had more mixed results. In other conditions the number of RCTs conducted was small and the evidence did not show improvements after pharmaceutical care, i.e. in depression, osteoporosis, and epilepsy. The majority of interventions were face to face interactions with patients, whilst a smaller number were conducted via the telephone and one via a web‐based system. Patient education was a key component of most interventions, either verbal and/or written. Longitudinal data, post intervention cessation, was not collected in the majority of cases. Conclusions RCTs conducted to evaluate pharmaceutical care appear to be effective in improving patient short‐term outcomes for a number of conditions including diabetes and cardiovascular conditions, however, other conditions such as depression are less well researched. Future research should attempt to evaluate the conditions where there is a lack of data, whether the positive effects of pharmaceutical care persist in patient populations after the interventions cease and what the long‐term clinical outcomes would be of continued pharmaceutical care.

What Do the Hospital Pharmacists Think about the Quality of Pharmaceutical Care Services in a Pakistani Province? A Mixed Methodology Study

The objective of this study was to evaluate the perception of hospital pharmacists regarding quality of pharmaceutical care services in Khyber Pakhtunkhwa (KPK) Province, Pakistan, through qualitative as well as quantitative approach. For qualitative study, snow ball sampling technique was used. In quantitative part, a cross-sectional study was conducted in 112 hospital pharmacists (out of 128 accessed ones) from both private and public hospitals in six major divisions (divisions are the third tier of government in Pakistan, between the provinces and districts) of KPK. The qualitative study yielded five major themes during thematic analysis: (a) patients reporting, (b) lack of patient counseling, (c) lack of participation in health awareness programs, (d) pharmacists reducing the prescribing errors, and (e) insufficient number of pharmacists. A great proportion (67.9%) of the pharmacists was unsatisfied with their participation in health awareness programs. Findings of both phases revealed that hospital pharmacists in Pakistan are not actively participating in the provision of pharmaceutical care services. They are facing various hurdles for their active participation in patient care; major obstacles include the unavailability of sufficient number of pharmacists, lack of appropriate time for patient counseling, and poor relationship between pharmacists and other health care providers.

Preparation, characterization and in-vitro evaluation of bacterial cellulose matrices for oral drug delivery

Bacterial cellulose (BC) is a pure form of cellulose and has some superior properties such as an ultrafine fiber network, high water-holding capacity and ease of fabrication into a desired shape. It has been widely studied for applications in tissue engineering, wound dressing, artificial skin and protein delivery. In the current study, BC matrices (12xa0mm diameter) were prepared and evaluated for in vitro release using famotidine and tizanidine as model drugs. The successful drug loading and uniform distribution into the matrices were confirmed through scanning electron microscopy and X-ray diffractrometry. Fourier transform infrared spectroscopy and thermogravimetric analysis revealed the chemical and thermal stability of the BC-drug composites, respectively. The percent drug loading of various matrices was in the range of 18.10–67.64%. Similarly, the friability test results were in the range of 0.69–0.83 and 0.14–0.89% for 20 and 40xa0mg/ml famotidine (low water soluble) loaded matrices, respectively, while no weight loss was observed in friability tests for formulations loaded with 6xa0mg/ml tizanidine (highly water soluble) because of the low dose and drug concentration. In vitro dissolution studies showed more than 80% drug release in the initial 15xa0min for all formulations, conforming to immediate release criteria. Comparison studies were carried out using famotidine and tizanidine commercial tablets. The results of current research work revealed that BC matrices have the potential for applications in single polymer-based oral drug delivery.

Facile synthesis of chitosan based-(AMPS-co-AA) semi-IPNs as a potential drug carrier: enzymatic degradation, cytotoxicity, and preliminary safety evaluation

OBJECTIVEnThe study describes the development of chitosan-based (AMPS-co-AA) semi-IPN hydrogels using free radical polymerization technique.nnnMETHODSnThe resulting hydrogels were characterized using Fourier Transform Infrared Spectroscopy (FTIR), Thermogravimetric Analysis (TGA), Differential Scanning Calorimetry (DSC), X-Ray diffraction (XRD), and Scanning Electron Microscopy (SEM). The successful crosslinking of chitosan, 2- Acrylamido-2-Methylpropane Sulfonic Acid (AMPS), and Acrylic Acid (AA) was confirmed by FT IR. Unloaded and drug-loaded hydrogels exhibited higher thermal stability after crosslinking compared to the individual components. XRD confirmed the decrease in crystallinity after hydrogel formation and molecular dispersion of Oxaliplatin (OXP) in the polymeric network. SEM showed rough, vague and nebulous surface resulting from crosslinking and loading of OXP.nnnRESULTSnThe experimental results revealed that swelling and drug release were influenced by the pH of the medium being low at acidic pH and higher at basic pH. Increasing the concentration of chitosan and AA enhanced the swelling, drug loading and drug release while AMPS was found to act inversely.nnnCONCLUSIONnIt was confirmed that the hydrogels were degraded more by specific enzyme lysozyme as compared to the non-specific enzyme collagenase. In-vitro cytotoxicity suggested that the unloaded hydrogels were non-cytotoxic while crude drug and drug-loaded hydrogel exhibited dose-dependent cytotoxicity against HCT-116 and MCF-7. Results of acute oral toxicity on rabbits demonstrated that the hydrogels are non-toxic up to 3900 mg/kg after oral administration, as no toxicity or histopathological changes were observed in comparison to control rabbits. These pH-sensitive hydrogels appear to provide an ideal basis as a safe carrier for oral drug delivery.

Synthesis and characterization of pH-sensitive genipin cross-linked chitosan/Eudragit® L100 hydrogel for metformin release study using response surface methodology

BACKGROUNDnIn this study, central composite design was utilized for the optimization of genipin cross-linked chitosan/Eudragit®-L 100 interpenetrating hydrogel network films fabricated through solvent evaporation technique.nnnMETHODSnHydrogel formulations were studied using response surface methodology; regression analysis and the surface plots were used to evaluate the effect of variables on T50% (the time for 50% of drug release) and dynamic swelling with optimum formulation selection. Initial burst release of drug was observed from the formulated hydrogels during the first 2 hours of dissolution at simulated gastric pH 1.2 and then slow release during the next 10 hours in the simulated intestinal fluid at pH 7.4. Different polymer ratios in formulation showed significant influence on T50% and dynamic swelling of hydrogel. The highest T50% was observed at 9.89 hour and dynamic swelling at 7.86 h.nnnRESULTnIt was observed that by changing the polymer ratio with cross-linker, release rate of metformin could be modified. Cross-linker also affects drug release rate, i.e. the release rate is decreased with the increase in its concentration. The physical state of hydrogel was investigated by scanning electron microscope.nnnCONCLUSIONnIt indicated the uniform distribution of drug in hydrogel matrix system. Moreover, the presence of hydrogen and ionic bonds between polymers and crosslinking agent formed interpenetrating hydrogel network, likely responsible for increased value of T50%, as confirmed by FTIR. Acute oral toxicity study was performed to investigate the toxic effect of crosslinking agent and polymer used in formulations.

Finasteride Topical Delivery Systems for Androgenetic Alopecia

Androgenetic alopecia, generally recognized as male pattern baldness, is a gradually developing medical and physiological change, which is manifested by continuous hair-loss from scalp. Finasteride (4-aza-3-oxosteroid) is a potent anti-baldness compound that selectively and competitively inhibits the 5α-reductase isoenzymes. Prolonged oral use of finasteride leads to the emergence of sexual disorders including decrease in libido, gynecomastia, erectile dysfunction, ejaculation disorder, orgasm disorders and mood disturbances. Since, hair follicles widely home in 5α-reductase, topical formulations of finasteride in comparison to its oral formulations are expected to potentially reduce its systemic adverse effects. The analysis of literature has revealed some delivery systems developed for the enhanced and localized penetration of finasteride into the skin. These finasteride delivery systems include polymersomes, vesicular nanocarriers, vesicular ethosomal carriers, liposomes and niosomes, liquid crystalline nanoparticles, topical solutions and gels. The aim of this review article is to briefly amass all literature on topical delivery of finasteride to elaborate best dosage form, i.e. formulation having maximum permeation rate. This study will serve as a future perspective regarding topical delivery of finasteride. The literature analysis has exhibited that most of the previous investigators have used propylene glycol in their finasteride-loaded topical formulations, while poloxamer P407, monoolein, transcutol P and choline was used in few formulations. Moreover, among all drug delivery systems, finasteride liposomal gel system consisting of 2% methyl cellulose and gel system containing poloxamer P407 exhibited the highest flux with a value of 28.4 ± 1.3 µg/cm2h and 23.1 ± 1.4 µg/cm2h, respectively. Several topical drug delivery techniques such as topical microneedles, aerosol foams, nanoemulsions, microsponges, and emulsifier free formulations, fullerenes, ointments, pastes, creams, gel and lotions are still to be worthy regarding finasteride topical delivery in future.

Nurses' Perception Towards the Benefits of Pharmaceutical Care Services in Tertiary Health Care Settings Pakistan: A Qualitative Insight.

pharmacy. Written consent was obtained from the participants prior to the interview. Results: Among the respondents interviewed. Thematic content analysis yielded 4 major themes: (a) Lack of documentation, (b) Improper patient counseling, (c) Unavailability of pharmaceutical care guidelines, (4) Lack of collaboration with other health care providers. ConClusions: This study concludes that community pharmacies are not very much involved in provision of pharmaceutical care to patients. Documentation and patient counseling is also very poor due to lack of enough time and no financial encouragement. There is also no effective professional relationship of community pharmacists with other health care providers.

Community Pharmacists Attitude and Perceived Need Towards the Provision of Pharmaceutical Care Services: A Qualitative Approach

The main objective of present study is to assess the perception of community pharmacists regarding the quality of pharmaceutical care services in Khyber Pakhtunkhwa (KPK) province, Pakistan. A qualitative study design was adopted. To identify the community pharmacists, snowball sampling technique was used. An interview guide (semi-structured) was designed and face to face interviews were conducted until point of saturation reached. Twelve pharmacists were interviewed working in community pharmacies of different cities of KPK, Pakistan. The participants were interviewed at the community pharmacies. Prior to the interview, written consent was signed by each of the participants. All the respondents interviewed were male pharmacists. Four major themes were yielded from thematic content analysis: (a) Lack of documentation, (b) improper patient counseling, (c) unavailability of pharmaceutical care guidelines, and (d) lack of collaboration with other health care providers. This study concludes that community pharmacists are not actively involved in provision of pharmaceutical care to patients. Documentation and patient counseling is also very poor due to shortage of time and low financial or promotional encouragement. There is also lack of effective professional relationship between the community pharmacists and other health care providers. RESUMEN. El objetivo principal del presente estudio es evaluar la percepción de los farmacéuticos comunitarios en cuanto a la calidad de los servicios de atención farmacéutica en Khyber Pakhtunkhwa (KPK), Pakistán. Se adoptó un diseño de estudio cualitativo. Para identificar los farmacéuticos comunitarios, se utilizó la técnica de muestreo de bola de nieve. Fue diseñada una guía de entrevista (semi-estructurada) y entrevistas cara a cara se llevaron a cabo hasta el punto de saturación alcanzado. Fueron entrevistados doce farmacéuticos que trabajan en farmacias comunitarias de diferentes ciudades de KPK. Los participantes fueron entrevistados en las oficinas de farmacia. Antes de la entrevista, el consentimiento por escrito fue firmado por cada uno de los participantes. Todos los encuestados fueron entrevistados porfarmacéuticos masculinos. Cuatro temas principales fueron cedidos de temática análisis de contenido: (a) La falta de documentación, (b) el asesoramiento incorrecto del paciente, (c) la falta de disponibilidad de directrices de atención farmacéutica, y (d) la falta de colaboración con otros proveedores de atención médica. Este estudio concluye que los farmacéuticos comunitarios no participan activamente en la prestación de la atención farmacéutica a los pacientes. La documentación y el asesoramiento del paciente también es muy pobre debido a la escasez de tiempo y al bajo estímulo financiero o promocional. También hay falta de relación profesional efectiva entre los farmacéuticos de la comunidad y otros proveedores de atención médica.