Yaser Mohammed Ali Al-Worafi

Combating sale of counterfeit and falsified medicines online: a losing battle

The rapid growth of technology has transformed many brick-and-mortar businesses into online businesses, and medicines are now being sold over the internet. Influenced by the notions that online purchases are economical and do not require a prescription, the general public are keen to purchase medicine online through websites, social media and mobile apps. Online medicine purchase is presumed to be convenient and confidential, free from embarrassment of sharing personal and sensitive health information to a healthcare professional. Public in United States, Europe, Australia is generally aware that internet sales form part of the official medicines distribution channels, often a valid prescription is required for controlled medicine. However, unlicensed, substandard and falsified medicines with various dubious medical claims are advertised and sold illegally in many rogue online pharmacies (Jack, 2016). These include medications for weight loss, hair growth, and treatment of erectile dysfunction. Such medicines are termed as substandard, spurious, falsely labeled, falsified and counterfeit medical products by the World Health Organisation (WHO). Similarly, the European Commission defines such products as falsified medicines or fake medicines that pass themselves off as real, authorized medicines (European Commission, 2016). These medicines may contain substandard active ingredients, which are low quality and/or an incorrect amount, either too high or too low, and have not been properly evaluated by authorities in terms of quality, safety, and efficacy. It must be noted that falsified medicines are often confused with counterfeit medicines. According to European Commission, counterfeit medicines refers to medicines that do not comply with European Union law on intellectual and industrial property rights, for example, unregistered medicines sourced from parallel import (European Medicines Agency). In this article, the illegal sales of both counterfeit and falsified medicines (CFMs) are discussed. In 2012, the WHO estimated the CFMs industry to be worth USD 431 billion a year, but further estimates has not been reported in the recent years due to the fast growing, widespread practice of this industry, making it impractical to estimate on a global scale (Garrett, 2012). Authorities are finding it difficult to curb CFMs due to the lack of governance over the internet. Furthermore, fragmented cybercrime legislation leads to large substantive and procedural lacunae in law, rendering law enforcement efforts useless.

Use of Medical Mobile Applications Among Hospital Pharmacists in Malaysia

Background: Handheld computers (HHCs) such as smartphones and tablets are providing a variety of drug information (DI) applications to assist pharmacists’ decision making in the clinical and hospital setting. However, little is known about the extent of their use among Malaysian pharmacists. The current study aimed to assess the use of electronic DI resources via HHCs by pharmacists in Malaysia. This study also aimed to investigate the pharmacists’ perception toward the DI content and functions of mobile medical applications. Methods: A convenience sampling method was adopted to invite pharmacists (N = 450) working in various sectors such as hospitals, the drug approval authority, and academia to participate in this online survey. A 36-item questionnaire was administered, and data were summarized and presented using descriptive statistics. Results: The response rate to this survey was 49.8% (n = 224). Overall, 213 respondents (95.1%) were active HHCs users in their daily clinical practice. About 194 respondents (86.6%) disclosed that they often use HHCs for searching DI. Dosage recommendations (n = 198; 88.4%), adverse drug reactions (n = 153; 68.3%), and drug interactions (n = 146; 65.2%) were the most common DI retrieved. Meanwhile, general dosage recommendation, pediatric dosage recommendations and dosage recommendations for renal failure were ranked as the most important DI in mobile medical applications. Gaining access to the latest information on drugs and clinical practice were regarded as the most important functions of the mobile medical app. Conclusions: The use of HHCs for DI among pharmacists in Malaysia was high. The use of locally produced DI sources is still low compared to overseas sources. The most popular applications used for drug-related medical information were Micromedex, followed by Lexicomp and Medscape.

Perception of self-medication among university students in Saudi Arabia

The aim of this study is to assess self-medication practice among university students in the Al-Qassim Province of Saudi Arabia. A cross-sectional community-based survey was conducted by distributing a self-administered 18-item questionnaire among university students in the Al-Qassim Province of Saudi Arabia in the period between October and December 2012. The participants were selected using a convenience sampling technique. Data were collected from the questionnaire and analyzed using SPSS version 19. A total of 354 male students with an average age of 21.95 (SD ± 3.43) participated in this study. Our study showed that self-medication among male students was high (86.6%) compared to results shown in other studies in the same region. Headache (59.9%), cough/cold (41%) and fever (24.6%) were the most common symptoms associated with self-medication. Congruent with the medical conditions reported, the most widely used medications without prescriptions were paracetamol (34.7%), followed by antibiotics (31.4%) and nonsteroidal anti-inflammatory drugs (28.7%). Our study shows that antibiotics were sometimes irrationally used for self-treatment of cough and fever. Self-medication was highly frequent among the students. Influence of TV advertisements, high accessibility of pharmacies and convenience stores, as well as good buying power were found to be leading factors for self-medication among male university students.

Assessing the pharmaceutical care issues of antiepileptic drug therapy in hospitalised epileptic patients

Studies concerning epilepsy in the context of pharmaceutical care in Malaysia are lacking. Optimal pharmacotherapy management is necessary to achieve good seizure control.

Empirical use of antibiotic therapy in the prevention of early onset sepsis in neonates: a pilot study

Introduction To identify and assess the characteristics, risk and outcome of neonates treated with empiric antibiotics for suspected early onset sepsis (EOS). Material and methods This is a retrospective study conducted at a Malaysian government hospital. Records of neonatal patients admitted within 72 h of life and prescribed with empirical antibiotic therapy for suspected EOS were reviewed. Results Three hundred and twenty-three cases met the inclusion criteria and were divided into gestational age (premature < 36 weeks; term ≥ 37 weeks) and birth weight (low birth weight (LBW) < 2.5 kg; normal body weight (NBW) ≥ 2.5 kg) groups. Premature (n = 197) and LBW (n = 194) neonates required significantly longer hospital stay, a higher degree of ventilator support and more surfactant (p = 0.001). More than 90.0% of premature and LBW neonates were diagnosed with respiratory distress syndrome, congenital pneumonia and presumed sepsis. Term (n = 123) and NBW (n = 129) neonates had greater maternal risk factors, especially meconium-stained amniotic fluid (MSAF) and perinatal asphyxia. The incidence of demonstrated EOS was 3.1%. Crystalline penicillin plus gentamicin was the standard therapy for all groups and was started within 24 h of life, with a mean treatment duration of ∼4 days. The treatment success rate was 89.0%, and only LBW neonates showed a higher risk of overall treatment failure (OR = 3.75; 95% CI: 1.22–11.53). Seventy-four percent of term and NBW neonates discharged well, while 42.0% of premature and LBW neonates required referral. Conclusions Crystalline penicillin plus gentamicin prescribed within 24 h of life is effective in the prevention of EOS. However, low birth weight neonates have a higher risk of treatment failure.

Comment on: “Pharmacovigilance in the Middle East”

I enjoyed reading the article entitled ‘‘Pharmacovigilance in the Middle East: A Survey of 13 Arabic-Speaking Countries’’, which was recently published in Drug Safety [1]. The author stated that ‘‘Six countries possess formal national pharmacovigilance programmes (Egypt, Iraq, Jordan, Kingdom of Saudi Arabia [KSA], Oman and the United Arab Emirates [UAE]), while five (Bahrain, Kuwait, Palestine, Qatar and Yemen) reported no active programme or designated centre’’ [1]. In this letter I would like to update readers on the information regarding pharmacovigilance in Yemen. The Yemeni Pharmacovigilance Center (YPVC) was established in early 2011 in the capital Sana’a, with the following objectives: early detection of adverse drug reactions (ADRs); detection of increase in frequency of (known) adverse reactions; identification of risk factors and possible mechanisms underlying adverse reactions; estimation of quantitative aspects of benefit/risk analysis and dissemination of information needed to improve drug prescribing and regulation; prevention of ADRs; drug quality surveillance; encouraging rational and safe use of drugs; and communication with international institutions working in pharmacovigilance [2]. To achieve its objectives, the YPVC has visited many hospitals (Government and private) and pharmacies (Government and private) with the purpose of increasing their awareness towards ADR detection, ADR assessment, ADR reporting and quality of medicines. The YPVC has published reports on ADRs and on the quality of pharmaceutical products (in English for healthcare professionals and in Arabic for the general public) [3]. Pharmacovigilance in Yemen has faced many challenges since the introduction of the YPVC in early 2011. Based on findings from the literature, pharmacovigilance in Yemen is no different from other developing countries in terms of pharmacovigilance challenges. However, below are some challenges and practical recommendations from the literature [4, 5] which can lead to improving the pharmacovigilance center in Yemen and lead to better outcomes in both patient care and for policy makers.

Pharmacovigilance and adverse drug reaction reporting: a perspective of community pharmacists and pharmacy technicians in Sana’a, Yemen

Objective The aim of this study was to compare the knowledge, attitude and barriers of pharmacy technicians and pharmacists toward pharmacovigilance, adverse drug reactions (ADRs) and ADR reporting in community pharmacies in Yemen. Methods This cross-sectional survey was conducted among community pharmacists and pharmacy technicians in the capital of Yemen, Sana’a. A total of 289 community pharmacies were randomly selected. The validated and pilot-tested questionnaire consisted of six sections: demographic data, knowledge about pharmacovigilance, experience with ADR reporting, attitudes toward ADR reporting, and the facilitators to improve ADR reporting. Results A total of 428 pharmacy technicians and pharmacists were contacted and 179 went on to complete a questionnaire (response rate: 41.8%). Of the 179 respondents, 21 (11.7%) were pharmacists and 158 (88.3%) were pharmacy technicians, of which, 176 (98.3%) were male and 3 (1.7%) were female. The mean age of the respondents was 25.87±2.63 years. There was a significant difference between the pharmacists and pharmacy technicians in terms of knowledge scores (P<0.05). The mean knowledge scores for pharmacists was 3.33±2.852 compared to 0.15±0.666 for pharmacy technicians. With regard to attitudes toward ADR reporting, all pharmacists (100%) showed a positive attitude, while only 43% of pharmacy technicians showed a positive attitude. Conclusion Pharmacists have a significantly better knowledge than pharmacy technicians with regard to pharmacovigilance. More than half of pharmacy technicians showed a negative attitude toward ADR reporting. Therefore, educational interventions and training is very important for community pharmacists and pharmacy technicians in Yemen to increase their awareness and participation in ADR reporting.

Content Analysis of Mobile Health Applications on Diabetes Mellitus

Diabetes self-management offers an opportunity to patients to be actively involved in managing their conditions and modifying lifestyle behaviors to attain positive health outcomes. With the unprecedented growth of mobile technology, smartphone plays a role in supporting diabetes self-management. Nonetheless, selecting appropriate mobile applications (apps) is challenging for patients. Thus, this study aimed to evaluate and compare the contents and features of mobile medical apps for diabetes self-management. Of 346 commercial apps, 16 (16%) and 19 (7.72%) of the diabetes apps found in Apple and Google Play stores, respectively, were included based on the selection criteria and individually scored for the availability of 8 main features of diabetes self-management. The apps supported self-management by offering features such as free installation, less than 50 MB space used, offline use, automated data entry, data export and sharing, educational tool, and advice. Of the 8 evaluated features, only 11 (31.4%) apps had a score of 5 whereas 7 (20%) apps scored the lowest, with a score of 3. The majority of apps were free, required no Internet connectivity to use and were less than 50 MB in size. Our findings showed that the design of diabetes mobile apps focused on reporting and setting reminders, rather than providing personalized education or therapeutic support. In the future, the design of apps could be improved to integrate patients’ needs, usability for disease management, and lifestyle modifications.

How to help patients to control their blood pressure? Blood pressure control and its predictor

Introduction: Good blood pressure (BP) control is one of the aims of hypertension disease management. Consistently achieving the targeted BP could reduce patient′s risk of developing the complication of hypertension. Materials and Methods: This study is a prospective cohort study aimed to investigate the blood pressure reading among in patients in a public tertiary hospital in northern Malaysia and to determine predictor of good BP control among patients. Patients were followed from their admission day until discharge. Data were collected by the researcher from the medical records. Information collected were BP reading on admission, day 1 and discharge. Other information includes demographic data, social factors, medication name and number, co-morbidities, target organ damage, cardiovascular risk factors. Descriptive analysis was done to determine the characteristic of patients and logistic regression was done to identify factors associated with BP control. Results: A total of 400 patients were followed up from admission till discharge. BP was controlled in 24% on admission and in 54% of patients on discharge. Multivariate analysis on admission revealed that the predictors of BP control were the use of diuretics and statin. Factors identified to be associated with poor BP control were diabetes mellitus, cerebrovascular disease and retinopathy. Multivariate analysis on discharge showed that the predictors of good BP control were diuretics and beta-blockers and the predictors of poor BP control were diabetes, chronic kidney disease, diabetic nephropathy, cerebrovascular disease and number of comorbidity. Conclusion: These results demonstrated that hypertension was poorly controlled among in-patients and that BP control was better on discharge than on admission. Patients with diabetes mellitus, renal disease and cerebrovascular disease were more likely to have poor hypertension control.

Completeness and Legibility of Handwritten Prescriptions at Sana’a, Yemen

Objective: The aim of this study was to investigate the completeness and legibility of prescriptions dispensed in community pharmacies located in Sana’a, Yemen. Materials and Methods: A cross-sectional study was conducted at 23 randomly selected community pharmacies throughout the capital city of Sana’a, Yemen, from May 2015 to January 2016. A total of 2,178 prescriptions were analyzed for the essential elements of a complete prescription using a validated checklist. Results: Of the 2,178 prescriptions, 19 (0.87%) were considered to be of good quality. The remaining 2,159 (99.12%) were considered as being of very poor quality. Writing errors relating to patients and prescribed medications were the most common errors. Conclusion: In this study, the quality of prescription writing was found to be very poor. Hence, continuous professional development programs are recommended to improve the quality of prescription writing among physicians. Future studies in other cities and investigation of the impact of continuous educational programs on the quality of prescription writing are strongly recommended.