Zikria Saleem

Mesenchymal stem cells (MSCs) as skeletal therapeutics–an update

Mesenchymal stem cells hold the promise to treat not only several congenital and acquired bone degenerative diseases but also to repair and regenerate morbid bone tissues. Utilizing MSCs, several lines of evidences advocate promising clinical outcomes in skeletal diseases and skeletal tissue repair/regeneration. In this context, both, autologous and allogeneic cell transfer options have been utilized. Studies suggest that MSCs are transplanted either alone by mixing with autogenous plasma/serum or by loading onto repair/induction supportive resorb-able scaffolds. Thus, this review is aimed at highlighting a wide range of pertinent clinical therapeutic options of MSCs in the treatment of skeletal diseases and skeletal tissue regeneration. Additionally, in skeletal disease and regenerative sections, only the early and more recent preclinical evidences are discussed followed by all the pertinent clinical studies. Moreover, germane post transplant therapeutic mechanisms afforded by MSCs have also been conversed. Nonetheless, assertive use of MSCs in the clinic for skeletal disorders and repair is far from a mature therapeutic option, therefore, posed challenges and future directions are also discussed. Importantly, for uniformity at all instances, term MSCs is used throughout the review.

Antibiotic Self-Prescribing Trends, Experiences and Attitudes in Upper Respiratory Tract Infection among Pharmacy and Non-Pharmacy Students: A Study from Lahore.

Pharmacists are the custodians of drugs; hence their education, training, behaviors and experiences would affect the future use of drugs at community and hospital pharmacies. Therefore, we aimed at evaluating the self-prescribing antibiotic trends, knowledge and attitudes among pharmacy and non-pharmacy students. We found that pharmacy students had higher risks of experiencing URIs related symptoms such as cough (RR; 1.7, p = 0.002), allergy (RR; 2.07, p = 0.03) and running nose (RR; 3.17, p<0.005), compared to non-pharmacy students -resulting in higher probabilities of selecting cough syrups (OR; 2.3, p<0.005), anti-histamines (OR; 1.8, p = 0.036) and anti-inflammatory/anti-pyretic (OR; 2.4, p<0.005) drugs. Likewise, bachelor’s degree pupils (OR; 2, p = 0.045), urban area residents (OR; 2.44; p = 0.002) and pharmacy students (OR; 2.9, p<0.005) exhibited higher propensities of antibiotic self-use–notable classes include, b-lactams (45.9%) followed by macrolides (26.5%) and augmentin (28.94%), respectively. Surprisingly, pharmacy and non-pharmacy students had higher odds of using antibiotics in common cold (OR; 3.2, p<0.005) and pain (OR; 2.37, p = 0.015), respectively. Unlike non-pharmacy students, pharmacy students were likely to select alternative therapy, such as Joshanda (OR; 2.22, p = 0.011) and were well acquainted with antibiotic hazards, with 77% reduction in risk of antibiotics re-use. In conclusion, university students exhibited antibiotic self-prescribing trends in conditions that does not warrant their use, thus are irrational users. The pharmacy education confers very little benefit to rational self-prescribing practices among students, while non-pharmacy students are more vulnerable to repeated antibiotic usage. Thus, the educational and training modules should be designed for university students to disseminate targeted information regarding the potential hazards of antibiotic self-use and importance of consultation with qualified and registered medical doctor/pharmacist before starting with antibiotics.

Genderwise clinical response of antipsychotics among schizophrenic patients: a prospective observational study from Lahore, Pakistan

Abstract Objective: The study was aimed to evaluate the gender specific response to adherence and occurrence of side effects among schizophrenic patients in Lahore, Pakistan. Methods: A prospective study was performed for a period of 1 year among 180 newly diagnosed schizophrenics, aged 20–60 years to observe the symptoms, medication adherence and side effects. Morisky–Green–Levine Scale was used to evaluate medication adherence, LUNSER for side effects and PANSS to measure positive and negative symptoms. Data were analyzed using SPSS. Results: Positive symptoms (Male: Baseline 36.14 vs. endpoint 23.58, Female: 35.29 vs. 23.74) and negative symptoms (Males 27.9 vs. 20.05, Females 28.41 vs. 20.2) of schizophrenia were equally reduced after a follow up of 1 year in both the genders. Male population suffered more accumulative side effects (11.4 in males vs. 6.40 in females), extrapyramidal symptoms such as tardive dyskinesia and tremors (1.21 in males vs. 0.57 in females) and other side effects as compared to women (p ≤ .005). Males were found poorly adherent to antipsychotic treatment than females (93.3% in males vs. 6.7% in females (p ≤ .005). Conclusions: Prescribing practices should not overlook sex specific factors like hormonal changes, altered brain morphology and socioeconomic factors that may be responsible for the difference in the response to the course of schizophrenia.

Exploring the knowledge and attitude of medical and pharmacy students about generic medicine in Lahore, Pakistan:

Background The age of out-of-pocket health-care expenditures demands the practice of generic medicine. Our objective was to evaluate the knowledge and attitude about generic medicine among medical and pharmacy students of Lahore, Pakistan. Methods A cross-sectional study was performed among calculated sample size (via online Raosoft calculator) of 295 students including 185 pharmacy and 110 medical students from third, fourth, and final year of studies using convenient sampling approach. A pre-validated questionnaire was used to assess the knowledge of students regarding generic medicine. Data were analyzed using SPSS version 20. Results We found that a majority of both pharmacy and medical students were aware of the meaning of brand and generic medicine where 86 (29.7%) students believed that generic medicine is bioequivalent to brand name product and 108 (36.5%) students agreed that cost burden will be reduced with the use of generics. There were concerns about quality (P ≤ 0.05) and side effects (P ≤ 0.005) of generic medicine as compared to brands. Significant associations were found between the knowledge of medical and pharmacy students (P ≤ 0.005). Conclusion Educational interventions and policies regarding generic medicine practices are strongly needed to overcome the knowledge deficits among pharmacy and medical students.

Impact of duration of therapy on side effect profile of anti-HCV protocol: A retrospective cohort study from two tertiary health facilities in Pakistan

Purpose: To evaluate the plausible risks and adverse effects related to the duration of therapy in hepatitis C (HCV) patients in Lahore, Pakistan. Method: A retrospective observational study involving 250 HCV patients who received combination therapy with ribavirin and interferon was conducted. The patients were segregated into two groups on the basis of duration of therapy (≤ 6 months and > 6 months). Adverse effect profiles of patients under treatment were collected using a pre-validated questionnaire and compared using Pearson’s Chi- Square Test/Chi-Square Goodness-of-Fit tests and unpaired t-test. Results: Patients who underwent treatment for ≤ 6 months frequently encountered side-effects such as GIT disturbance (23.77 %) and joint pains (29.63 %). Additionally, diabetes mellitus (27.86 %) and frequent injections (74.59 %) were the most commonly observed co-morbid condition and disease risk, respectively. On the other hand, in patients who underwent therapy for > 6 months, skin disorders (30.46 %) and gastric acidity (10.15 %) were the most frequently observed side-effects with less frequent reporting on co-morbid conditions and disease risk factors. Moreover, there was a significant reduction in body weight (p = 0.03), serum bilirubin (p = 0.0005), albumin (p = 0.003) and triglycerides (p = 0.006) levels due to longer duration of treatment. Conclusion: The data suggest that treatment-related risks are higher among HCV patients on shorter treatment duration whereas adverse events subside in patients on longer duration of therapy (>6 months). Changes in biochemical profile were also more evident in those receiving treatment for periods >6 months. Keywords: Interferon, Ribavirin, Side effects, Duration of therapy, Outcomes of therapy

Computer Aided Formulation and Characterization of Propranolol Hcl Buccal Tablet Using Polymeric Blend

The current study was aimed to formulate a continuous release mucoadhesive buccal tablet containing propranolol HCl. The type and quantities of polymers as well as method of compression were set in a preliminary study (F1-F13). Direct compression method was employed in the main study (F14-F24) using Carbopol 934P (CP), ethylcellulose (EC), sodium alginate (SA), hydroxypropyl methylcellulose (HPMC k4M) and carboxymethylcellulose (CMC) as mucoadhesive polymers and were tested for physicochemical tests i.e. swellability, surface pH, mucoadhesive time, mucoadhesive strength, in vitro release etc. Results obtained from the study were optimized using NeuralPower 3.1, an artificial intelligence approach. Against the desirability of physicochemical parameters, the software optimized the ingredients as HPMC (150mg), CMC (25mg), CP (20mg) and EC (20mg). Outcome revealed that HPMC primarily contributed to the physicochemical properties of mucoadhesive formulation. To compare prediction, optimized ingredients were formulated (F25) and tested. The swellability index of confirmation formulation (F25) was 102% at 6 h. As predicted, similar release pattern was of F25 was obtained as 26% (0.5h), 34% (1h), 40% (2h), 45% (3h), 50% (4h), 62% (5h), 76% (6h), 85% (7h) and 97% (8h) respectively. For release kinetics, DD solver suggested the release of the drug to be non-Fickian.