Clinical Pharmacology articles list

The prevalence rate of vitamin D deficiency over the last decades has grown up rapidly worldwide among young adults. Therefore, the aim of this study is to explore knowledge, attitude and practice of Libyan medical students of Sebha University regarding vitamin D deficiency. Out of a total of 200 questionnaires, 148 completed questionnaires were returned (74.0% response rate). The majority of respondents did not measure their vitamin D levels (62.1%). Participants who indicated they exposing to sunlight for less than 15 min were 47.2% while 74.9% exposing to less than 30 min with highly significant difference in gender (p < 0.001). All the males did not use sunscreen creams compared with females (43.5%). Nearly two-thirds of the participants (61.4%) denied drink milk almost daily with significant differences based on the gender (p < 0.005) while 56.0 % of the participants reported eat fish, 60.8% of the students denied eating fast food and 74.3% eating eggs daily or weekly. However, 49.3% of the students are usually drinking of tea and coffee after meals, and do not usually practice exercise (53.3%), however, disagreed that their food has a low amount of calcium (30.4%). Most of the students agreed with the benefits of vitamin D (72.0%). Based on the assessment of awareness of the participants about vitamin D information, the average of correct answers percentage of the respondents was 47.1%. The most frequent sources of vitamin D information were the internet which accounted for 49.3%, followed by relatives and friends (31.7%). Some of the respondents (58.7%) reported that unawareness is the main cause of vitamin D deficiency. This study highlights the lack of awareness about the importance of vitamin D among medical students. This finding provides the institutions of medical education in Libya with an evidence base for a deficit knowledge regarding young health which could be utilized it to draw a strategy to correct health behaviors of students and community through medical education programs.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The present study deals with the phytochemical analysis and evaluation of antibacterial activity of hydroalcohol, acetone, and hexane extracts of the leaves of Psidium guajava. The antimicrobial activity was measured by the agar well diffusion method. Gastric volume, pH, total and free acidity and the ulcerative index was also measured in hydroalcoholic extract of Psidium guajava on gastric ulcer pyloric ligation in rat. Glycosides, terpenoids, and tannins are only present in the hydro alcohol extract. The extracts are tested against gram-negative (Escherichia coli) and gram-positive (Staphylococcus aureus, Bacillus subtilis) bacterial strains. The zone of inhibition against microorganisms is direct proportional to the concentration of extract. Maximum zone of inhibition (24mm) against Staphylococcus aureus except hexane extract was seen. Psidium guajava leaves show maximum phytochemicals compounds and inhibition of microorganisms in hydroalcoholic extract. So the hydroalcoholic extraction was used for anti-ulcer activity. The present study was performed in pylorus ligation induced gastric ulcer model in albino rats in which the ability of hydroalcoholic extracts of Psidium guajava was tested at a dose level of 400 mg/kg body weight orally and compared with Ranitidine (10 mg/kg) as standard. From the results it is concluded hydro alcohol leaf extracts of Psidium guajava 400 mg/kg dose level showed significant anti-ulcer activity when compared to that of standard drug.

Sudha Rameshwari.K Assistant Professor

Anemia, iron deficiency and iron deficiency anemia are common blood disorders. The role of vitamin D was agreed to be regulating in calcium and phosphate absorption and bone metabolism and its deficiency is observed as a crucial nutritional problem. Vitamin D is created under the skin by ultraviolet light. It is usually get vitamins from the food; however, in the case of vitamin D, there simply are not enough rich food sources for people to get adequate amounts in their diet. Its effects on the prevention of diseases such as cardiovascular disease and anemia has received much attention recently. To get sufficient vitamin D, need to be exposed to sunshine or use supplements. Vitamin D3 was found in the largest population as a deficiency. With regard to hemoglobin was the subject whom has less normal range of hemoglobin (19.05%) than international normal range, and in ferritin the low population number was the subject whom has less normal range of ferritin than WHO normal range. The population who has low ferritin also has low vitamin D3 and variable hemoglobin. According international guidelines, optimizing nutrition with daily or intermittent (1 to 3 times per week) iron supplementation, should be considered a first-line intervention in high-risk or high-prevalence groups. Although it is probably less effective than daily iron supplementation, intermittent iron appears to be a useful and cost effective way of controlling anemia and iron deficiency anemia. This may indicate that a positive relation between the low concentration parameter of vitamin D3 and ferritin level but no significant correlation with hemoglobin.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Various quality control tests are employed for solid dosage forms such as uniformity, dissolution and drug contents in order to assess their pharmaceutical equivalence. The objective of the current study was to assess and contrast five distinct metformin hydrochloride brands that are offered for sale in the Libyan market. The physicochemical equivalence of the five brands of metformin hydrochloride tablets (500 mg) were determined through the evaluation of official and non-official standards according to the USP including uniformity of weight, friability, hardness, dissolution rate and drug content. All the examined brands available in the Libyan market passed the official weight variation, friability, dissolution and disintegration tests and were equivalent. The friability test was found within the specified limit. All the formulations were disintegrated within 09 - 15 min. The tested brands were non-equivalent to the innovator Glucophage® according to their dissolution evaluation. The percentage content of the active ingredient of five brands of metformin tablets showed values within the monograph specifications (95% - 105%). In conclusion, all the five brands available in the Libyan market which were evaluated in this study cannot be substituted with the innovator product in clinical practice.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The propagation of using drugs on the road was the main reason for focusing on the development of the rapid methods which are used to detect the presence of drugs which may have been taken. Oral fluid has become a popular specimen to test for the presence of drugs. In vitro tongues were prepared with different concentrations of hydroxypropyl methyl cellulose (HPMC E4M); one of these concentrations was chosen to be used for tests. Chemical reagents were prepared which included: cobalt thiocyanate, fast blue B test, Marquis, Mandelin and Zimmerman reagents which were used to examine eight drugs in three different concentrations, each of 10.0 mg/mL, 05.0 mg/mL and 01.0 mg/mL where each reagent was used for a particular drug. The drugs were amphetamine, cannabis, cocaine, 3,4-methylenedioxymethamphetamine (MDMA), codeine, diazepam, heroin, methadone and morphine. Each drug was tested by a specific reagent. The difference in the concentrations gave various results in terms of achieving positive results and the ratio of the clarity of the colour. The amount of the drug on the tongue was between 20 μg and 400 μg. Positive and negative results were obtained in this study. Most of the high concentrations gave positive results; however, the low concentrations gave different results which were between positive, negative and light or very light in colour. In conclusion, there is an explanation of the difference in sensitivity of the effects of the different kinds of reagents in the drug, such as cobalt thiocyanate which was more sensitive at the low concentration of heroin and gave a clear result.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The diversity of reactogenicity and its variation in terms of risk and prevalence among populations had raised the need to study and evaluate the reactogenicity of different COVID-19 vaccines in our region. Thus, this study aimed to estimate the prevalence of reactogenicity of COVID-19 vaccines and compare the three vaccines (AstraZeneca-Oxford, Sinovac and sputnik V). An analytical cross-sectional study was conducted using a semi-structured telephonic interview with a sample size of 430 individuals who received one of the included COVID-19 vaccines (AstraZeneca, Sinovac or sputnik V) and were recorded at one of the vaccination centers' records that were affiliated with Aljamail Department of the National Centre for Disease Control, Libya. 410 Libyan participants met the inclusion criteria and were enrolled in the final analysis. The study has shown that 57.3% (CI 52.7-62) of the participants had at least one reactogenic event. Pyrexia (40.7%), headache (27.3%) and fatigue (19.5%) were the most common reactogenic events. In conclusion: the study found that reactogenic events were mild to moderate and the COVID-19 vaccines were safe and encouraged our community to be vaccinated. However, prospective studies with larger sample sizes, longer follow-up and inclusion of important laboratory parameters such as IgG and IgM immunoglobulins are recommended to better understand the relationship between the reactogenicities of COVID-19 vaccines with immunity system development and the factors associated with it.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The 2019 coronavirus disease (COVID-19) was declared by the World Health Organization as a pandemic on 11th March, 2020 which spread rapidly all over the world. COVID-19 disease has different clinical presentations, ranging from asymptomatic to severe symptoms. Laboratory findings are important in determining which therapeutic strategies to seek and to identify severe cases initially. In this study, we compared the results of C-reactive protein, D-dimer, blood electrolytes and mean corpuscular hemoglobin concentration between survivors and non-survivors of 22 Libyan patients with COVID-19 present in the intensive care unit at Maitika Isolation Center (Tripoli, Libya) in the period of January to June 2021. We could not detect any significant difference in C-reactive protein between survivors and non-survivors but a significant difference in D-dimer level was observed. Non-survivor COVID-19 patients have a higher level of D-dimer. Moreover, a statistical significant difference in chloride and sodium levels but not in potassium level were detected. A marked lower of mean corpuscular hemoglobin in non-survivor than survivor COVID-19 patients was shown. Thus, these parameters could act as biomarkers for COVID-19 patients.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Background: The determinants of medication adherence in people with diabetes may differ between populations of an area due to social environment, cultural beliefs, socioeconomic conditions, education, and many other factors differences. Objective: Therefore, this study aims to explore, identify and classify the determinants of medication adherence in several Asian regions. Methods: A systematic literature review was conducted to gain insight into the determinants of medication adherence. Seven relevant databases (EBSCO, ProQuest, PubMed, ScienceDirect, Scopus, Wiley, dan Taylor, and Francis) and hand-searching methods were conducted from January 2011 to December 2020. Keywords were compiled based on the PICO method. The selection process used the PRISMA guidelines based on inclusion, and the quality was assessed using Crowe’s critical assessment tool. Textual summaries and a conceptual framework model of medication adherence were proposed to aid in the understanding of the factors influencing medication adherence. Results: Twenty-six articles from countries in several Asian regions were further analyzed. Most studies on type 2 diabetes patients in India used the MMAS-8 scale, and cross-sectional study is the most frequently used research design. The medication adherence rate among diabetic patients was low to moderate. Fifty-one specific factors identified were further categorized into twenty-three subdomains and six domains. Furthermore, the determinants were classified into four categories: inconsistent factors, positively related factors, negatively related factors, and non-associated factors. In most studies, patient-related factors dominate the association with medication adherence. This domain relates to patient-specific demographics, physiological feelings, knowledge, perceptions and beliefs, comorbidities, and other factors related to the patient. Several limitations in this review need to be considered for further research. Conclusion: Medication adherence to diabetic therapy is a complex phenomenon. Most determinants produced disparate findings in terms of statistical significance. The identified factors can serve various goals related to medication adherence. Policymakers and health care providers should consider patient-related factors.

Much Ilham Novalisa Aji Wibowo

Kepatuhan terhadap terapi farmakologi merupakan kunci utama pengobatan penyakit diabetes, tetapi belum mendapat perhatian penuh oleh para klinisi. Beberapa systematic review faktor kepatuhan telah dilakukan di beberapa kawasan negara. Namun, tidak menampilkan studi dari Indonesia. Penelitian ini bertujuan untuk meninjau secara sistematis faktor-faktor yang dapat memengaruhi kepatuhan minum obat diabetes melitus (DM) di Indonesia. Systematic literature review dilakukan melalui pencarian pada database jurnal Nasional (Garuda dan Sinta) dan Internasional (PubMed dan Science Direct). Penelitian yang sesuai dengan kriteria inklusi dan dipublikasikan pada Januari 2011 – Desember 2020. Kualitas penelitian dinilai menggunakan panduan SQAT. Metode pelaporan penelitian menggunakan pedoman PRISMA. Faktor kepatuhan diklasifikasikan berdasarkan domain faktor kepatuhan menurut World Health Organization (WHO). Sebanyak 370 artikel ilmiah penelitian dari database Garuda (n=36); Science Direct (n= 108); PubMed (n= 18); Sinta (n= 208). 341 artikel penelitian dieksklusi, 29 artikel skrining full text, dan 16 artikel penelitian memenuhi kriteria inklusi untuk dianalisis. Faktor yang memengaruhi kepatuhan minum obat diabetes adalah faktor sosial dan ekonomi (penghasilan, tingkat pendidikan, dan pekerjaan), faktor tenaga dan sistem kesehatan (tenaga kesehatan), faktor terapi pasien (jumlah obat diabetes, frekuensi minum obat, dan produk obat), faktor penyakit pasien (kadar gula darah, durasi penyakit), faktor pasien (jenis kelamin, faktor emosional, dukungan sosial, tingkat pengetahuan, dan kepuasan pengobatan), dan faktor pengelolaan penyakit (konseling dan edukasi farmasi). Faktor yang memengaruhi kepatuhan minum obat DM di Indonesia sangat beragam, dan multi faktor. Faktor tersebut dapat berfungsi sebagai target intervensi yang relevan. Para klinisi perlu mempertimbangkan penyesuaian frekuensi minum obat dan pemberian dukungan sosial kepada pasien DM.

Much Ilham Novalisa Aji Wibowo

Diabetes mellitus (DM) is considered as ”the mother of all diseases" because it causes many complications. Knowing and measuring medication adherence may have a greater effect on DM patients. Several studies in Indonesia used a questionnaire scale to measure adherence, however they do not validate the study population, so it could still be found anomalous correlation analysis between adherence and clinical data even though it measured in the same country and scale. This study measure the adherence level of type 2 diabetes patients, evaluates the validity of the medication adherence scale, and analyze the correlation with the clinical outcome of type 2 diabetes patients in four health centers in Banyumas district. The study uses a cross-sectional design in Prolanis type 2 DM patients of January -April 2020. The adherence is measured by MARS-10, backward-forward translation method followed by content and internal validation. Clinical outcome is evaluated based on fasting blood glucose measurement. The results of the MARS-10 Gregory index analysis showed content validity in the high category (IG ≥ 0.8). The content validity showed the results of 9 questions with the value of r count> r table (n = 30, r table = 0.361). Reliability analysis showed Cronbach's Alpha 0.747> 0.6. The measurement showed 80.3% were adherent patients and 19.3% were non-adherent patients. Correlation analysis showed that there was no significant relationship (p> 0.05) between patient adherence and clinical outcome. Those results showed that type 2 diabetes mellitus patients in 4 health centers were categorized as adherent but not correlated with the clinical outcome. This was enabled due to the clinical outcome was simultaneously influenced by several factors: general factors, individual factors, and unpredictable factors.

Much Ilham Novalisa Aji Wibowo

Using off-label drugs in obstetric-gynecology patients requires caution because of the high risk of pregnancy. Although there is still debate, data profiling its use in clinical practice is lacking. This study aims to observe the use of off-label drugs in obstetrics and gynecology patients in private hospitals, especially the pill Misoprostol. This study used a descriptive observational approach to hospital medical record data. Retrieval of research data retrospectively at Bunda General Hospital (X Hospital) for July 2017 – December 2017 and Sinar Kasih Hospital (Y Hospital) for January 2018 – December 2018. The number of samples was determined using the Slovin formula, with a systematic random sampling technique at X Hospital and total sampling at Y Hospital. The samples were 220 RM at X 130 Hospital and Y 90 Hospital. The research was conducted in the period January 2019 - March 2019. The results were analyzed univariately using several related references. The results showed 26.92% of misoprostol off-label use in X Hospital and 4% in Y Hospital. The off-label drug found was Misoprostol which belongs to the category of off-label indications (Missed Abortion, Incomplete Abortion, Blighted Ovum, and Induction of labor in cases of Serotinus, KPD, and IUFD), off-label doses (50 µg, 100 µg, and 400 µg), and off-label routes of administration (sublingual and vaginal). ​

Much Ilham Novalisa Aji Wibowo

Compliance with pharmacological therapy is the primary key to treating diabetes, but it has not received full attention from clinicians. Several systematic reviews of compliance factors have been conducted in several regions of the country. However, it does not feature studies from Indonesia. This study aims to systematically review the factors that can influence adherence to diabetes mellitus (DM) medication in Indonesia. A systematic literature review was conducted by searching the National (Garuda and Sinta) and International (PubMed and Science Direct) journal databases. Research that met the inclusion criteria was published from January 2011 to December 2020. The quality of the study was assessed using the SQAT guidelines. The research reporting method uses the PRISMA guidelines. Compliance factors are classified based on the domain of compliance factors, according to the World Health Organization (WHO). A total of 370 scientific research articles from the Garuda database (n=36); Science Direct (n = 108); PubMed (n = 18); Sinta (n= 208). Three hundred forty-one research articles were excluded, 29 full-text screening articles, and 16 research articles met the inclusion criteria for analysis. Factors that influence adherence to taking diabetes medication are social and economic (income, education level, and occupation), factors of personnel and health systems (health workers), factors of patient therapy (amount of diabetes medication, frequency of taking medication, and drug products), factors patient's disease (blood sugar levels, disease duration), patient factors (gender, emotional factors, social support, level of knowledge, and treatment satisfaction), and disease management factors (pharmacy counseling and education). Factors that influence adherence to taking DM medication in Indonesia are very diverse and are multi-factor. These factors can serve as relevant intervention targets. Clinicians must consider adjusting the frequency of taking medication and providing social support to DM patients.

Much Ilham Novalisa Aji Wibowo

Pharmacists are expected to play major roles as members of diverse perioperative care teams besides implementing medication safety standards, pharmacist’s roles include optimizing drug therapy and other clinical interventions. Yet, developing general perioperative management as another crucial role operation room, pharmacists play and incorporating it into pharmaceutical education would be important. Enriching perioperative care provided by pharmacists can contribute toward improving the clinical competence of these professionals. Presently, there are no pharmacists in Zawia who participate in perioperative care. The objective of this study was to assess the pharmacist's knowledge of general anesthesia and drugs used to anesthetize patients who suffer from hypertension. A cross-sectional study was conducted in Zawia City, Tripoli in 2023. A self-designed questionnaire was distributed to 100 pharmacists. The study found that more than half of the pharmacists have humble knowledge about the drugs used in anesthesia, the findings indicated weakness in their information about drugs used to manage hypertension in surgery, and 36.0% know that sodium nitroprusside is used to control blood pressure during the operation. In conclusion, this study reported that some of the study's pharmacist participants had weak points that contributed to a high percentage of incorrect knowledge. These weak points may be attributable to poor educational preparation or a lack of training before the pharmacists began working in hospitals.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Chronic kidney disease is a public health problem affecting people worldwide. This study was aimed to examine the characteristics of patients with chronic kidney disease and to identify prevalence of drug-related problems among Libyan patients. This is a descriptive retrospective study carried out in Southern-west part of Libya, Sebha City. Information abstraction forms were used for collection of data. The investigators reviewed the medications, medical records and laboratory data to identify drug-related problems.1 000 patients' files during 2019-2020 were examined and only 120 files were selected for this study. The majority of the participants were male (73, 61.0%) and the mean age was 56.1 years. 576 comorbidities among the selected patients were identified (73.61%) and the average number per patients was 4.8 concurrent diseases. There were 1 350 medications prescribed and the average of prescribed drugs per patient was 11.25. The majority of patients use more than 10 drugs (64, 53.3%) and the average length of staying in the hospital was 5.58 days. 502 drug-related problems were identified with an average of 4.18 per patient. Untreated conditions such as Hyponatremia and anemia were the highest rate of drug-related problems identified (199, 39.6%) followed by improper drug selection (82, 16.3%) such as cefotaxime, vancomycin and aminoglycoside for chronic kidney disease and drug use without indications such as antibiotics (68, 13.5%) and over-therapeutic dose such as metoclopramide(63, 12.5%). In conclusion, all the patients have polypharmacy and the majority have comorbid conditions and chronic kidney disease with frequent drug-related problems, thus, to lower the incidence rate of drug-related problems, therapeutic interventions are needed. Subsequently, it is a crucial to involve clinical pharmacist in hospital to improve the care of patient with chronic kidney disease.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Acenocoumarol is the only oral antivitamin K anticoagulant prescribed and marketed in Algeria for the prevention and treatment of thromboembolic diseases. Nevertheless, the difficulty of handling this drug linked to a narrow therapeutic index and to great inter- and intra- individual variabilities of the response to the treatment poses a major public health issue because of its iatrogenic risk. To improve the management of patients on acenocoumarol and optimize its dosage adjustment and reduce iatrogenic secondary to vitamin K antagonists, our main objective work is to assess the knowledge, attitude and practice of health care professionals regarding this anticoagulant agent. We conducted a multicenter descriptive cross-sectional study from April to May 2021. We interrogated 152 health professionals of all ages, all sexes and all grades from different health departments in Oran City (Algeria) prescribing anticoagulants, through a validated questionnaire made up of 26 questions. Statistical analysis was achieved by SPSS version 20 software. Thus, 59.9% were women with a sex ratio of 0.67, 92.8% knew that acenocoumarol belongs to the antivitamin K class, 45.0% chose INR and PT as follow-up parameters, 36.0% chose INR alone and 78.9% were unaware of acenocoumarol dose adjustment algorithms as well as 82.0% were unaware of the existence of pharmacogenetics testing. 54.0% use the recommendations of the HAS for dosage adjustment of patients on acenocoumarol. 07.9% suggested using pharmacogenetic tests to improve the dosage adjustment of acenocoumarol, 06.6% suggested patient follow-up and 05.9% suggested therapeutic patient education as well as 74.3%, wanted to do training on. Therefore, this study highlighted gaps in the medical practice of physicians in terms of dosage adjustment, pharmacogenetics and its impact on dosage optimization. However, the evaluation of their knowledge was considered unsatisfactory. To overcome this lack of knowledge, it seems necessary to make physicians aware of the contribution of pharmacogenetics of acenocoumarol in Algeria.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Febrile convulsions have been defined as any convulsion associated with a fever of more than 38 oC without central nervous system infection in a child aged six months to five years. Febrile convulsion can be divided into two groups of simple and complex seizures. This study aimed to determine the prevalence of febrile convulsions in Libyan children and to investigate the associated risk factors related to this type of seizure in children. 120 cases of febrile convulsions with one day - 12 years old were collected during from April to August 2022. A study has conducted in the Pediatrics Hospital in Bayda City, Libya about the prevalence of febrile convulsions in children, the data collection tool was a self-designed pre-tested validated questionnaire including general information such as age, gender, family history, and admission to the hospital. In addition, data such as body temperature, recurrent convulsion attacks, the condition of hospital admission, discharge status, the treatment in-hospital and out-hospital. The collected data were analyzed by using descriptive methods. Among the 120 children, the majority of the cases were aged between two years and five years old. The gender prevalence rate in this study was 55.0% in males and 97 of the children were hospitalized due to simple febrile seizure (80.8%), 92 of the cases with no family history of febrile convulsions (75.0%) and respiratory tract infections is the main cause of febrile convulsions. In conclusion, this study indicated that respiratory tract infections is the most common cause of febrile convulsions among Libyan children, however, a large sample study is needed to support this issue in Libya.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Diabetes mellitus (DM) is a complex and chronic illness requiring continuous medical care. Type 2 diabetes (T2D) is commonly associated with obesity, hypertension, and a tendency to develop thrombosis, and an increase risk of cardiovascular diseases (CVD). Diabesity is a term used to indicate the coexistence of obesity and DM. Diabesity increases as obesity is an emerging epidemic in modern societies, the co-incidence with DM is also rising, so a joint plan of anti-obesity and anti-hyperglycemia for the management approaches. Therefore, this study aimed to identify the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on body weight and glycemic response in obese Libyan patients with T2D at the National Diabetes Centre in Tripoli, between July 2013 and May 2022. This prospective study included obese adults with T2D who were newly prescribed GLP-1RA therapy for six months with dulaglutide once weekly or liraglutide once daily. The study included 170 diabetic patients who were started on GLP1-RA as add on therapy to their treatment, with a regular follow-up with dietitian and their physicians to adjust their glucose-lowering medications, then comparing the effect of these agents on body weight and the level of glycated hemoglobin before and after 24 weeks of treatment. Most of the patients (n = 99, 58.23%) were in the age period from 54 to 74 years old and 101 of whom were female subjects (59.4%), with a mean duration of DM equal to 8.8 ± 7.3 years. The patients were divided randomly into two groups, the first group included 110 patients who received liraglutide pens showed a significant reduction in HbA1c from 9.6% (± 1.54) to 7.4% (± 1.03) by p < 0.001 and a significant weight loss from 88.3 kg (± 10.68) to 80.8 kg (± 11.83) by p < 0.001. The reported adverse events were in 23 cases of minor hypoglycemia due to gastrointestinal upset. The other group included 60 patients for dulaglutide pens and showed significant decrease in HbA1c = 9.6% (± 1.54) to 7.1% (± 1.2) by p < 0.05 and a significant reduction of bodyweight from 88.3 kg (± 10.68) to 83.8 kg (± 16.3) by p < 0.05. The reported adverse events were mild transient gastrointestinal distress for the initial week of a start and then subside with regular intake. Whereas, 115 patients (67.6%) with HbA1c above 10.0% before starting therapy, no patient with HbA1c above 10.0% after six months of both GLP-RA agents therapy. Thus, the uses of GLP-RA as add-on therapy for obese patients with T2D significantly improved glycaemic control with less hypoglycaemia, accordingly, reduce insulin requirement for blood glucose control and loss in body weight. It can thus be concluded that GLP-1RA therapy is an effective treatment option when used in obese patients with DM.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Inhalation of a gas anesthetic produces rapid induction of anesthesia without the need for intravenous drugs. Although it is specifically useful for patients who are afraid of injections or if their intravenous access is difficult, single-breath induction may also allow patients to wake up more quickly than intravenous induction drugs. The object of this study is to compare isoflurane and sevoflurane during inhalation in Libyan patients undergoing surgery in terms of side effects like blood pressure and heart rate changes and complications. Seventy- five patients were recruited in this study from different hospitals in Benghazi City, Libya (January to March, 2022) including Aljalaa Hospital and Alatfal Hospital, and data including side effects and complications were collected through data collection. Surgeries that used isoflurane, or sevoflurane or both inhalation gases for anesthesia were included in our data. While the surgeries which did not use any of these inhalation gases were excluded from our data. When we compared the side effects of using isoflurane with sevoflurane according to the age group, we found that hypotension is the most occurring side effect companies to the use of isoflurane in our adult population (28.6%) and in pediatrics (14.3%) but there was a low incidence of other side effects related to sevoflurane administration. Regarding to side effects related to the use of sevoflurane according to the age groups, 16 adult Libyan patients experienced no side effects (61.5%) compared to 10 children (38.5%). It can be concluded that both isoflurane and sevoflurane are suitable for daycare anesthesia. Sevoflurane might be an ideal drug for single-breath inhaled induction of anesthesia due to it has fewer side effects and complications.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Bone resorption is created by different etiological factors, such as tumors, infections, and trauma. When defects are too large and healing is not possible in a spontaneous way, the defect is called a critical size defect, which is defined as the smallest size of an intra-osseous wound that will not heal spontaneously during the lifetime of the individual. This study was conducted to evaluate the use of a mineralized plasmatic matrix versus bone graft alone or in the augmentation of bony cavities in animals. Ten adult male dogs ranging in age from 12 months to 18 months with a mean weight of ten kilograms were used in this study. Bone cavities were made in the tibia of each animal. The upper holes were implanted with a bovine bone material substitute the medial holes were implanted with a mineralized plasmatic matrix and the lower holes were left free from any implant material acting as control. The dogs were euthanized at 2, 4, and 6 weeks and prepared for H and E stain and trichrome stain. The healing process of bone cavities implanted with mineralized plasmatic matrix was better compared to cavities filled with bone grafts and those left to heal spontaneously. Mineralized plasmatic matrix facilitates graft application, in its stabilization, and improves cell penetration into the graft.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Over the years, pharmacy has developed from a simple floor stock system to a complex unit dose, I.V. additive, and clinical pharmacy program. This development would have never been possible without the support of the nursing, medical, and administrative staff. The support of obtained slowly by developing services that increase the pharmacist's credibility as a team member concerned with the pediatric and neonate patients. These services include a unit dose program, I.V. additive program, drug information services, and pharmacy medication program. One area in which pharmacist does not obtain a background from generalized training is the area of pediatric dosing. Pediatric pharmacists must learn in clinical practice the proper dosing of the pediatric patient and neonate patient. The dose must be checked periodically. In the premature or newborn infant, the pharmacist must consider the immature renal and hepatic function so that he/she does not overdose initially and then underdose as the infant grows and matures. Neonates are a special group of children, they are less than 30 days, and within this group preterm babies (that means less than 37 weeks). Determining the correct dose for drugs used to treat neonates is a critically vital factor. Prematurity affects kidney and liver function and the proper adjustment of drug doses is crucial [1]. The absence of drug level necessitates the adjustment of drug doses and the presence of qualified oriented dependable pharmacists. Drug doses are not numbers, or decimals used within the therapeutic range. Neonatal Intensive Care Unit (NICU) needs a system for the calculation and preparation of drugs [2].

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences