Clinical Pharmacy articles list

Community pharmacy has undergone a rapid expansion with various services moving away from the traditional supply function to other patient-focused services. Thus, the aim of this study is to examine consumer views and expectations toward the services provided in Libyan private community pharmacies, as well as customers' skepticism and their general satisfactions toward these services. The study is descriptive, cross-sectional survey and self-designed administered questionnaire. Study population comprised 0f adult patients or costumers who visited the community pharmacies. Out of the 600 questionnaires were personally handed, 462 of the distributed questionnaires were returned (response rate 77%). The majority of the participants reported that community pharmacy staff dealing with customers in polite ways (75%) and providing privacy and sufficient consideration (60%). Respondents agreed that the staff listens attentively and satisfied with encounter time by 60% and 50%, respectively. For provision of drug information as “how the drug work in the first-time use”, “customer experience of the side effects” and “their ability to using the prescribed medicine properly” were reported by 45%, 30% and 30%, correspondingly, while 60% of the respondents denied that staff provided the medication storage information. Regarding the customer skepticism toward community pharmacy services, 55% respondents agreed that services of community pharmacies tend to just concern on commercial aspects and 60% of respondents believed that services concern toward the business matter more likely than patient health. Interestingly, 85% of the respondents acknowledged the role of community pharmacy as indispensable healthcare setting. The availability of the pharmaceutical product and the cost of pharmacy products satisfied by 40% and 20% of the respondents, respectively. In conclusion, this study demonstrated low customer satisfaction with regard to community pharmacy services in the southern region of Libya. Community pharmacy staff should have an understanding of the codes of conduct and the ethical requirements for their practice of pharmacy profession.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

In health care delivery systems, if you are not part of the solution, then you must be part of the problem. Over the last few decades, clinical pharmacy encourages pharmacists and pharmacy support staff to move their focus from product-oriented role towards new direct engagement with patients, to make the most of the benefits that patients obtain from the medicine they take, or the problems they encounter with their medicines use. In the USA, pharmacists’ participation in physicians ward rounds was shown to reduce adverse drug events by 78% and 66% in general medical and intensive care settings [1. 2]. A study covering 1 029 US hospitals indicated that centrally based and patient-specific clinical pharmacy services are associated with reduced mortality rates [3]. The services involved were medicine information, clinical research performed by pharmacists, active pharmacist participation in resuscitation teams and pharmacists undertaking admission medication histories. New pharmacists’ roles in healthcare systems around the globe have moved and developed significantly over the past few years, particularly with expansion of the scope of practice which allows pharmacists to focus on the clinical aspects of direct patient care [4, 5]. Pharmacists are drug therapy experts of health care team. Therefore, pharmacists, today, are the arbiters of effective and safe use of medicines. Medication therapy management is one of the major areas in which physicians more and more rely on pharmacists to benefit their patients.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Vitamin D deficiency and its effect have attracted a considerable research interest due to its relation to glucose homeostasis, insulin secretion, sensitivity and synthesis. The aim of this study was to evaluate vitamin D levels in patients with type II diabetes mellitus aged between 35 - 65 years and investigating their relations with glycemic control and obesity. The study included 74 Libyan patients with known history of type II diabetes mellitus (33 males and 41 females). Serum glucose, glycosylated hemoglobin (HbA1c) and vitamin D levels were biochemically estimated in these patients. Further, body mass index (BMI) was calculated for all the diabetic patients (weight in kilogram per height in meter square). The mean level of plasma glucose level was 150.58 ± 63.82 mg/dl (mean ± SD). The mean of HbA1c level was 7.90 ± 8.48% (mean ± SD). The mean level of vitamin D was 22.7 5 ± 14.97 ng/ml. The mean of BMI was 26.55 ± 4.10 Kg per m2. The findings showed that 58.10% of the cases had vitamin D deficiency (Out of which 24.24% were males and 85.36% were females). This study showed statistical significance differences in glucose, HbA1c, vitamin D and BMI between male and female patients. Moreover, elderly ages for both sexes had adverse effects on vitamin D status. Vitamin D levels have negatively been correlated with levels of glucose, HbA1c and BMI. It is concluded that vitamin D deficiency has an adverse effect on glucose homeostasis in patients with type II diabetes mellitus and this can be a contributor risk factor in complications of type II diabetes mellitus development in Libyan patients.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Epilepsy is a chronic neurologic disease that comes third after cerebrovascular and Alzheimer’s disease. Anti-epileptic drugs may affect certain hematological parameters of epileptic patients. Few researches investigated hematological adverse effects of antiepileptic drugs in Libya. Thus, the aim was to evaluate hematological parameters in epileptic children who are on antiepileptic drugs. This retrospective study included 83 pediatric patients with epilepsy recruited from Benghazi Children Hospital, Department of Neurology, from December 2017 to April 2018. Data collected included demographic characteristics, types of epilepsy, anti-epileptic drugs and serum hematological parameters. Hematological parameters recorded included: hemoglobin, hematocrit, platelet, mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration and white blood cell count. In all treated patients, regardless of the number of antiepileptic drugs therapy used, the average levels of hematological parameters were significantly lower in treated group compared to control group (11.64 gm per dl, 34.53%, 27.74 pg and 33.13 gm per dl, respectively). A significant increase (12.12109 per l) in white blood cell counts in treated group was found. Average hemoglobin, hematocrit and mean cell hemoglobin concentration levels were significantly lower in patients on poly-therapy compared to mono-therapy and control groups. Average white blood cell counts were significantly increased in patients on anti-epileptic drugs. In sodium valproate users, levels of hematological parameters were significantly decreased but significantly increased in white blood cell counts. In diazepam users, significant increases in white blood cells and platelet but no difference in other parameters observed. There were no differences in all hematological parameters among patients using carbamazepine except for platelet counts (significantly decreased). In conclusion, there is substantial effect of the anti-epileptic drugs, especially sodium valproate, on hematological parameters of children despite the effects were not critical as the changes were still in the normal range.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Vitamin D is a hormone which plays a vital role in immune response regulation, including the prevention of inflammation and autoimmunity. Insufficient vitamin D may increase the risk of infection. Vitamin D deficiency is not the only factor linked to an elevated risk of COVID-19 infection. Recent studies have discovered a link between SARS-COV-2 infection risk and blood type. This study was aimed to examine the association of vitamin D and blood groups with the severity of COVID-19. A retrospective study was conducted on 224 confirmed COVID-19 patients, aged between 18 and 89 years old. Patients were divided into three groups (asymptomatic, moderate, and severe cases), and serum 25(OH)D concentration and blood group were analyzed for all the patients. Data of the severe cases were obtained from Souq Althalath Isolation Center, Tripoli, Libya, while moderate and asymptomatic cases were obtained from Abushusha Polyclinic and Aldahmani COVID Filtration Center, during 22nd February 2021 and 28th April 2021 and serum 25(OH)D concentration and blood group were statistically analyzed for all the patients. The percentages of males and females were found to be 47.3% and 52.7%, respectively. Disease severity was distributed as follows: 12.5% asymptomatic, 44.6 % moderate and 42.9% severe. Most of the severe cases had vitamin D deficiency (88.5%). Among the severely ill patients, 39.6% had blood group A and 09.4% had group O, while 22.9%, and 28.1% had blood group B and AB, respectively. In contrast, among the asymptomatic patients, only 7.1% had group A and 85.7% had group O. Overall, the difference in the distribution pattern of blood group in the three severity categories was highly significant (p < 0.001). The prevalence of Rh positivity among asymptomatic, moderate and severe cases was 78.6%, 76.0%, and 60.4%, respectively. This study concludes that insufficient vitamin D levels might influence the severity of COVID-19. COVID-19 patients with blood group A and those who are Rh-positive could be more vulnerable to developing COVID-19 severity.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The prevalence of vitamin D deficiency has recently been recognized in different parts of the world, even affecting healthy populations. The deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. Few studies have been done to evaluate the status of vitamin D in the medical community around the world. No studies have been done in Libya to evaluate the status of vitamin D in medical students. The aim of this study was to evaluate the prevalence of low level of vitamin D in among healthy Libyan medical students of first year in University of Tripoli, Tripoli. Prospective study was conducted on 100 medical students of first year in Faculty of Medicine with a mean age of 19.5 years, 38 males and 62 females. Blood samples were taken and investigated for different biochemical parameters including serum calcium, serum vitamin D and serum parathyroid hormone levels. Questionnaire containing different data was completed for each student including personal data (age, address, nationality, and other data related to vitamin D deficiency. The prevalence of vitamin D deficiency in all the participated students was 74% (58.7% in males and 83.8% in females), while 21% had vitamin D insufficiency (28% in males and 16.12% in females). Only 5% of the students that had normal vitamin D was males. The mean 25-hydroxy vitamin D level was 19.49 ± 8.56 ng/ml in males and 12.08 ± 6.70 ng/ml in female students. Statistical analysis revealed that there is a highly significant difference among the student in vitamin D deficiency. In conclusion, low concentration of vitamin D is highly prevalent among the medical students included. An urgent action has to be taken in order to prevent adverse consequences of low vitamin D in young population.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

In childhood, epilepsy is the most common globally widespread neurological problem, usually with serious consequences for this most critical period of development. Dravet and Lennox Gastaut syndromes are two forms of rare and severe treatment resistant epilepsies that occur early in the life. These resistant epilepsies recognised by continuous unrelenting seizures of many types including the occurrence of status epilepticus. In addition, it is associated with the development of behavioural, neurological, cognitive deficits and the sequelae of increased risk of mortality rate. Historically, cannabis was found to possess several medical benefits including its use for epilepsy. In this review, information and data were extracted from 99 references using PubMed and Google Scholar (November, 2021). Data with clinical evidence on cannabidiol regarding its efficacy on Dravet syndrome and Lennox Gastaut syndrome, mechanism of action, safety, pharmacokinetic properties and interactions with anti-epileptic medications were all reviewed and discussed. Highly purified cannabidiol is a cannabis derived compound that is suggested in recent research as an add-on therapy to the existing treatment of both resistant epileptic types; since it is able to reduce the duration, frequency and severity of seizure disorders. It is also characterised with multiple signalling transduction mechanisms, primarily via inhibition of excitatory and potentiation of inhibitory pathways.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Oxidative stress is due to altered levels of prooxidants and anti-oxidants in the body. This can lead to tissue damage especially the central nervous system. Oxidative damage has been implicated in several disorders including some psychiatric disorders such as schizophrenia and major depressive disorder. Uric acid is an anti-oxidant which prevents tissue damage caused by oxidative stress. In this review, the reduced levels of serum uric acid in schizophrenia and depression are discussed. The effect of treatment in these disorders leading to increased serum uric acid levels are also reviewed.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

In April 2020, Food and Drug Administration (FDA) requested immediate withdrawal of all prescription and over the counter ranitidine products. Ranitidine recalled due to the presence of unacceptable level of carcinogenic substance N-nitosodimethylamine (NDMA). Several pharmaceutical manufacturers have issued ranitidine product recalls including brand and generic ranitidine. FDA alerts patients to stop using ranitidine and advised to talk with their health care professional about alternative treatments. In Libya, limited studies have been conducted to address people awareness and knowledge in this regard. The objective of this study was to assess people's awareness and behavior towards ranitidine recall and related issues. A cross-sectional study was conducted in Zawia city for two months. Online questionnaire was distributed to 300 participants. Descriptive statistics analysis using statistical package for social sciences (SPSS) version 26.0 was used. The study found that more than half of the participants and their family member were likely to utilize ranitidine inappropriately. They seem to consume ranitidine more often without medical consultation. The findings also showed that 82.5% of the participants that were using ranitidine obtained the drug from pharmacies after the date of announcing ranitidine withdrawal from the market by FDA. Furthermore, the vast majority of the participants were poorly informed or even they had no information about ranitidine toxicity and their perception of the dangers of continue use of this drug is limited. The participants argued that pharmacists do not provide slightly information about dispensed ranitidine. In conclusion, all results reported as benefits of the participants in the study whereas the participant's perception and awareness increased when a brief notification regarding the reason of ranitidine toxicity was provided.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Schizophrenia is treated with antipsychotic drugs and is a chronic neuropsychiatric disorders. The influence of antipsychotics on the cytokine systems may be responsible for their clinical efficacy in schizophrenia. Granulocytopenia and agranulocytosis are severe side effects of antipsychotic therapy. The objective of this study was to estimate incidence of drug-associated agranulocytosis in newly diagnosed schizophrenic patients in and to evaluate the risk factors and outcomes. Seven participants groups were designed. Healthy persons as control. Schizophrenic patients before treatment. Schizophrenic patients after one-month of treatment. Schizophrenic patients after two - month of treatment. Schizophrenic patients after three - month of treatment. Schizophrenic patients after chronic treatments. Schizophrenic patients one month after chronic treatment. This study included screening for the expression and function of circulating leukocyte granulocyte-macrophage colony-stimulating factor receptor, screening of patient's biochemistry and haematology picture. Granulocyte-macrophage colony-stimulating factor expression was decreased after antipsychotic treatment for one month and continued to decrease after two months' treatment. Granulocyte-macrophage colony-stimulating factor expression starts to increase after the two-month treatment and continues increasing to controls or newly diagnosed schizophrenics or after chronic treatment. Complete blood counts were not changed compared. Liver function showed a transient increase in serum alkaline phosphatase after one and two month of treatment. All other parameters were not changed. Kidney function showed that urea and creatinine levels were within the normal range during the different treatments. Concerning lipid profile, low density lipoproteins levels were increased after one month, two months of treatment and after chronic administration of the antipsychotic drugs. It is concluded that antipsychotic treatment produces a decrease in granulocyte-macrophage colony-stimulating factor expression; the decrease reach the maximum effect after two months, then starts to increase back to normal levels. A transient increase in serum alkaline phosphatase in the first two months' treatment. Urea and creatinine levels and lipid profile were within normal range, except low density lipoproteins levels were increased during the two months treatment and after chronic administration of the antipsychotic drugs.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Prescribing drugs for elderly patients is not an easy task since elderly patients are frequently with comorbid conditions. In Libya, there are no guidelines for the management of medications used in elderly patients and no specialized geriatric health institutions. The aim of this study is to assess the pattern of medication use among hospitalized elderly patients in Sebha Medical Centre and the drug-related problems associated with these patterns. This report is descriptive and retrospective cross-sectional study that is conducted at Sebha Medical Center during 2021. Potential drug-related problems were assessed based on the classification of Hepler and Strand. In this study, out of 195 participants, most of the patients have been given antibiotics (92%). The majority of patients have been prescribed anti-gastric agents, vitamins and anti-thrombotic agents which accounted for 75%, 62% and 55%, respectively. To less extent, anti-hypertensive agents, analgesics and anti-hyperlipidemics were reported by 45%, 43% and 38%, correspondently. Almost all the patients have at least one event of drug-related problem and more than three-quarters of the patients had more than one event of drug-related problems. The highest rate was untreated indications which were reported for 77% then followed by drug use without indication nearly a half of the events 48%. To fewer extent rates were reported: “in improper drug selection”, “drug interaction” and “adverse effects” which were reported for 25%, 23% and 18% of the total events, respectively. Almost all elderly patients have been prescribed antibiotics, analgesics and vitamins. Drug-related problems are predominant prevalent in the clinical practice at the center. This study highlights the importance of activation of clinical pharmacist interventions at hospitals which can contribute to reducing the chance of risk of drug-related problems events among hospitalized elderly patients and ensuring rational drug prescribing in the geriatric clinical settings.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Prevalence of hypovitaminosis D is not restricted to the elderly and hospitalized population. Worldwide, the rate of prevalence of vitamin D deficiency has grown up rapidly in adults over the past decades. Among Libyan population including young students may has a high risk of vitamin D deficiency. The aims of this study were to examine vitamin D status among pharmacy students of Sebha University and to study the hematological profile as well as correlation of vitamin D deficiency with incidence of anemia among the students. This study was carried out on Pharmacy students from 13th January to 12th March, 2020. This is a cross-sectional study designed to determine vitamin D status among healthy young pharmacy students studying at the Sebha University. The blood samples were collected randomly from 62 pharmacy students to analysis complete blood count and 25-hydroxyvitamin D. The concentration of hemoglobin on total student was 12.5 ± 1.9 g/dl which was normal according to the WHO level (12.0 g/dl). Out of total, 36 students (59.1%) were found to have normal hemoglobin concentration (13.7 ± 1.4 g/dl) and 26 students (40.9 %) were found to have low hemoglobin concentration (10.8 ± 1.1 g/dl). Other blood profile as HCT, MCV, MHC and MCHC where statistically significant lower but the counts of RBCs, WBC and platelets were not on anemic group comparing to normal group. The present study reported that majority of pharmacy students in male and female blood donors have low vitamin D levels which represent (87.0%). Out of the total participants (n = 54) who have low vitamin D (n = 49, 79.0%) were classified under vitamin D deficiency category while (n = 05, 08.0%) of students had vitamin D insufficiency. In conclusion, prevalence of hypovitaminosis D (low 25-hydroxyvitamin D) among the pharmacy students at Sebha University was highly occurrence with concomitant a high rate of prevalence of anemia. Thus, vitamin D deficiency at this age represents a public health problem that should be addressed.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The application of clinical pharmacokinetic is the responsibility of all pharmacists providing pharmaceutical care. An appropriately applied clinical pharmacokinetic is expected to result in improved patient outcomes: decreased mortality, reduced length of treatment, reduced length of hospital stays and cost-savings. Data on the extend of pharmacokinetic application in Libyan hospitals remain scarce but available subjective evidence suggests that services related to clinical pharmacokinetic are mostly provided and performed by professionals other than clinical pharmacists. To explore the training background and perceptions of pharmacists on the pharmacokinetic course contents they received during their undergraduate pharmacy programs. Also, to determine the attitudes and barriers experienced by the pharmacists when applying pharmacokinetic principles in their current practice. This is a cross-sectional, descriptive study that was conducted between July 2018 and November 2019 using a self-administered survey. The study targeted hospital pharmacists practicing in different hospitals in Libya. A total of 104 pharmacists completed the questionnaire and submitted it back. The majority of participants learned pharmacokinetic courses as a mandatory course during undergraduate courses 81.0% with 37.0% selecting that course was taught as a separate course or courses. Around 80.0% of the participants agreed or strongly agreed that pharmacokinetic courses received in undergraduate studies are useful in pharmacy practice with over 75.0% of the participants agreeing or strongly agreeing on relevance of those course to their current clinical practice. About 40.0% of the participants described their current skills in allowing optimal patient care as can be better. Different barriers were highlighted by the participants to allow sufficient clinical pharmacokinetic practice including lack of sufficient information, lack of awareness of pharmacists’ role and skills in applying clinical pharmacokinetic by other pharmacists and by other health care providers. Thus, this study shows that most practicing pharmacists showed a positive attitude of current pharmacokinetic practice and to the impact of their undergraduate studies on their successful practice. However, they have clearly addressed the room for improvement.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

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

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

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

HIV/AIDS cases in Indonesia continue to increase and have spread to all provinces in Indonesia. Bandung is one of the cities with a high number of people living with HIV/AIDS in Indonesia. As one of the areas with the highest number of reported HIV cases, the Bandung city government seeks prevention and treatment through the role of existing stakeholders. However, stigma and discrimination against people living with HIV & AIDS, now referred to as PLHIV, are still found and are difficult to eliminate. People diagnosed as contaminated with the HIV & AIDS virus often get a negative stigma. This study aims to analyze how to remove the stigma and discrimination of people with HIV/AIDS through the role of civil society. The research results show that stigma against HIV is often directed at certain minority groups and is often associated with morals and religion. Meanwhile, discrimination against people with HIV is manifested in violations of individual rights in the economic, social, and cultural spheres. The issue of stigma and discrimination against PLWHA has not received serious attention. Therefore, the role of civil society is very important because it can open a dialogue with the community regarding HIV/AIDS to dispel myths that tend to discriminate against PLHIV.

Syahrul Tuba

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

Adherence to pharmacological therapies are keys to effective treatments in diabetic patients. Previous reviews found that most adherence measurement studies on chronic diseases used a self-reported scale. However, there is no consensus on the best scale to measure adherence in diabetic patients. The purpose of this systematic review was to identify the potential self-reported scale that could be considered for measuring medication adherence in diabetic patients and to provide recommendations for researchers or clinicians to determine appropriate adherence self-reported scales in diabetic patients. This review follows general guidelines in the implementation of systematic reviews. After further review, it was found that 33 studies met all inclusion criteria from 4 databases (Wiley, Science Direct, Scopus, and PubMed). The articles were done by the PRISMA, while the keywords were determined by the PICO method. Most research was conducted in Asia (69.7%) and America (18.2%) on patients with type 2 diabetes (81.3%), patients in hospitals (54.5%), suffering for 1–6 months (54.5%), and using a cross-sectional study design (78.8%). HbA1c clinic data (57.6%) were used in most studies as biological markers of adherence. The measurement scales of medication adherence in diabetic patients are MMAS-8 (57,.5%), MMAS-4 (12.1%), BMQ (9%), MCQ (6%), ARMS (3%), ARMS-D (3%), GMAS (3%), LMAS-14 (3%), and MARS-5 (3%). This review provides information on the different self-reported scales most widely used in diabetic medication adherence research. Various aspects need to be considered before choosing the scale of adherence.

Much Ilham Novalisa Aji Wibowo