Reflections of pharmacy students on experiential education in providing health services to people with history of substance use disorders in Malaysia

Introduction: Accreditation standards for pharmacy students’ education include the requirement for experiential education (EE) and acknowledge, in building life-long learning skills, the need to develop students’ skills in analysing their practice-based performance. The goal of this qualitative study was to assess students’ ability to reflect on their experience providing face-to-face care to patients with a history of substance use disorders (PHSUDs). Materials and methods: Interviews were conducted with undergraduate pharmacy students who provided care to PHSUDs in an EE programme. An interview guide was used to explore students’ experiences and their perceptions regarding the challenges they encountered, changes in their attitude towards PHSUDs and ways to improve their ability to care for PHSUDs. Data relevant to the study was extracted from interview transcripts, manually sorted and coded using Microsoft Excel and subjected to thematic analysis. Results: The themes identified were 1) Increased self-confidence in face-to-face interactions with PHSUDs 2) Increased empathy towards PHSUDS 3) Reduction in stigmatised attitudes towards PHSUDs 4) Positive nature of the interactions with PHSUDs 5) Appreciation for the opportunity to apply knowledge in practice 6) Recognition of the need for improved communication skill training 7) Recognition of the need to improve training for dealing with unexpected questions and situations. Conclusion: Pharmacy students demonstrated reflective skills in identifying multiple positive learning outcomes stemming from a one-day EE programme involving PHSUDs. In addition, they provided insights useful to faculty in curriculum planning.

review of black seed extract as an agent in the wound healing process

Introduction: Nigella Sativa or Black Cumin is an annual flowering plant that can be used for wound treatment. In the treatment for wound healing, this plant contains many beneficial components that can help with the treatment but this plant utilisation in the medical field is still limited. This review will provide an overview of the advantages when this plant is used in the wound healing treatment. Method: The review was based on the ROSES protocol, and the databases used were ScienceDirect, PubMed, and Google Scholar. After the search, only 11 papers had been chosen to be included in the results and they were divided into four main themes that were used for the analysis of the results. Results: The themes were gross analysis, microscopic analysis, biochemical analysis and antimicrobial analysis. Conclusion: In conclusion, the black seed extract contains several valuable properties, such as antimicrobial and antioxidant properties, which help improve the wound healing process. Further study needs to be done to discover more potential of Nigella Sativa in treating the wound.

Assessment of medication adherence and quality of life among patients with type 2 diabetes mellitus in a tertiary hospital in Kelantan, Malaysia

Introduction: Previous studies have reported the relationship between medication adherence and quality of life are interrelated. However, many of the results were found to be conflicting. This study aimed to assess the level and association of medication adherence and quality of life among type 2 diabetes mellitus patients in Raja Perempuan Zainab II Hospital, Kelantan, Malaysia. Materials and methods: A cross-sectional survey was conducted among adult type 2 diabetes mellitus patients on treatment for over 1 year using convenience sampling at outpatient. Medication Compliance Questionnaire (MCQ) and revised Diabetes Quality of Life Questionnaire (DQOL) instrument were self-administered to eligible subjects. Data were analysed using GNU PSPP version 0.8.5 and reported for descriptive statistics as well as correlation of both parameters. Results: A total of 200 patients were recruited and they were mostly at the age of 40 to 60 years old. The mean (SD) score for MCQ was 26.0 (1.6) with the majority of them were non-adherent (55.0%, n=110). The mean (SD) score for overall revised DQOL instrument was 25.5 (8.9) while each domain of “satisfaction”, “impact” and “worry” had mean (SD) scores of 12.0 (5.0), 7.7 (3.4) and 5.9 (2.7), respectively. The scores obtained were only approximately half of the possible range of scores for QoL. There was no significant correlation between total score of medication adherence and quality of life when tested using Pearson’s correlation (r=-0.083, p=0.240). Independent t-test also demonstrated no significant relationship between medication adherence status and quality of life (p=0.883). Conclusion: Type 2 diabetes mellitus patients in our setting had unsatisfactory adherence but exhibited acceptable quality of life. We observed that both variables were not associated with one another. Further research is warranted to identify potential factors affecting non-adherence to medication.

Perception towards Insulin Therapy and Factors Related to Insulin Refusal among Insulin Naive Type 2 Diabetes Mellitus Patients in Primary Care Clinics PKD Lipis

Introduction: Insulin is one of the suggested treatments to prevent and reduce long-term diabetes complications. However, due to many factors such as socio-demographic factors, many Type 2 diabetes mellitus patients refuse this treatment. This study aimed to determine perception towards insulin among naive Type 2 diabetes mellitus patients, to calculate the prevalence of rejecting insulin therapy, and to find out factors related to the refusal. Materials and methods: This cross-sectional study involved 188 insulin naive Type 2 diabetes mellitus patients attending five primary health clinics in Lipis district, Pahang from October to November 2017. A five-point Likert Scale was used to determine perception towards insulin therapy and the Chi-square test was used to assess the proportion of acceptance of the therapy. Simple and multiple logistic regressions were utilised to study the associated factor(s). Results: Mean score of 60.5 ± 8.2 pointed towards a negative appraisal of insulin therapy. Embarrassment to inject in public (69.1%) and concern of frequent hypoglycaemia (52.7%) were the most common perception. Nearly half of the respondents (46.3%) refused insulin therapy upon suggestion. After adjusting the variables using multiple logistic regressions, only gender (Adjusted OR=0.20, 95% CI=0.10-0.40, p<0.001), educational level (Adjusted OR=0.17, 95% CI=0.06-0.50, p=0.001), age (Adjusted OR=1.04, 95% CI=1.01-1.08, p=0.012) and glycated haemoglobin level (Adjusted OR=1.33, 95% CI=1.07-1.67, p=0.013) remained significant. Conclusion: In conclusion, insulin refusal among insulin naive patients was common in Lipis with an overall negative perception towards therapy. By tailoring strategies according to the patient’s factors such as gender, educational level, age, and glycated haemoglobin level, the insulin refusal rate might decrease in the future.

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS): knowledge, perception, and attitude among pharmacists in Kelantan, Malaysia.

Introduction: Although pharmacists’ role in the care of human immunodeficiency virus (HIV)-infected and acquired immunodeficiency syndrome (AIDS) patients is well established, studies had reported pharmacists’ negative attitudes towards people living with HIV/AIDS (PLWHA), with negative impact on HIV management. This study aimed to explore pharmacists’ knowledge of HIV/AIDS, perception towards the changing of treatment regimens of HIV/AIDS, attitudes towards PLWHA, and to identify factors affecting the pharmacists’ attitudes towards PLWHA in the state of Kelantan, which reportedly have the third highest number of HIV/AIDS patients in Malaysia. Materials and method: A validated online 43-item questionnaire was distributed to 400 pharmacists in Kelantan. Multivariate logistic regression was performed to identify factors associated with pharmacists’ negative attitude towards PLWHA. Results: A total of 170 respondents (response rate 42%) completed the questionnaire. Respondents had knowledge on the potential causes of HIV infection [median(IQR) score=13.00(1); maximum score=14.00], and preventive measures of HIV/AIDS transmission [median(IQR) score=12.00(1); maximum score=12.00]. On decision in changing regimens, the respondents agreed on the need to change treatment regimen for HIV/AIDS when required [median(IQR) score=7.00(2); maximum score=8.00]. Up to 40.6% of respondents thought that the treatment regimen should not be switched based on cost. Two-thirds of the respondents had negative attitudes towards PLWHA (67.1%). Respondents who worked in community pharmacy reported positive attitudes towards PLWHA (Adj OR=0.125; 95%CI=0.025-0.623; p=0.011). Conclusion: Pharmacists in Kelantan had several misconceptions towards the causes of HIV/AIDS, preventive measures of HIV/AIDS transmission, and necessity in changing treatment regimen when required. Despite good disease related knowledge, most pharmacists had negative attitudes towards PLWHA, while pharmacists working in community settings presented more positive attitudes towards PLWHA.

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications (PIMs) of Elderly Outpatients in a State Hospital in Malaysia.

Introduction: Malaysia will be a full aging nation by 2030. The elderly (aged >65 years old) population often has multiple comorbidities, which increases the risk of polypharmacy and potentially inappropriate medications (PIMs). This study aims to investigate the prevalence, factors associated with PIMs among elderly outpatients, and its burden of direct pharmacotherapy cost to the Ministry of Health Malaysia. Materials and method: A cross-sectional study involving clinic prescriptions among the elderly with more than one-month prescribing duration received from a tertiary hospital specialist clinic pharmacy from March to April 2017. Patient identifiers were screened using the Pharmacy Information System (PhIS) by including prescriptions from other clinics while excluding multiple visits and duplicate prescriptions. Patients were categorised as PIM group and non-PIM groups using Beers Criteria 2015. Logistic regression analysis was conducted to examine the factors associated with PIMs. The median monthly prescription cost was compared between PIM and non-PIM groups by Mann-Whitney test. Results: Among 472 patients, 39.4% of patients had at least one PIM while 60.6% of patients did not receive any PIM. The number of medications prescribed was an independent risk factor contributing to PIMs (OR:2.04; 95% CI:1.40, 2.97). The median monthly prescription cost for the PIM group was MYR 29.50 (?USD 7.53) which was not statistically significant (p=0.735) compared with the non-PIM group which was MYR 28.50 (USD 7.28). Conclusion: PIM was frequently prescribed in our setting with the number of medications as the only factor. However, the prescribing of PIM did not add nor reduce the direct cost of pharmacotherapy.

Antimicrobial Study of Chloroform Fraction from the Leaves of Entada spiralis Ridl.

Introduction: Entada Spiralis Ridl., or locally identified as Sintok, contains flavonoid, saponin, tannin, and glycoside, compounds that have antifungal and antibacterial activities. This research aims to identify bioactive compounds and determine the antimicrobial activity from crude and fraction of E. spiralis extract. Methods: The crude extract was prepared by macerating the leaves with chloroform, and then proceeded to fraction it by vacuum liquid chromatography with Dichloromethane (DCM)/Hexane (Hex) (1/9) and Dichloromethane (DCM)/Methanol (MeOH) (9/1) solvent system. Disk Diffusion Test and Microdilution Assay evaluated the extracts' antimicrobial activity against S. aureus, E. coli and C. albicans. The determination of bioactive compounds was done by Thin Layer Chromatography (TLC). Determination of Total Phenolic (TPC) and Flavonoid Content (TFC) were performed by Folin-Ciocalteu and AlCl3 Colourimetric Assay Results: The greatest inhibition zone against C. albicans was obtained from fraction Chloroform (CHCl3) extract with an inhibition zone of 10.33 mm. DCM/MeOH (9/1) effectively killed S. aureus and E.coli with an inhibition zone of 11.67 and 12 mm, respectively. The minimum inhibitory concentration (MIC) of CHCl3 crude extract were 1.563 mg/mL for both E. coli and S. aureus, and 0.781 mg/mL for C. albicans. The TLC revealed the presence of tannins, saponin, glycosides, phenol, flavonoid, triterpenoid, and aromatic compound in CHCl3 crude extract. TPC of DCM/MeOH (9/1), CHCl3, and DCM/Hex (1/9) were 50.56 ± 0.188, 51.913± 0.089, 24.16 ± 0.175 mg GAE/g extract. Conclusion: In conclusion, E. spiralis leaves could be a source of active antifungal and antimicrobial agents used for food preservation by using a semipolar solvent for extraction.

Review on Conventional and Novel Topical Ocular Drug Delivery System

Ocular drug delivery is a very challenging area for ophthalmologists and drug delivery scientists due to the structural and barrier complexity of the eye. Barriers such as different layers of cornea, sclera, conjunctival blood flow, and tear dilution limit the efficacy of drug delivery to the anterior part of the eye in addition to more barriers present to the posterior part. Due to these, scientists have designed and studied various delivery systems to increase drug delivery and treatment efficacy to the eye. Among conventional ocular drug delivery systems, ophthalmic solution or eye drop is widely used and preferred by consumers. Conventional dosage forms available in the market are emulsion, suspension, ointment and polymeric gels. Several ocular formulations such as nano-formulations, liposomes, ocular inserts, and ocular mini-tablets are also being widely studied as future treatments to improve ocular drug delivery and as an alternative to conventional drug delivery. This review intends to summarise several conventional and novel topical formulations for ocular drug delivery.

Stability of extemporaneous rifampicin prepared with X-temp® oral suspension system

Introduction: Rifampicin is a first line antituberculosis drug that is commonly used in the treatment of tuberculosis, both in adults and paediatric patients. However, there is a lack of liquid formulation for rifampicin in the market due to the small market size and the physicochemical properties of the drug itself. An innovative new mix called X-Temp® oral suspension system (OSS) has been available in the market as a choice of vehicle for extemporaneous suspension. Aim: The aim of this study was to prepare rifampicin suspension in the X-Temp® OSS and evaluate its stability following storage at two temperatures – refrigerated (5 °C ± 3 °C) and in a stability chamber (30 °C ± 2 °C/RH 75% ± 5%). Materials and method: This study investigates the physicochemical and microbiological stability of rifampicin formulated in X-temp® OSS. The rifampicin suspension was prepared at 25mg/ml and kept in two types of amber-coloured storage bottles. The bottles were stored in an open and close storage system at 5 oC (refrigeration) and 30 °C/75% RH (non-refrigerated) and the stability of the product was evaluated at specified time intervals. Results: It was found that the content of rifampicin remained above 90% of the original concentration throughout the study as required by the standard references. Visual appearance, colour, odour and pH remained unchanged throughout the study period and the extemporaneous preparation was not susceptible to microbial contamination. Conclusion: Results from this stability study confirmed that the X-temp® OSS is a suitable vehicle for the preparation of extemporaneous rifampicin liquid formulation.

Potential Nanospray Inhalation of Remdesivir and Hydroxychloroquine using Poly (lactic-co-glycolic) Acid as Fast Delivery for Covid-19 Treatment.

Introduction: The oral medication of remdesivir and hydroxychloroquine face several limitations in covid-19 therapy. Despite having the first-pass metabolism, it also has a limitation in the patient who has hospitalised with a severe covid-19 infection. It is especially for a drug that is targeting the angiotensin-converting enzyme II (ACE2) receptor where the receptors are found abundantly in the lung, kidney, heart, and gastrointestinal tract. Therefore, an alternative delivery such as nanospray inhalation would provide a great benefit to those patients. Methods: Scientific sources from Scopus, PubMed, Google Scholar, EBSCO, ScienceDirect, and Elsevier were accessed for publication of this review article regarding the nanospray inhalation for Covid-19. Results: Since the main organ infected by SARS-CoV-2 is the esophagus and lung, inhalation may be the best route to deliver the drug to the site of action. It is proposed that poly (lactic-co-glycolic) acid to be used in the formulation. Conclusion: Poly (lactic-co-glycolic) acid (PLGA) is considered a suitable polymer since it is biocompatible and noncytotoxic, it is the most widely applied in drug delivery either as carrier or excipient for the optimal formulation and distribution of the drugs. Dry powder inhalation of remdesivir and hydroxychloroquine may be an alternative way to deliver the drug against Covid-19.