A Pharmacoeconomics Study for Anticoagulants used for Hospitalized COVID-19 Patients in Al-Najaf Al-Ashraf city –Iraq(Conference Paper )#

Background: The novel coronavirus 2 (SARS?CoV?2) pandemic is a pulmonary disease, which leads to cardiac, hematologic, and renal complications. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis. The world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions. Objective: compare the clinical outcome and the costs of two anticoagulants (heparin and (enoxaparin)) used to treat hospitalized patients with COVID-19 infection. Patients and method: The study was a retrospective review of medical records of adult, non-pregnant, COVID-19 infected hospitalized patients who had baseline and last outcome measurements at Alamal Epidemiology Center, Al-Najaf city from (Augast 2020 to June 2021). The outcome measures included D-dimer, length of stay (LOS), and mortality rate. Only the cost of the medical treatment was considered in the analysis. The pharmacoeconomics analysis was done in three different cost-effectiveness analysis methods. Microsoft Excel spreadsheet and Statistical Package for the Social Sciences software (SPSS), was used to conduct statistical analysis. Kaplan Meier test was used to compare the mortality rate. T-TEST was used to compare the outcomes of the two groups. Results and discussion: two groups were compared, the first group consists of 72 patients who received heparin, and the second group consists of 72 patients who received enoxaparin. COVID-19 infected patients had a higher abnormal average D-dimer (2534.675 ng/dl). No significant differences between both genders with regards to the basal average D-dimer (males= 2649.95 ng/dl, females= 2374.1mg/dl, P-value>0.05). There was a significant difference between patient's ages 60 years and patients <60. (3177.33 ng/dl, 1763.06 ng/dl, P-value <0.05). It seems that, higher D-dimer levels were associated with a higher mortality rate (died=3166.263 ng/dl, survived= 1729.94 ng/dl, P-value <0.05). Heparin was more effective in decreasing D-dimer levels than enoxaparin which inversely increased the D-dimer levels (-24.4 ng/dl/day, +154.701 ng/dl/day, P-value <0.05). Additionally, heparin was more effective in increasing the survival rate compared to enoxaparin (55% vs, 35%, P-value<0.05). Heparin was associated with a longer duration of stay in hospital than enoxaparin but with no significant difference (13.7 days, 12.3 days, P-value >0.05). Concerning the cost, treatment with heparin cost less than enoxaparin (2.08 U.S $, 9.44 U.S $)/per patient/per day. Conclusion: Originator heparin was a more cost-effective anticoagulant therapy compared to originator enoxaparin, it was associated with a lower cost and better effect, treatment with Heparin resulted in positive INB= 11.3, where a positive result means that heparin is more cost-effective than Enoxaparin. All three methods of pharmacoeconomic analysis decide that heparin was more cost-effective than enoxaparin in treating COVID-19 infected patients.

Adherence and Beliefs to Adjuvant Hormonal Therapy in Patients with Breast Cancer: A Cross-Sectional Study (Conference Paper) #

Breast cancer is the most common cancer among women over the world. To reducing reoccurrence and mortality rates, adjuvant hormonal therapy (AHT) is used for a long period. The major barrier to the effectiveness of the treatment is adherence. Adherence to medicines among patients is challenging. Patient beliefs in medications can be positively or negatively correlated to adherence. Objectives: To investigate the extent of adherence and factors affecting adherence, as well as to investigate the association between beliefs and adherence in women with breast cancer taking AHT. Method: A cross-sectional study included 124 Iraqi women with breast cancer recruited from Middle Euphrates Cancer Center. Morisky medication adherence scale (MMAS) and beliefs about medication questionnaires (BMQ) are used to assess adherence and beliefs respectively. Result: 25% of women were fully adherent (MMAS = 8). 83.06% of all women developed side effects from medications received. Side effects and unemployed women were significantly associated with non-adherence. Additionally, there is no significant association between beliefs in medications and adherence. conclusion The enormous percent of poor adherence caused by side effects suggests the need for interventions by educating patients about the importance of their treatment and how to overcome side effects.

Evaluation of Community Pharmacists Knowledge, Attitude and Practice towards Modified Release Dosage Forms

Purpose:To evaluate knowledge, practice and attitude of community pharmacists in Basra regarding modified release dosage forms which are widely used for many therapeutic purposes in pharmacy practice. Methods:The current study was conducted among certified pharmacists in Basra governorate- south of Iraq. Data collection was carried out by a questionnaire. Results:A total number of 175 community pharmacists responded to the questionnaire. The majority worked in OTC based dispensing pharmacies located in the center of the city. Most respondents missed K1 and were unable to state the difference between different types of modified products. There was a major positive agreement towards medical representatives' rule in promoting the prescribing of modified release products by physicians. Avoiding crushing and breaking of solid oral modified release drugs were identified by the majority of participants. Correlation analysis showed a 22.8 correlation coefficient between knowledge and attitude which was statistically significant. Males showed statistically significant higher knowledge and practice scores than females. Conclusions:The conduction of a brief educational program would be very beneficial in bringing basic theoretical knowledge with practicing points of interest and promote a more positive attitude toward this unique class of novel drug delivery system.

Evaluating the Impact of Pharmacist Counselling for Asthmatic Children at Karbala Teaching Hospital for Children: An Interventional Prospective Study (Conference Paper )#

Asthma is one of the most common chronic, non-communicable diseases affecting children worldwide. The estimated prevalence of pediatric asthma in Iraq is 15.8%. Physiologic, inflammatory and structural factors contribute to the development of asthma. Assessment and monitoring of asthma control can be done by a validated children asthma control test (CACT). Management of asthma must address three components which are an appropriate management plan, the most appropriate medication if necessary, and the use of safe and effective medication. The management plan should consider patient counseling and education about the definition of asthma, signs, and symptoms, the pathophysiology of asthma, common triggers for asthma and how can avoid them, what are the rescue medication and the controller one, proper inhaler techniques, and how to monitor asthma control. Patient education accounts for 90% of success and this can be achieved by an active collaboration among health care providers. This is a prospective interventional study that aims at evaluating pharmacist counseling for asthmatic children. The study involved 105 participants whose consent was taken and underwent a face-to-face interview about asthma counseling and inhaler technique for those who use it. Ninety-two eligible participants remained. Their CACT was recorded at the first visit and then followed up weekly for one month either by phone or physical to assess asthma control. In the fourth week, a CACT was recorded and compared to the first one before intervention. There was a significant improvement in CACT after providing the counselling and weekly follow up.

Permeability Enhancement of Methotrexate Transdermal Gel using Eucalyptus oil, Peppermint Oil and Olive Oil(Conference Paper )#

Objective: the idea of this study to improve transdermal permeability of Methotrexate using eucalyptus oil, olive oil and peppermint oil as enhancers.Method: eucalyptus oil (2% and 4%), peppermint oil (2% and 4%) and olive oil (2% and 4%) all used as natural enhancers to develop transdermal permeability of Methotrexate via gel formulation. The gel was subjected to many physiochemical properties tests. In-vitro release and permeability studies for the drug were done by Franz cell diffusion across synthetic membrane, kinetic model was studied via korsmeyer- peppas equation.Result: the results demonstrate that safe, nonirritant or cause necrosis to rats' skin and stable till 60 days gel was successfully formulated.Methotrexate penetration alone without enhancer is only about 20%, while using enhancers reach to 85%, 99% and 90% with eucalyptus oil 4%, peppermint oil 4% and olive oil 4% respectively after 24 hours.Conclusion: Methotrexate transdermal gel was prepared and evaluated fruitfully in-vitro with a good permeation across semipermeable membrane. The results indicated that using of peppermint oil as enhancer have superiority to enhance the transdermal permeation of the Methotrexate.

Rheological Investigation of Lipid Polymer Hybrid Nanocarriers for Oral Delivery of Felodipine (Conference Paper )#

The rheological behavior among factors that are present in Stokes law can be used to control the stability of the colloidal dispersion system. The felodipine lipid polymer hybrid nanocarriers (LPHNs) is an interesting colloidal dispersion system that is used for rheological characteristic analysis. The LPHNs compose of polymeric components and lipids. This research aims to prepare oral felodipine LPHNs to investigate the effect of independent variables on the rheological behavior of the nanosystem. The microwave-based technique was used to prepare felodipine LPHNs (H1-H9) successfully. All the formulations enter the characterization process for particle size and PDI to ascertain the colloidal properties of the prepared nanosystem then use coaxial rotational digital rheometer for rheological evaluation. The outcomes show that all felodipine LPHNs formulations (H1-H9) had a nanosize and homogenous structure that ascertain colloidal features of the nanodispersion system. The rheogram chart indicates that all of the felodipine LPHNs formulations (H1-H9) show pseudoplastic flow (non-Newtonian flow) that have shear-thinning property. The microwave-based method prepares felodipine LPHNs formulations (H1-H9) that show excellent physical texture that ascertains its ability as a technique for the preparation of nanoparticles. All of the felodipine LPHNs formulations (H1-H9) show pseudoplastic flow that supports the physical stability of the nanosystem.

The Effect of Anabasis articulata Stems Extract on Lowering Intraocular Pressure in the Glaucoma Rat Model(Conference Paper )#

High intraocular pressure (IOP) is a recognized risk factor for glaucoma and optic nerve injury, and it is one of the primary causes of vision loss globally. Anabasis articulata (AA) is a desert plant found in Iraq. The extract of AA is used to cure diabetes, fever, eczema, and kidney infections. The aim of the study is to evaluate the antioxidant effect of methanol extract of AA on intraocular pressure in the glaucoma rat model. Forty-two rats were allocated into seven groups, each with six animals:: group 1 (normal), group 2 (control), in which animals were induced to have elevated IOP by betamethasone suspension injection, groups 3,4 and 5 for evaluating the effect of 50,100 and 150 mg/kg/day of the tested extract, respectively, and the remaining two groups (group 6 and 7) for evaluating oral acetazolamide and topical timolol 0.5% respectively. Betamethasone was used for the induction. Measure the IOP every 2 days for 2 weeks. The daily dose of AA extract (50 mg/kg/day) for 6 days significantly reduces intraocular pressure (p ? 0.05), from (34.23± 0.58) to (32.83± 1.38) mmHg when compared with the control group. In group 4, IOP decreased significantly from (35.5±1.37) to (31.35±0.40) mmHg (p ? 0.05) after 1 week of treatment. In group 5, the significant (p? 0.001) IOP reduction from (35.66±0.39) to (31.88±0.74) mmHg started on day 6 and continued until the end of the experiment, reaching (24.53±0.53) mmHg (p? 0.001). The antioxidant and anti-angiogenic properties of AA make it a promising adjuvant treatment for glaucoma.

Students Experience of Hybrid- Education Model at The University of Baghdad College of Pharmacy

The impact of COVID-19 pandemic on education models was mainly through the expansion of technology use in the different educational programs. Earlier impact of COVID-19 was manifested in the complete and sudden transition to distance education regardless of institution preparedness status. Gradually, many institutions are moving back to on-campus face-to-face education. However, others including all higher education institutions in Iraq are adopting the hybrid education model. This report presents part of the end of semester evaluation survey conducted at the University of Baghdad College of Pharmacy for the Spring 2021 semester. The survey aims to address points of strength and weakness associated with the hybrid education model and specifically the virtual content delivery aspect of hybrid education. The outcomes of the end of semester evaluation will shape a better experience for upcoming years and guide distance education implantation in the program.

Antioxidant Activity of Total phenols and Flavonoids extracted from Echinops polyceras roots grown in Syria

Free radicals are reactive compounds, their excessive production is considered to be an important cause of oxidative damage in biomolecules causing degenerative diseases. Polyphenols are one of the most important groups of secondary metabolites of plants, which have an antioxidant activity depending on their properties as hydrogen donors. Echinops polyceras Boiss. (Asteraceae) is one of Echinops genus species that spread in Syria, Lebanon, and Palestine. Phytochemicals found in this species leaves have been extracted with gradient polarity solvents, and primary screening of the secondary metabolites was established. The phenolic compounds and flavonoids contents were determined. The free radicals scavenging activity was evaluated for all extracts with DPPH• in a 96-well microplate. The specificity study indicates that ascorbic acid was absent, and reducing sugars were exist in the aqueous extract. The identification tests showed the presence of polyphenols like flavonoids and coumarins. The methanolic extract of the E. polyceras leaves was the most effective scavengers of free radicals (90.22% in 30 min) with phenolic compounds content 682.5 mg GAE/g of dried extract (DE) and flavonoids content 194.5 mg QE/ g DE. The chloroform extract was the least effective as free radical scavenging (60% in 30 min) as the phenolic compounds content was 278.5 mg GAE/g DE and flavonoids content 94 mg QE/ g DE. In conclusion, the phenolic compounds and flavonoids from Echinops polyceras Boiss. are effective in free radicals scavenging and protecting from diseases caused by oxidative stress.

Gender Differences in Adverse Drug Reactions Among Adult Patients Reported to the Iraqi Pharmacovigilance Center

For many years it was argued that there may be a gender differences in adverse drug reactions (ADRs). This assumption was based on many possible factors such as hormonal or behavior differences, and it was not clearly identified since the female gender was not preferred to be enrolled in many clinical trials. The primary aim of this study was to assess the extent of possibly relevant gender differences in drug–ADRs regarding causality, severity, preventability, seriousness, expectedness and outcome. While the secondary aim was to assess for which group of drugs and for which ADRs gender differences are identified most often. The study was a retrospective one that depends on processing a specially selected group of data obtained from the Iraqi Pharmacovigilance Center database. The data included consisted of 3833 individual case safety reports sent during the period from 1st January 2017 to 31st December 2019. It was found that the reported adverse drug reactions for females (60.84 %) were much more than males (39.16 %). In addition, significant differences in age group distribution of adverse drug reactions were found in which females in their reproductive age had more adverse drug reactions while the older adult males were more likely to suffer adverse drug reactions if compared with the same age groups from the opposite gender. The highest type of adverse drug reactions for both genders were those that fall in the skin and subcutaneous tissue disorders (26.4 % in females) and (22.6 % in males) with statically significant difference between the two genders. While the highest group to cause adverse drug reactions was the systemic anti-infective agents with a greater chance ‘statistically significant’ in females to suffer a side effect from this group of medications (40.8 %) compared to male gender (35.5 %). The frequency of serious adverse drug reactions was significantly more prevalent in females (45.4 %) than for males (41.3 %) while the fatal outcome was significantly more observed in males (0.8 %) as compared with females (0.2 %). The expectedness analysis gave the finding that for each gender the expectedness of adverse drug reactions was nearly equal.