Clinical Pharmacology Papers & Publications

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

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

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

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

Diabetic foot ulcers are moderately severe complications in patients with type 2 Diabetes Mellitus, with peripheral neuropathy and angiopathy often serving as risk factors. This study aimed to examine the clinical characteristics and risk factors linked to diabetic foot ulcers in type 2 diabetes mellitus individuals within the Pakistani demographic. A retrospective cross-sectional design was used, to analyze the medical files of 68 diabetic foot ulcer patients. Data were collected from the Departments of Medicine and Surgery at Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore Pakistan from Sept. to Dec. 2024. Patients’ clinical profiles, including demographic data, diabetes duration, diabetes control, HbA1c levels, and the presence of comorbidities were all evaluated. Out of the 68 patients, 70.6% were male having a mean age of 55.6±11.7 years, and 55.9% had diabetes for seven years or more. With regard to clinical factors, 61.8% had peripheral neuropathy, 58.8% had hypertension, 47.1% had retinopathy, 26.5% had nephropathy, 20.6% had ischemic stroke, 8.8% had ischemic heart disease, and 2.9% had hypothyroidism, with 97.1% showing poor glycemic control. This study identified a high rate of comorbidities in patients with diabetic foot ulcers, with inadequate diabetes control being a major contributing factor. Timely detection and management of diabetes and its complications are crucial to alleviating the impact of diabetic foot ulcers.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Stroke and its associated disabilities are a growing public health challenge in many developing countries where a combination of poor awareness and poor medical care is driving up mortality rates. The rising cases are attributed to the rising prevalence of uncontrolled hypertension, obesity, smoking, alcohol abuse, and diabetes mellitus within the population. The prevention of stroke through awareness, knowledge, and lifestyle modification is a common approach used in public health intervention programs. Awareness and knowledge of stroke vary widely between communities partly because of access to relevant health information. This study assessed awareness, knowledge of stroke risk factors, and attitude toward stroke prevention. This study was a community-based survey among adults ≥40 years old in semi-urban communities of two local government area councils of Benue State, North Central Nigeria. The sixteen-item questionnaire used in this study is subdivided into socio-demographic information, knowledge of risk factors, symptoms of stroke, current morbidity, and attitude toward stroke prevention. The survey was done using two adults per household selected using simple random method and completed questionnaires were retrieved for analysis. The Chi-square test was used to determine the association between demographic variables and knowledge of stroke. The result showed poor levels of stroke awareness (47.3%), knowledge (44.6%), symptoms (44.6%), risk factors (20.6%), and symptoms (44.6%). Awareness of stroke and its risk factors is significantly association with age, gender, marital status, educational status, occupation, and income. Many respondents had poor knowledge of stroke and its risk factors. There is a need for improvement in stroke awareness in underserved communities, particularly those with limited access to mass media.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Hypertension is a high-risk factor for cardiovascular diseases and its prevalence rate is increasing due to risk factors such as unhealthy lifestyles and aging populations. Managing hypertension is crucial to avoid complications such as stroke, heart failure, and kidney failure. In Northern Cyprus, where hypertension is a growing public health concern, pharmacists are increasingly recognized as key players in managing this ongoing condition. This study investigates the impact of pharmacists in controlling hypertension in Northern Cyprus through a survey-based observational approach. Data were collected from 70 hypertension patients engaging with community pharmacists. The results highlight pharmacists’ contributions to patient education, blood pressure monitoring, and medication adherence. Relevant studies in other countries contextualize the findings about the importance of the pharmacist role. An analysis of the data confirms significant improvements in patient outcomes with pharmacist interventions. The survey results provide insights suggesting that overcoming systemic barriers and strengthening collaboration can optimize pharmacists' roles in managing hypertension in Northern Cyprus.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences