Preferred Dose Research Articles

Effective Mucosal Adjuvantation of the Intranasal Enterovirus A71 Vaccine With Zymosan.

Enterovirus A71 (EV-A71) has caused hand, foot, and mouth disease with an increased prevalence of neurological complications and acute mortality, threatening young children around the globe. By provoking mucosal immunity, intranasal vaccination has been suggested to prevent EV-A71 infection. However, antigens delivered via the nasal route usually fail to induce a protective memory response. Zymosan has been identified to activate multiple pattern recognition receptors to orchestrate innate and adaptive immunity. Herein, we aimed to investigate the capacity of zymosan to strengthen the vaccine response induced by an intranasal EV-A71 vaccine. First, we confirmed its remarkable capacity to ignite innate signaling by upregulating cytokine production in primary DCs invitro. Second, we verified its capacity to promote the vaccine immunogenicity invivo after triple vaccination with EV-A71, especially with the notable induction of virus-specific IgA at multiple mucosae and the IL-17-producing splenic population after antigen reencounter. Lastly, we validated its capacity to improve vaccine efficacy invivo after dual vaccination by furnishing neonatal protection against lethal infection. Our findings show that zymosan, at a preferable dosage, could augment the benefits of the intranasal vaccination to tackle EV-A71 infection. This research provides a feasible strategy for preventing EV-A71 infection with severe complications and contributes to the development of nasal spray vaccination.

Dysphagia Prevalence in Brazil, UK, China, and Indonesia and Dysphagic Patient Preferences.

Dysphagia is common, but there is limited information about its prevalence and patient preferences regarding dosage forms (oral solids, liquids, topical, etc.) in Brazil, China, the United Kingdom (UK), and Indonesia. We conducted an online survey of 1000 adults from each country, without any required disease, to estimate the prevalence of dysphagia in these four nations and the dosage form preferences among UK patients. A total of 36.9%, 40.5%, 54.9%, and 64.5% from the UK, Indonesia, Brazil, and China, respectively, had an Eating Assessment Tool (EAT-10) score of ≥3 (indicative of dysphagia). Only 2% of UK respondents and 5% of Brazilian respondents reported a formal diagnosis of dysphagia. Indonesian (74%) and Chinese respondents (77%) were more likely than Brazilian (52%) and UK respondents (45%) to report that their swallowing problems affected their ability to adhere to medication instructions. Liquids were the oral medication formulation most preferred by those who reported difficulty swallowing. To conclude, substantial populations have difficulty swallowing, which can translate into an access issue for medical treatment. The availability of people's preferred dosage forms may help alleviate the adherence issues associated with difficulty swallowing and the concomitant effects on health outcomes.

PRESCRIPTION PATTERN OF NUTRACEUTICALS IN PATIENTS VISITING A TERTIARY CARE HOSPITAL, KATHMANDU, NEPAL

Objectives: This study aims to provide a comprehensive analysis of the prescription pattern of nutraceuticals in patients visiting a tertiary care hospital in Kathmandu which includes identification of commonly prescribed nutraceuticals, analysis of co-prescribed drug classes, identification of major nutraceutical compositions, analysis of patient expenditure on nutraceuticals, and quantification of nutraceutical availability. Methods: A purposive sampling method was used to conduct a descriptive cross-sectional study involving 304 patients from the outpatient departments of a tertiary care hospital, Nepal. Data on patients’ sociodemographic characteristics, co-prescribed drugs, nutraceutical details, and supplement expenses were collected using a structured questionnaire and form. Patient cards provided the necessary information, which was then analyzed with SPSS-16 and Microsoft Excel. Results: Out of 304 prescriptions analyzed, 64% were prescribed to females and 26% to patients aged 31–45 years. The general medicine department accounted for 44% of nutraceutical prescriptions, with multivitamins being the most common (91%). Tablets were the preferred dosage form 56%, and gastrointestinal disorder medicine was commonly co-prescribed with nutraceuticals. Nutraceuticals alone accounted for approximately 52% of the total medicine cost. Conclusion: Nutraceuticals are being continuously used in the treatment of various diseases. The future of nutraceuticals is bright and can transform health care. More studies need to be taken up on the prescription of nutraceuticals in health care.

An experimental study on high strength self-compacting concrete inclusion of zeolite and silica fume as a potential alternative sustainable cementitious materials

One of the major sources of carbon dioxide and other greenhouse gases around the world is the cement industry. They make up 6–8 % of global warming. Therefore, by conducting this experiment, we may examine the possibility of replacing cement with different cementitious materials which include zeolite,silica fume and fly ash. These mineral additives will lessen the need for cement while enhancing the properties of the concrete that has just been hardened and also in fresh state. The objective of this experiment is to explore the impact of zeolite and silica fume on the physical and durability qualitiesof high strength, self-compacting concrete utilising nano silica that has been optimised. In the course of this study, various concrete mixtures were cast with zeolite and silica fume substituted for cement in varying amounts, and there was also a control mix for reference. These additives arereplacedcement in multiples of 5 up to 20 %. The preferred dosage as 2 % Nano silica is substituted as a regular mineral additive in all mixtures. Workability tests on the fresh qualities of concrete mixtures are conducted and the EFNARC stipulations are met by these experimental findings. All the concrete mixes' parameters, including strengths like splitting tensile and compressive were identified. Tests such as the Rapid chloride permeability test, the abrasion test, water absorption and desorption test were used to evaluate the concrete's durability.

The efficacy of aspirin as a prophylactic agent for patients recovering from total knee arthroplasties

Guidelines regarding deep vein thrombosis (DVT) prophylaxis following total knee arthroplasties (TKAs) have had conflicting information regarding the use of aspirin as a prophylactic agent in recent years. The National Institute for Clinical Excellence refrains from listing the drug in its guidelines, while the American College of Chest Physicians advocates for the drug. Despite the conflicting guidelines, physicians have favored the drug in recent years, with more than 80% utilizing it as a prophylactic agent in TKAs. Although a consensus may have been reached by physicians regarding the use of the drug, a consensus has not been reached regarding the preferred dosage. With this in mind, a search of the PubMed database was conducted, which yielded six studies that discussed the efficacy of various dose ranges of aspirin. All studies corroborated that not only was aspirin an effective prophylactic agent but also that there was no significant difference between dosages regarding efficacies. Due to factors such as aspirin resistance and the potential of aspirin to cause gastrointestinal injuries, this literature review concludes that the dosage of aspirin given for the prophylaxis of DVT in TKAs should be considered on a patient-to-patient basis.

Enhancing Awareness of Diclofenac as an Over-the-Counter Analgesic in the Northern Border Region of Saudi Arabia

Introduction: Diclofenac was identified by the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency as a high-risk NSAID in terms of its effects on the heart and circulation when administered systemically, i.e. capsules, tablets or injections.
 Objective: To evaluate the knowledge and awareness about over the counter analgesic medication (Diclofenac) among people living in northern border region – Saudi Arabia.
 Methodology: Self-administered cross-sectional study conducted during a period of two months (October and November 2023) on random sample of 430 Saudi people living in the Northern Border Region. The data was analyzed by Microsoft excel program by means of Descriptive statistics.
 Results: Toothache and headache were the most worried pain among participants (32%) and (31%) respectively, majority (72%) of participants buy OTC medication for pain from community pharmacy on the advice of pharmacist. Small percentage (20%) thought that medications containing diclofenac have very few side effects, 76% didn’t know any side effect of diclofenac, 47% didn’t know that diclofenac in high dose has adverse effects on kidney, 71% didn’t know that diclofenac cause gastrointestinal adverse effects. About one fifth of participants (21%) didn’t know the maximum dose of diclofenac when they use it, tablet is the preferred dosage form of diclofenac (27%) followed by granules (16%), dosage of 100 mg is the most frequently used (36%) followed by 50 mg (16%). 
 Conclusion: Saudi people’s knowledge about diclofenac as one member of non-steroidal anti-inflammatory drugs was insufficient. Knowledge about related adverse effects of diclofenac was lacked which exposes to misusage that may carry accidents and severe side effects especially among high-risk population.

What to consider for successful administration of oral liquids via enteral feeding tubes? a case study with paediatric ibuprofen suspensions

Administration of medications via enteral feeding tubes (EFTs) is a common practice for children who cannot swallow properly. Although liquid formulations are the preferred dosage forms for this route of administration, little attention has been paid to the amount of drug that reaches the site of absorption after administration via an EFT. This systematic in vitro study aimed to identify formulation parameters and administration approaches that are critical for successful dose delivery via EFTs. For this purpose, drug recovery after administration of three different paediatric ibuprofen suspensions via different types of EFTs was studied using derivative UV spectrophotometry for quantification. Study results indicate that in addition to formulation parameters, feeding tube characteristics and the administration process can have a significant impact on the administered dose. The ratio between the total administered fluid volume (TAV), represented by the sum of dose- and flushing volume, and the feeding tube volume (FTV) proved to be a valuable indicator for assessing successful administration. Incorrect dosing and complications could be avoided if the TAV/FTV ratio was greater than 4. This and other knowledge gained in the study will help to make the administration of liquid paediatric medicines via EFTs both more effective and safer.

Clinical pharmacists' perspective of medication adherence support in Ethiopian hospital settings: a qualitative study.

Hospital pharmacists can assist patients with medication adherence in a hospital setting. No studies have explored the views of hospital pharmacists on medication adherence. The study aimed to explore Ethiopian clinical pharmacists' understanding of and experience with medication adherence, and identify strategies for medication adherence support. Semi-structured interviews were conducted via ZOOM/Skype. Hospital pharmacists were recruited through a professional network and snowball sampling. All interviews were audio recorded, transcribed verbatim, translated into English and analysed using thematic analysis techniques. The data coding followed a hybrid deductive and inductive approach. Fourteen Ethiopian clinical pharmacists participated in the study. Analysis yielded five main themes including: medication adherence definition and measurement; pharmacists' perceived roles; enablers of medication adherence; barriers to medication adherence; and ways forward. Participants indicated that accurately assessing medication adherence was complicated because of an absence of cost-effective and validated tools. Pharmacist education, clinical pharmacy services, physical structure, sources of medication information, and government initiatives to reduce financial burdens were the facilitators identified. Eight barriers were identified, and these were broadly classified as factors intrinsic or extrinsic to the patient. Medication adherence support could face barriers intrinsic or extrinsic to patients. Strategies were proposed to overcome the identified barriers and to harness existing facilitators. These strategies included the need for validated local language medication adherence tools, instituting regular adherence measurement and prioritizing patients for available interventions. Patient's preferred dosage form should be considered along with medication complexity and medication knowledge when supporting medication adherence.

A Nationwide Survey on Malaysian Hospital Physicians’ Practices of Intravenous Potassium Chloride Supplementation and Opinions on Premixed Formulation in the Treatment of Hypokalaemia

This study aims to evaluate the Malaysian hospital physicians’ practices of intravenous potassium chloride in the treatment of hypokalaemia and their opinions on using premixed formulation. This was a nationwide online survey using a self-administered questionnaire. The survey link was sent to the practising hospital physicians in Malaysia through email (n = 1,455), Facebook Messenger (n = 2,734) and posted on Facebook as well. A total of 207 responses were received. The physicians were mostly males (63.8%), aged between 30 years old–39 years old (51.2%) and worked in the government sectors (76.8%). The most preferred dosage of potassium chloride for mild, moderate and severe hypokalaemia was 10 mmol (44.4%), 20 mmol (55.1%) and 30 mmol (37.7%), respectively. The mostly chosen infusion rate of potassium chloride for mild hypokalaemia was over 24 h (41.1%) while for both moderate and severe hypokalaemia were over 1 h–2 h (63.8% and 89.9%, respectively). The concentration of intravenous potassium chloride is the main factor (68.1%) which would influence the infusion route choice. Serum potassium monitoring of every 24 h was chosen by 52.7% of the respondents for mild hypokalaemia while every 1 h–2 h was mostly chosen for moderate and severe hypokalaemia (49.3% and 87.4%, respectively). Cardiac monitoring was mostly opted in severe hypokalaemic patients (70.0%). Majority of physicians agreed that a premixed formulation is easier to administer (64.7%) and safer for the patients (51.7%). In conclusion, there were variations in the prescribing practices among Malaysian physicians to treat hypokalaemia. Most physicians were in favour of premixed formulation.

Practice and knowledge of dietary supplement consumption among Indonesian adults post-delta wave of the COVID-19 pandemic.

Background: Increasing dietary supplement (DS) consumption was observed during the COVID-19 pandemic, including during the post-Delta wave period. This study aimed to measure the practice of DS consumption and respondents' knowledge of DS. Methods: An internet-based survey was distributed from October-December 2021 and obtained 541 valid and completed responses. Descriptive analysis was performed to present the practice of DS consumption, including frequency, duration, aim, preferable dosage form etc. Level of knowledge on DS principles, side effects and regulation were also measured. Inferential analyses were conducted to determine the predictors of the respondents' DS practice and level of knowledge. Results: Data from 541 valid responses showed that 77.63% of respondents consumed DS in the last 3 months, with only 59.52% reporting also consuming DS before the COVID-19 pandemic. One half of the respondents had good knowledge about DS; however, some knowledge regarding side effects and possible drug-supplement interaction needed improvement. Their DS consumption practice was affected by their economic status and history of contracting COVID-19. Nevertheless, the level of knowledge was not affected by the sociodemographic factors and DS supplement experience. Conclusions: Taken together, the practice of self-consumption of DS in Indonesia is increasing; hence, knowledge of DS is necessary to avoid detrimental effects that might occur in the future. Increasing access to information on better labelling and educating consumers about DS are important actions to consider.

Formulation and Evaluation of Herbal Cough Syrup

The most common problem suffered by individuals everywhere over many centuries is cough. Coughing is the protective mechanism of the body. Coughs are classified further accordingly which are depending upon factors such as signs and symptoms, duration, type, character, etc. Most commonly used, prepared and popular dosage form to cure cough and cold is syrup. The most preferred dosage form to cure cough is herbal syrup, which is used mostly due to its benefits over synthetic syrups. Medicinal plants are used as primary health care agents, mostly in Asian countries. Ingredients showing expectorant antitussive activity are used. Hereby cough and herbal treatments associated with cough are studied briefly. The herbal cough syrup is studied which is liquid dosage form, it is easy to administer than solid dosage form and is more effective and fast acting in order to cure cough. Method of preparation of cough syrups were discussed. The material and quantity used in preparation were listed. Here honey based three batches were performed having concentration such as 35%, 40%, 45% w/v. the quality of final syrup was evaluated for post formulation studies.

A Review on the Appropriate Dosage of Aspirin as a Prophylactic Agent Against Deep Vein Thrombosis Following Total Knee Arthroplasties

Guidelines regarding Deep Vein Thrombosis prophylaxis following total knee arthroplasties have had conflicting information regarding the use of aspirin as a prophylactic agent in recent years. The National Institute for Clinical Excellence refrains from listing the drug in its guidelines while the American College of Chest Physicians advocates for the drug. Despite the conflicting guidelines, physicians have favored the drug in recent years, with more than 80% utilizing it as a prophylactic agent in total knee arthroplasties. Although a consensus may have been reached by physicians regarding the use of the drug, a consensus has not been reached regarding the preferred dosage. With this in mind, a search of the PubMed database was conducted which yielded six studies that discussed the efficacy of various dose ranges of aspirin. All studies corroborated that not only was aspirin an effective prophylactic agent, but that there was no significant difference between dosages regarding efficacies. Due to factors such as aspirin resistance and the potential of aspirin to cause gastrointestinal injuries, this literature review concludes that the dosage of aspirin given for the prophylaxis of DVT in TKAs should be considered on a patient to patient basis.

Industrial Manufacture of Enteric Hard Capsules Using Novel Formulations Based on Hypromellose Phthalate/Gelatin and Investigation of Pantoprazole Release.

Capsules are popular oral dosage forms because of their ease of production. They are widespread pharmaceutical products. Hard capsules are preferred dosage forms for new medicines undergoing clinical tests because they do not require expansive formulation development. Functional capsules with built-in gastroresistance, aside from the traditional hard-gelatin or cellulose-based vegetarian capsules, would be beneficial. In this research, the effect of polyethylene glycol-4000 (PEG-4000) was investigated on the formulation of uncoated enteric hard capsules based on hypromellose phthalate (HPMCPh) and gelatin. Three different formulations based on HPMCPh, gelatin, and PEG-4000 were tested to achieve the optimal formulation for the industrial production of hard enteric capsules with desired physicochemical and enteric properties. The results reveal that the capsules containing HPMCPh, gelatin, and PEG-4000 (F1) are stable in the stomach environment (pH = 1.2) for 120 min, and during this time, no release happens. The outcomes also demonstrate that PEG-4000 blocks the pores and improves enteric hard capsule formulation. In this research, we present a specific procedure for manufacturing uncoated enteric hard capsules on an industrial scale that does not require an extra coating step for the first time. The industrial-scale validated process can considerably reduce the cost of manufacturing standard enteric-coated dosage forms.

Practice and knowledge of dietary supplement consumption among Indonesian adults post-delta wave of the COVID-19 pandemic

Background: Increasing dietary supplement (DS) consumption was observed during the COVID-19 pandemic, including during the post-Delta wave period. This study aimed to measure the practice of DS consumption and respondents’ knowledge of DS. Methods: An internet-based survey was distributed from October-December 2021 and obtained 541 valid and completed responses. Descriptive analysis was performed to present the practice of DS consumption, including frequency, duration, aim, preferable dosage form etc. Level of knowledge on DS principles, side effects and regulation were also measured. Inferential analyses were conducted to determine the predictors of the respondents’ DS practice and level of knowledge. Results: Data from 541 valid responses showed that 77.63% of respondents consumed DS in the last 3 months, with only 59.52% reporting also consuming DS before the COVID-19 pandemic. One half of the respondents had good knowledge about DS; however, some knowledge regarding side effects and possible drug-supplement interaction needed improvement. Their DS consumption practice was affected by their economic status and history of contracting COVID-19. Nevertheless, the level of knowledge was not affected by the sociodemographic factors and DS supplement experience. Conclusions: Taken together, the practice of self-consumption of DS in Indonesia is increasing; hence, knowledge of DS is necessary to avoid detrimental effects that might occur in the future. Increasing access to information on better labelling and educating consumers about DS are important actions to consider.

Bonding performance evaluation on WTR-APAO composite modified asphalt as waterproof adhesive layer for concrete bridge

• The preferred concrete surface depth was 0.88 mm, and the gravel covering rate at 70 %. • The optimal dosages of WRAMA, WRMA, and SMA were 1.7 kg/m 2 ,1.2 kg/m 2 and 1.2 kg/m 2 . • WRAMA has higher bonding performance than WRMA and SMA at mid and high temperatures. • WRAMA shows good resistance to water immersion, freeze–thaw cycling, and aging. • The material cost of WRAMA is 30% lower than SMA based on economic comparison. Insufficient bonding at the waterproof adhesive layer (WAL) between the concrete bridge deck and asphalt pavement surface often leads to distress on the bridge or its surfacing pavement. This study proposes a relatively novel material, WTR (Waste Tire Rubber)/APAO (Amorphous Poly Alpha Olefin) composite modified asphalt (WRAMA), as WAL and evaluates its bonding performance compared to the commonly used interlayer SBS modified asphalt (SMA) and waste tire rubber modified asphalt (WRMA). The bonding performance was evaluated using straight shear tests and pulling out tests. Firstly, the optimal concrete surface chiseling depth was explored and determined at 0.88 mm, corresponding to 2 rounds of chiseling on the concrete surface. Then the preferred gravel coverage rate was set at 70 %, and optimum asphalt dosages were determined at 1.7 kg/m 2 , 1.2 kg/m 2 , and 1.2 kg/m 2 for SMA, WRMA, and WRAMA, respectively. While all three asphalts show good impermeability at their preferred dosage, WRAMA has the highest shear and pulling strength. Secondly, the bonding performances of investigated asphalts were evaluated and compared under controlled environments, including water immersion, temperature, free-thaw cycle, and aging. The results showed that WRAMA has the slightest temperature sensitivity but the least moisture resistance than SMA and WRMA. However, the shearing and pulling strength of WRAMA after freeze–thaw and water immersion was around 0.45 MPa, still higher than SMA (around 0.40 MPa) and WRMA (around 0.39 MPa). All three asphalts have decent resistance to aging. Thirdly, a preliminary economic analysis was conducted, and the results show that the material cost of WRAMA is around 66 % of SMA. Considering the WRAMA makes use of wasted tire rubber, this research reveals that the proposed WTR/APAO composite modified asphalt is potentially a cost-effective and environmental-friendly waterproof adhesive layer.

Mechanical and Self-Healing Performance of Yellow River Alluvial Silt Treated with Composite Flexible Curing Agent

The silt in the Yellow River alluvial plain has low clay content, low cohesion and poor structure. Its stability has always been a difficult problem in the engineering field. In order to improve the engineering properties of the silt in the alluvial plain of the Yellow River, a new type of silt composite flexible curing agent was prepared by using sintered red mud and matrix asphalt as the main materials to comprehensively stabilize the silt. The aim of this study was to investigate the effects of sintered red mud-asphalt composite flexible curing agent on aged mechanical properties of treated silt, in which the replacement levels of the flexible curing agent below 10% by weight are compared. Apart from the compressive strength, the drying shrinkage, low temperature freeze-thaw and high temperature self-healing ability are measured. The test results show that the flexible curing agent has a positive effect on improving the mechanical properties of stabilized silt. The flexible curing agent series exhibit higher compressive strength, better water stability, resistance to freeze-thaw and high temperature self-healing ability, and lower drying shrinkage compared to silt and cement stabilized silt. The preferred dosage 4%~6% of the flexible curing agent is obtained by mechanical property analysis. The SEM images show that the incorporation of the flexible curing agent helps the silt form dense cementation and non-connected microporous structure, that is beneficial to the improvement of water stability and frost resistance. The asphalt component in the flexible curing agent can reorganize and diffuse in the soil, fill the internal pores and micro cracks, and realize the repair of soil damage and structural reinforcement.

The Development and Characterization of a New Easily Swallowed Valsartan Oral Jelly

For many years oral solid dosage forms were the most preferred dosage form for a wide range of populations due to their safety, efficacy, stability cheapness, and ease of administration. Although, they possess certain drawbacks mainly swallowing difficulties and bioavailability problems. Therefore, oral jellies were developed in an attempt to overcome these restrictions. In this study, six valsartan oral jellies were prepared using three different gelling agents (xanthan gum, sodium alginate, and gelatin) in different concentrations that are designed especially for pediatric patients with swallowing problems. These oral jellies were optimized by the evaluation of the physical appearance, pH, viscosity, and syneresis. In addition to the study of taste masking, content uniformity, and in vitro release profile. Furthermore, FT-IR and stability analyses were performed on the optimum formula. As a result oral jelly (F6) containing 6% gelatin was selected as the optimum formula possessing an acceptable physical property with a pH value of (7.25±0.47) and viscosity of (91200±1.95, 42170 ±2.7) cps at 5 and 10 rpm respectively which showing no syneresis. Moreover, F6 had an acceptable content uniformity of (96.30±1.38) and higher percent drug released in 30 minutes (98.40 ± 1.04) with good taste masking (1.22%±1.18, 4.37%±1.06) after 1 and 2 minutes respectively. Furthermore, the absence of any interactions or instability was assured by the result of the FT-IR and stability analysis. In a conclusion, this study was succeeded to formulate a valsartan oral jelly that can be used as a new easily swallowed form of the antihypertensive drug for the dysphagic population with improved bioavailability.

Verejní lekárnici a správna aplikácia inhalačných liekov

Inhaled medications are considered a preferred dosage form of medicine to treat respiratory diseases, such as bronchial asthma and chronic obstructive pulmonary disease (COPD), when bronchodilators or, more precisely, controlled drugs for treatment are used. The main objective of our research was to find out community pharmacists’ general knowledge of particular inhalation systems (IS) dispensed in pharmacies. All data necessary for the evaluation have been obtained by an anonymous survey questionnaire carried out between September 2020 and January 2021, which was done both in printed form and online. The questionnaire was self-construction, anonymous, consisting of sociodemographic data (age, gender, residence address – region) and 22 research questions. Both the administration of bronchodilators and inhaled corticosteroids were monitored in the survey. A total of 115 respondents participated in the survey, 86 females (75%) and 29 males (25%). Most of the respondents, 45 (39%), were aged between 23 and 29. The data show that 62 respondents (53.91%) encounter inhaler dispensing several times a day, with the prevalence of aerosol inhalers (MDI), which was confirmed by 78 pharmacists (67.83%). Most of the time, pharmacists meet patients with bronchial asthma, 80 (69.57%), and bronchodilators are prescribed for therapy mainly, 74 (64.35%). In total, 60 respondents (52.17%) provide patients with information on proper administration of inhaled medicines at their request, and only 46 of the respondents (40%) do it without being asked. The survey outcomes show that community pharmacists have minimum knowledge of nebulizers and also of the use of inhalator attachments. The vast majority of participants, 90 (78.26%), say that since they graduated, they haven’t attended any education courses aimed at proper administration of inhaled medications as part of their constant education. Up to 95 respondents (82.61%) are interested in IS mock-ups in a pharmacy, 103 pharmacists (89.97%) in information materials for their self-study, and 110 respondents (95.65%) in IS leaflets and brochures for patients. A positive finding of the survey is that the majority of the respondents, 101 (87.83%), are interested in further educating themselves to get knowledge of this matter in the future. Our survey outcomes show that our respondents’ knowledge of inhalation systems (IS) is sufficient. Most of the pharmacists who participated in the survey can provide patients with basic information regarding the proper administration of inhaled medicines.

Neuroprotective Effects of Citicoline on Methanol-Intoxicated Retina Model in Rats.

Purpose: This study aims to evaluate the effect of citicoline administration in suppressing retinal damage due to methanol intoxication. This study hypothesizes that citicoline will minimize the loss of retinal ganglion cells (RGCs), minimize disruption of photoreceptors, suppress ganglion layer edema, increase expression of bcl-2 as the antiapoptotic protein, and decrease expression of caspase-3 as the proapoptotic protein. Methods: Fifteen Sprague-Dawley rats were divided into 5 groups, including the control group (A); methanol groups, observed on day 3 (B1) and day 7 (B2); and methanol+citicoline groups, observed on day 3 (C1) and day 7 (C2). Rats in groups B and C were placed in an inhalation chamber filled with N2O:O2 during the experiment, then methanol was administered orally. Citicoline, 1 g/kg every 24 h, was orally administered for group C. Enucleation was performed and retinas of rats were prepared for histology and immunohistochemistry examination to evaluate photoreceptor morphology and RGC density, as well as bcl-2 and caspase-3 expression. Results: RGC density of citicoline-treated intoxicated rats was higher than no-citicoline methanol-intoxicated rats on both day 3 (P < 0.001) and day 7 (P < 0.001). The ganglion layer thickness of citicoline-treated intoxicated rats was thinner than no-citicoline intoxicated rats, which means citicoline-treated rats had milder ganglion layer edema. Citicoline-treated rats showed higher bcl-2 and lower caspase-3 expression than no-citicoline rats. No differences were found in photoreceptor findings among groups. Conclusions: This study demonstrated citicoline's potential benefits for management of ocular methanol intoxication. However, more preclinical and clinical trials are needed to obtain a preferred dosage and timing of citicoline administration.

The sun is here! What will you recommend?

Spring and summer are just around the corner, and most areas accustomed to clouds and cooler temperatures will begin to experience a warming trend. This means folks will be spending more time in the sun. Pharmacists should be prepared to answer questions and make recommendations about sunscreen. Here's some important information to consider as you counsel patients on sun safety and the benefits of using sunscreen. The ultraviolet (UV) spectrum is divided into three major bands—ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC)—all of which may cause or exacerbate sun-induced skin disorders. UVA and UVB primarily are responsible for photodamage, as all UVC radiation is removed by the ozone layer. UVA and UVB both play a role in causing skin cancer. The only true therapeutic effect of UVB exposure is synthesis of vitamin D3 in the skin. Sun protection factor (SPF) is one parameter for determining a sunscreen's effectiveness for UV protection. Another parameter, minimal erythema dose, is used to calculate a sunscreen's SPF. SPF is calculated based on the time to skin burning with sunscreen compared with time to skin burning without sunscreen. For example, by using SPF 10, a person who usually stays in the sun for 10 minutes before starting to burn can prolong that time to approximately 100 minutes. Many dermatologists recommend using a product with SPF 30 or higher. Topical sunscreens can be divided into two major subgroups: chemical and physical. Chemical sunscreens absorb and thus block the transmission of UV radiation to the epidermis. Physical sunscreens are generally opaque; instead of absorbing UVR, they reflect and scatter it. Broad-spectrum sunscreens are designed to protect against both UVA and UVB rays. Many medications are associated with photosensitivity reactions. Review your patient's medication list and counsel patients to prevent any negative reactions. ▪For maximum effectiveness, apply sunscreens liberally to all sun-exposed areas of the body and reapply at least as often as the label recommends.▪Apply to dry skin at least 15 to 30 minutes before sun exposure if expecting to spend more than 20 minutes in the sun.▪Reapply every 2 hours at minimum, even on cloudy days.▪Reapply after heavy sweating, swimming, and toweling off. Reapplying doesn’t extend the length of time a person is protected from sunburn.▪When using sunscreen sprays, spray and rub into skin to ensure uniform coverage.▪If using insect repellent and sunscreen, apply sunscreen before insect repellent.▪Do not use on children younger than 6 months. Lotions are the preferred dosage form for children.▪For sufficient protection, the average adult in a bathing suit should apply nine portions of sunscreen of approximately ½ teaspoon each, or approximately 4.5 teaspoons (22.5 mL) total. Distribute the sunscreen as follows:–Face and neck (including ears): ½ teaspoon–Arms and shoulders: ½ teaspoon to each side of body–Torso: ½ teaspoon each to front and back–Legs and tops of feet: 1 teaspoon to each side of body As we consider the opportunities to counsel patients on appropriate sunscreen use, we shouldn’t assume they’re getting this advice elsewhere. Many people believe they’re knowledgeable about sunscreens and protection from the sun's harmful rays—until they get a sunburn. Because of the cost of sunscreen products and the need to apply them often and in sufficient amounts, users may apply substantially less sunscreen than is required to provide adequate protection. Find ways to educate your patients on optimal ways to protect against the potential dangers of the sun's UVA and UVB rays while still enjoying outdoor fun and activities. Shelf talkers and signage in the appropriate OTC sections of the pharmacy can facilitate dialogue. And don’t forget to practice what you preach!