Rational Drug Use Research Articles

Evaluation of Drug Prescription using WHO Prescription Indicators at a Tertiary Care Teaching Hospital, Raipur Chhattisgarh, India: A Cross-sectional Study

Introduction: Prescription patterns significantly impact healthcare quality and patient outcomes. Evaluating these patterns using World Health Organisation (WHO) indicators helps identify areas for improvement and ensures rational drug use. The present study was conducted to evaluate prescription patterns via WHO indicators, aiming to uncover insights, identify discrepancies and enhance prescription quality within the institute for improved healthcare outcomes. Aim: To evaluate drug prescription patterns using WHO prescription indicators in the prescriptions of outdoor patients at a tertiary care teaching hospital in Chhattisgarh, India. Materials and Methods: A cross-sectional study was conducted in the Department of Pharmacology at Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, Chhattisgarh, India, from July 15, 2023, to October 15, 2023 (a duration of 3 months), involving 1,000 outpatient prescriptions at Dr. Bhimrao Ambedkar Memorial Hospital (BRAM), Raipur, Chhattisgarh. Ethical clearance was obtained from the Institutional Ethics Committee (IEC) (No./MCI/Ethics/2023/45 Raipur, dated 12/07/2023). Data were collected using a digital form and analysed statistically. Parameters evaluated included the average number of medicines per prescription, the percentage of drugs prescribed by generic name, the percentage of prescriptions containing antibiotics, the percentage of prescriptions containing injections, and the percentage of drugs prescribed from the Essential Drug List (EDL). Descriptive statistics were used to summarise the data, and analysis was performed using Microsoft (MS) Excel 2021. Results: The present study included 1,000 prescriptions. A total of 4,320 medicines were prescribed across these prescriptions, with 2,853 (66.04%) prescribed by their generic name. Injections accounted for 483 (11.18%) prescriptions, while antibiotics were included in 663 (15.34%) prescriptions. Additionally, 2,973 (68.81%) medicines were prescribed from the EDL. The average number of medicines prescribed per prescription was 4.3. Conclusion: The study revealed that while certain aspects of prescription practices aligned with WHO indicators, notable discrepancies persisted. The percentage of antibiotics prescribed per prescription was in accordance with WHO guidelines. Strategic measures are needed to enhance prescription practices and align them more closely with WHO guidelines.

Проблема антибиотикорезистентных штаммов и её решение

Antibiotic resistance is a global health problem around the world and is a type of antimicrobial resistance. Solving it requires concerted efforts on a global scale. The main antibiotic-resistant microorganisms are Enterococcus spp., Staphylococcus aureus, Klebsiella pneumonia, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, Helicobacter pylori. Many countries have programs aimed at preventing the development of antibiotic resistance, as well as stimulating the development of new drugs with antimicrobial activity. Many scientific works are devoted to this topic. The rational use of available antimicrobial drugs, considering the spectrum of their activity and the antibiotic resistance profile of the main pathogens, is becoming increasingly necessary. The purpose of this study was to examine interventions aimed at combating the growing antibiotic resistance in the world. The basic principles of the development of these problems and mechanisms of antibiotic resistance are shown. The mechanism is mainly associated with the evolution of microorganisms of a phenotypic and genetic nature. An analysis of antibiotic-resistant strains was carried out, their characteristics were given, and methods for studying antibiotic resistance to antibacterial drugs were reflected. The diffusion method and the dilution method for assessing sensitivity are described. The problem of antibiotic resistance has been confirmed by many studies in various departments, especially surgical ones and in intensive care units. In Kazakhstan, the main antibiotic-resistant pathogens are considered Acinetobacter spp., Enterococcus spp., Haemophilus influenza, Pseudomonas spp., streptococci, staphylococci and enterobacteriae. The main measures to prevent this problem are control over the use of antibiotics, the development of new drugs, namely new antibiotics and bacterial lysates based on thtse microorganisms.

Этиологическая структура и антибиотикорезистентность возбудителей сепсиса у больных COVID-19

The purpose — to study the etiological structure and antibiotic resistance of sepsis pathogens in patients with COVID-19. Material and methods. A retrospective observational, uncontrolled study was conducted. We analyzed the results of an examination survey of 584 patients with severe and extremely severe forms of COVID-19 hospitalized at the Republic Clinical Infectious Diseases Hospital in Kazan from April 1, 2020 to October 1, 2022. Identification of the pathogen in blood and other biological materials was carried out using a Microflex LT Bruker mass spectrometer. The antibiotic sensitivity of the isolated bacterial strains was determined by the disk diffusion method using an ADAGIO analyzer (France). Results. Various types of bacteria were isolated from the blood of 76 (13%) patients with severe and critical forms of COVID-19, including: A. baumannii (23.7%), K. pneumoniae (19.7%), S. haemolyticus (19.7%), S. aureus (7.9%), E. faecium (11.8%), E. faecalis (7.9%), E. coli (3.9%), R. planticola (2.6%), P. aeruginosa (2.6%), S. pneumoniae (2.6%), S. maltophilia (1.3%), and B. cereus (1.3%). In 15 patients (19.7%) associations of 2–3 types of bacteria were isolated from the blood. A. baumannii isolates were resistant to carbapenems (94.5%), fluoroquinolones and aminoglycosides (100%), and trimethoprim-sulfamethoxazole (83.3%) strains. K. рneumoniae strains were resistant to carbapenems (60%), cephalosporins (cefixime, ceftazidime) (73.3%), fluoroquinolones (ciprofloxacin) (80%), aminoglycosides (60%), and semisynthetic penicillins (100%). 33.3% of S. aureus strains were resistant to trimethoprim-sulfamethoxazole, 16.7% — to oxacillin, erythromycin and gentamicin. Resistance of S. haemolyticus to trimethoprim-sulfamethoxazole was detected in 86.7%, to erythromycin — in 80%, to norfloxacin — in 50% of strains. 93.3% of S. haemolyticus strains were methicillin-resistant. 88.9% of E. faecium strains were resistant to ampicillin, 22.2% to tigecycline, 11.1% to linezolid. 50% of E. faecalis strains were resistant to norfloxacin, 16.7% of strains were resistant to amoxicillin, ampicillin and piperacillin. P. aeruginosa 50% of strains were resistant to levofloxacin. R. planticola was resistant to all antibiotics tested. S. maltophilia demonstrated sensitivity to co-trimoxazole only with increased exposure. Conclusion. Bacterial sepsis was diagnosed in 13% of severe and extremely severe patients with COVID-19. The etiological structure of sepsis includes a wide range of pathogens with a predominance of multi-resistant bacteria from the group of ESKAPE pathogens. Data on the etiological structure and antibiotic resistance of isolated pathogens should be taken into account for the rational use of antimicrobial drugs in the treatment of sepsis in patients with COVID-19.

Neratinib safety evaluation: real-world adverse event analysis from the FAERS database.

Neratinib has emerged as significant theraputic option for breast cancer treatment. However, despite its approval, numerous adverse drug events (ADEs) associated to it remain unrecognized and unreported. This study aims to mine and analyze the signals of ADEs related to neratinib from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database, providing insights for safe and rational clinical use of drug. All the neratinib-related ADEs data were collected from FAERS database from the third quarter (Q3) of 2017 to the fourth quarter (Q4) of 2023. After standardizing the data, 4 disproportionality methods were used to assess the correlation between neratinib and ADEs. Of the 1,544 ADEs implicating neratinib as the primary suspected drug, a combined total of 48 preferred terms (PTs) and 10 system organ classes (SOCs) showed significant disproportionality accross all four algorithms simultaneously. These SOCs included gastrointestinal disorders (n = 2,564, ROR 7.14), general disorders and administration site conditions (n = 958, ROR 0.77) and injury poisoning and procedural complications (n = 474, ROR 0.58) among others. Upon comparison with the neratinib manual, 34 ADEs not documented in the manual were found at the PT level. Our study provide new real-world evidence for drug safety information of neratinib. While the majority of our findings were aligned with the information provided in the manual. We identified additional ADEs not previously documented. Consequently, further studies are needed to validate unreported ADEs to ensure the efficacy and safety of neratinib for patients.

Determining knowledge of antimicrobial therapy in practitioners (results of the KANT-IV project)

Objective. To determine the level of knowledge of doctors on the rational use of antimicrobial drugs in clinical practice and to compare with data of the previous stage of the study and results obtained from students in a parallel project. Materials and Methods. A multicenter questionnaire survey of practitioners with analysis of results – stage of KANT project (full name of the project – «Physicians’ (Students’) knowledge in antimicrobials usage») conducted in 2020–2023. Results. A total of 336 participants were surveyed in 5 centers (10 Russian regions: Belgorod, Novosibirsk, Rostov, Voronezh, Lipetsk, Sakhalin, Primorsky, Krasnodar, and Krasnoyarsk regions, Republic of Tatarstan). The average level of correct answers (LCA) for the whole questionnaire was 47.5% (taking into account the extended analysis of sub-items questions No. 8 and 9 – 46.8%). Doctors showed the best results in answering questions about the time interval during which the effectiveness of antimicrobial therapy is evaluated (LCA – 84.2%); about choosing the most rational action if antimicrobial therapy (AMT) has a positive clinical effect, but requires a long course of therapy (LCA – 72.6%); selection of rational diagnostic/treatment action in the diagnosis of acute tonsillitis or pharyngitis, in a case where etiologic diagnosis is required (LCA – 63.1%). The worst results were recorded in answering to the following questions: indication of the antimicrobial drug of choice in the treatment of various infections (LCA – 29.1%); the choice of auxiliary drugs in addition to the justified appointment of antimicrobial drugs in the treatment of bacterial infections of the respiratory tract for the entire period of the disease or in certain phases (LCA – 26.6% – 35.1%); indication of a combination of antimicrobial drugs that is irrational to prescribe in clinical practice due to a similar mechanism and/or spectrum of activity against pathogens (LCA – 24.4%). Significant differences were found between centers in a number of questions, between physicians in KANT-III and KANT-IV projects (p < 0.001), and between physicians and students in a parallel project (KANT-IV students, LCA – 42.6%, p < 0.001). Conclusions. An unsatisfactory level of physicians’ knowledge of AMT and choice of adjuvant agents, as well as appropriateness of antimicrobial combination was found. The authors believe there is a need for making more efforts in areas of increasing physicians’ compliance to clinical recommendations, expertise and quality control of pharmacotherapy, recruitment of clinical pharmacologists; to optimize the educational process in universities, to expand the scope and availability of additional educational programs within the system of continuous education, as well as to train physicians in using modern sources of scientific medical information.

Effect of High Altitude Environment on Pharmacokinetic and Pharmacodynamic of Warfarin in Rats.

High altitude environment affects the pharmacokinetic (PK) parameters of drugs and the PK parameters are an important theoretical basis for guiding the rational clinical use of drugs. Warfarin is an oral anticoagulant of the coumarin class commonly used in clinical practice, but it has a narrow therapeutic window and wide individual variation. However, the effect of high altitude environment on PK and pharmacodynamic (PD) of warfarin is unclear. The objective of this study is to investigate the effect of a high altitude environment on PK and PD of warfarin in rats. Rats were randomly divided into plain group and high altitude group and blood samples were collected through the orbital venous plexus after administration of 2 mg/kg warfarin. Warfarin concentrations in plasma samples were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and PK parameters were calculated by the non-compartment model using WinNonlin 8.1 software. Meanwhile, the expression of PXR, P-gp and CYP2C9 in liver tissues was also determined by western blotting. The effect of high altitude environment on PD of warfarin was explored by measuring activated partial thromboplastin time (APTT) and prothrombin time (PT) values and then calculated international normalized ratio (INR) values based on PT. Significant changes in PK behaviors and PD of warfarin in high altitude-rats were observed. Compared with the plain-rats, the peak concentration (Cmax) and the area under the plasma concentration-time curve (AUC) increased significantly by 50.9% and 107.46%, respectively. At the same time, high altitude environment significantly inhibited the expression of PXR, P-gp and CYP2C9 in liver tissues. The results of the PD study showed that high altitude environments significantly prolonged PT, APTT and INR values. High altitude environment inhibited the metabolism and increased the absorption of warfarin in rats and increased the effect of anticoagulant effect, suggesting that the optimal dose of warfarin for patients at high altitude should be reassessed.

Optimising antidiabetic medication management for type 2 diabetes and renal dysfunction in Can Tho City, Vietnam.

The research aimed to delineate and investigate the utilisation of antidiabetic drugs in type 2 diabetes patients with kidney failure at a hospital in Can Tho City, Vietnam. The research analysed the use of antidiabetic drugs at various time points, determined the drug interaction rate, and evaluated the appropriate use of drugs and the relationship with the achievement of target blood glucose and HbA1c levels. A two-tailed Student's t-test was employed to compare continuous variables, an ANOVA test was used to assess multiple values, and an χ2 test was utilised to evaluate categorical variables. Insulin monotherapy was the predominant regimen for treating type 2 diabetes in patients with impaired kidney function. Metformin was the most prescribed oral medication. Approximately 85.78% of patients received safe and appropriate diabetes treatment. Statistical analysis revealed a significant relationship between achieving target blood glucose and HbA1c after 3 months and factors such as safe drug use and minimal drug interactions (p < 0.05). Patients with chronic kidney disease demonstrated better blood glucose control compared to those with acute kidney disease. The most common drug used for type 2 diabetes patients with impaired kidney function was insulin monotherapy, with usage increasing with the severity of chronic kidney disease. The chronic kidney disease group exhibited a higher rate of achieving target blood glucose and HbA1c compared to the acute kidney disease group. Rational, safe, and interaction-free drug use significantly contributed to better blood sugar control compared to less prudent medication choices.

Comparison of Imipenem Prescription Model in Imam Khomeini and Taleghani Educational Center of Urmia

Introduction: Drug utilization evaluation (DUE) studies are designed to evaluate the rational use of drugs. Our purpose in this study is to evaluate the pattern of Imipenem, a broad-spectrum antibiotic used in different parts of Imam Khomeini and Taleghani Educational Center of Urmia.&#x0D; Method and material: This is a cross-sectional and retrospective study. The study was conducted by reviewing medical records of 200 admitted patients who received Imipenem during March 2016 to 2017.&#x0D; Results: In the study Imipenem was prescribed most frequently for intra-abdominal infection in 71 cases (35.5%), 41cases (20.5%) respiratory infection, 31 cases (15.5%) urinary tract infection, 25 cases (12.5%) skin infection, 15 (7.5%) cases septicemia infection, 7 (3.5%) cases bone and neutropenic infection, endocarditis infection were reported in 3 cases (1.5%). The highest incidence was related to intra-abdominal infections. 61% of Talehgsni hospital patients and 46% of Imam Khomeini hospital patients received Imipenem less than a week. The used dose in all patients was between one to four grams per day and the frequency of use was not correct in 7% of Taleghani hospital patients and 23% of patients in Imam Khomeini hospital.&#x0D; Conclusion: Some AB combination was proved to be inappropriate to the guidline consedering the indication or the microorganism to be covered. It is necessary to take action to improve prescribing habit in order to reduce the unnecessary usage of antibiotic thus enhance rational antibiotic use.

A Study on OTC Products in India and Europe: Market Prospective

India has a growing market for pharmaceutical over-the-counter medications, which indicates that the pharmaceutical industry in this nation is expanding rapidly. In the past ten years, the Indian pharmaceutical business has experienced a significant change in marketing tactics. Companies actively publicize their over-the-counter products to promote them. In contrast to Europeans who rely on their local chemist to treat small ailments, North Americans place a greater emphasis on seeking medical guidance for treating minor ailments. Only ongoing public education with a broad perspective on the good health and wellbeing of society may raise awareness of rational drug use. Compared to other consumer commodities, OTC medications have significant brand loyalty. But going forward, it is also expected that merchants with strong sales capacities will be able to boost the market presence of their own private-label goods. The government and several pharmaceutical firms are undertaking a number of programmes to raise awareness about various medications and shift Rx to OTC.

EFFECTS OF E-HEALTH LITERACY ON RATIONAL DRUG USE: THE MEDIATING ROLE OF HEALTH PERCEPTION

Rational drug use can make important contributions to the treatment of diseases. Many factors affect rational drug use. This research was undertaken with the aim of defining the mediating role of health perception (HP) in the effect of e-health literacy (eHL) on rational drug use (RDU). The research presented here was performed between March 11 and April 29, 2023, in the Istanbul and Kocaeli provinces and their districts in Türkiye. Data were collected from individuals residing in Istanbul and Kocaeli provinces or in their districts aged 18 and over by online survey method. A total of 520 questionnaires were collected in this process. The findings revealed that eHL positively affects HP. Moreover, eHL and HP positively affect RDU. Finally, it was determined that HP has a mediating role in the effect of eHL on RDU. The research presented here has confirmed that eHL and HP are determinants of RDU. According to these results, some suggestions are presented.

The effect of long-term drug use on rational use of medicines in children with medical illness

Introduction: This study was conducted to investigate the effect of long-term drug use due to medical diseases on rational drug use in children, using data obtained from parents. It is a cross-sectional study. Methods: Among the 288 parents who applied to the pediatric outpatient clinics of Muğla Training and Research Hospital between January 1, 2022 and March 31, 2022; 144 people with children aged 0-12 who have a chronic disease and have been using regular medication for at least three months are included in the research group, 144 people who did not have a chronic disease and did not use medication constantly were determined as the control group. In addition to the form containing sociodemographic data and questions to evaluate rational drug use awareness, knowledge, attitudes and behaviors, the "Parental Attitude Scale For Rational Drug Use (PASRDU)" was answered through a face-to-face interview. Data analysis was conducted with SPSS 26 program with a confidence level of 95%. Parental Attitude Scale For Rational Drug Use scores showed normal distribution in both groups. Independent samples t-test was used to compare Parental Attitude Scale For Rational Drug Use scores according to groups, a chi-square test was used to compare the relationship between groups and categorical (grouped) variables, and a two-way ANOVA test was used to compare demographic characteristics and group variables according to Parental Attitude Scale For Rational Drug Use scores. Results: Of the parents participating in the study, 67.71% were mothers and 32.29% were fathers. The average age was 34.88±6.44 years in the research group and 33.57±6.57 years in the control group. The rates of having chronically ill individuals at home and individuals constantly using medication at home are higher in the research group and are statistically significant. While the presence of leftover or spare medication at home was be similar in the research and control groups, the rate of using these medications when necessary was 45.8% in the research group and 56.3% in the control group. While 43.1% of those in the research group did not give over-the-counter medicine to their children, this rate was 16% in the control group. The control group uses over-the-counter vitamins twice as much as the research group. The most commonly used over-the-counter medication in the entire population is antipyretics with a rate of 44.79%. The scores of the research group in Parental Attitude Scale For Rational Drug Use and its subscales are higher than the control group and are statistically significant. The place of residence for the longest time, educational level, having too much medication at home, and using non-prescription medication statistically affect the scores. In addition, the duration of the disease of the children in the research group significantly affected the Parental Attitude Scale For Rational Drug Use total score and the Accurate and Conscious Use subscale, and the disease group significantly affected the Effective and Safe Use subscale score. Conclusion: According to our research, long-term use of medication in children due to medical illness affects rational drug use. Accurate and current information is required in the preparation and use of drugs used in children due to the change in dosage and pharmaceutical form depending on age. In addition, herbal products and food supplements are also used during childhood. Therefore, the knowledge, attitudes and behaviors of healthcare professionals and parents affect children’s health. As studies on rational drug use in different regions in our country increase, more detailed and separate planning can be made for drugs used in childhood while preparing education and policies for rational drug use.

The use of antihypertension in hypertension patients with chronic kidney failure at the Universitas Gadjah Mada (UGM) Academic Hospital, Yogyakarta

According to the 2018 Indonesian Basic Health Research data, the prevalence of hypertension in the Yogyakarta Special Region (11.0%) is higher than the national average of 8.8%. Hypertension with chronic kidney failure is currently a prevalent and increasing issue. This study aimed to investigate the pattern and rationality of antihypertensive use in hypertension patients with chronic kidney failure (CKF) participating in the National Health Insurance (Jaminan Kesehatan Nasional/JKN) program at Universitas Gadjah Mada (UGM) Academic Hospital period of 2020 to 2022. The study was conducted using quantitative descriptive non-experimental methods. Data collection was carried out retrospectively through medical records of patients diagnosed with hypertension with CKF (ICD I12.0). Samples were selected using purposive techniques and analyzed by comparing the suitability of drug selection with standard hypertension therapy with CKF based on JNC 8 and NKF-K/DOQI, including the rationality of their use. A total of 68 patients over the age of 18 were used as samples. The The majority of drug groupsresults showed that a combination of 2 drugs is more dominant (52.9%) compared to monotherapy (29.4%) and a combination of 3 drugs (17.6%). The majority of drug groups used were angiotensin receptor blockers (ARBs), especially candesartan (45%). ARB and calcium channel blockers (CCB), especially candesartan+amlodipin (50%), and ARB +CCB+diuretic, especially andesartan +amlodipine + furosemide (33%).. The rationality of drug use showed that 66.2% in the right indications, 89.7% the right drugs, 100% in the right patients and 85% the right doses. Therefore, health workers still need to make efforts to encourage rational drug use.

Time series analysis of using the PDCA method combined with the Teach-back method to improve spontaneous reports of adverse drug reactions in a grade IIIA hospital in China.

Spontaneous reporting of adverse drug reactions (ADRs) is essential for the post-marketing safety evaluation of drugs. Therefore, good monitoring of ADRs is vital for strengthening drug supervision, management, and guiding rational drug use. Chinese medical institutions are the primary source of ADR case reports, but the proportion of the reports in grade IIIA hospitals is still low due to serious under-reporting. The 3rd Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People's Hospital, also has such a problem. To improve the quantity and quality of ADR reports and enhance the level of pharmacovigilance in hospitals, the Third Affiliated Hospital of Chengdu Medical College, People's Hospital of Chengdu Pidu District experienced 10years to gradually establish a management model to improve the medical staff's reporting rate of spontaneous reporting of ADRs. The management model is led by clinical pharmacists and combines the PDCA with Teach-back methods. The purpose of this paper is to introduce the management model and discuss its advantages and shortcomings of this model. This study was conducted at the Third Affiliated Hospital of Chengdu Medical College-Chengdu Pidu District People's Hospital. From 2016, the daily management of reporting, auditing, and data improvement of adverse drug reactions in the hospital was carried out by clinical pharmacists, who used the PDCA method combined with the Teach-back method to continuously improve the reporting program of ADRs in the hospital during 2016-2021. Then, the proportion of spontaneous reports of total, new, and serious ADRs was compared before and after the intervention. Also, we performed a time series analysis using an autoregressive moving average model to assess changes in the total number of spontaneous ADR reports before the intervention (2013-2015), the first intervention (2016-2018), and the second intervention (2019-2021). After the combined PDCA and Teach-back method intervention, the median number of reported ADRs per year increased from 50 (range 37-55) in the pre-intervention period to 88 (range 83-162) in the first intervention period and to 374 in the second (range 312-566). Breakpoint regression analysis of the spontaneous reporting rate of ADRs showed that the instantaneous increase after the first intervention was not statistically significant (P = 0.526). However, the reporting rate of ADRs increased at a month-by-month growth rate during the second intervention compared to the first intervention. Its spontaneous reporting rate improved 1.034 times (P = 0.002). After the second intervention, the spontaneous reporting rate of ADRs transiently increased 6.111-fold (P < 0.001), and the month-to-month growth rate increased 1.024-fold (P < 0.001) again. The management model that combines the PDCA and the Teach-back method significantly improves the reporting rate of adverse drug reactions.

Overview of the Research System Cost-effectiveness of Emicizumab in Preventing Bleeding for People with Hemophilia A

Systematic review research helps provide more scientific evidence for doctors in drug use as well as policymakers for safe, rational, and effective drug use. Emicizumab was first approved by the FDA in 2017 for patients with congenital hemophilia A and was later approved for prophylaxis. However, the high cost of Emicizumab treatment makes it difficult for patients to access the drug as well as pay for this by the insurance fund. A systematic review of studies on Emicizumab in the world that meets the conditions inclusion and exclusion criteria shows that 7 out of 8 studies (accounting for 87.5%) showed results that helped reduce total costs and increase treatment effectiveness compared to the placebo or alternatives. One study (accounting for 12.5%) resulted in increased total costs and reduced effectiveness compared to the intervention substance. Of these seven studies, one study achieved cost-effectiveness, three studies did not achieve cost-effectiveness (because ICER was lower than the willingness-to-pay threshold), and three studies could not be concluded as to whether they achieved cost-effectiveness.&#x0D; Keywords: Systematic review, cost, effectiveness, Emicizumab, Hemophilia A.

Medical Students' Knowledge, Attitudes, and Behaviors Regarding Self-Medication and Rational Drug use

Background: Patients who use drugs in a rational way should get the medicine that is right for them, in the right dose, for the right amount of time, and at the lowest cost to them and their community. In reality, prescribing does not always follow these ideals. Instead, prescribing that is not suitable or logical is what happens most of the time. The study's goals are to find out how common self-medication and legal drug use are among first-year college students in Madinah city so that knowledge in this area can be kept up to date. Methods: The study used a cross-sectional design and looked at medical students in their first year. The sample size was calculated using the Epi Info program, and the number of students was 357 in Madinah City between September 2022 and September 2023. A poll was sent up in the air. As a result, when participants experienced side effects while taking medication, 28.9% stopped taking it, 28.2% talked to their doctor, 19.6% talked to their pharmacist, 13.2% stopped taking the medication and started a new one that had the same effect, 6.2% talked to their family, and 3.9% did nothing. Conclusions: Medical students don't really understand, think about, or act on self-medication or drugs, even though more and more of them are taking antibiotics and medications they didn't get given.

Antibiotic safety among neonates and paediatrics in a public hospital: KwaZulu-Natal.

The World Health Organization (WHO) guidelines recommend the empiric treatment of infections before definitive treatment begins. However, ethical concerns limit the availability of clinical trials in neonates and paediatrics to fully ascertain the safety profile of antibiotics in these populations. This study aimed to quantify the use of antibiotics among neonates and paediatrics and commented on the use, rationale and appropriateness of antibiotics prescribed. A secondary level public sector hospital located in Durban, KwaZulu-Natal. Demographic and treatment information of neonates and paediatrics were collected retrospectively from January 2022 to June 2022. Data were obtained from patient files and extracted for analysis using Microsoft Excel®. Analytical and descriptive statistics were used to analyse patient demographics and treatment variables. A total of 568 antibiotics, issued to 389 patients, were reviewed. Penicillins (40.1%), aminoglycosides (24.3%) and combination penicillin-beta-lactam inhibitors (23.3%) were identified as the most frequently prescribed antibiotics for inpatients. Most antibiotics prescribed to inpatients were for complications associated with pre-term birth (66.9%). Combination penicillin-beta-lactam inhibitors (34.7%), penicillins (29.5%) and cephalosporins (29.5%) were the most frequently prescribed antibiotics to outpatients. A correlation was found between the route of administration and the duration of therapy; the intravenous route (63.6%) was preferred over the oral route (36.4%) for administration. Many broad-spectrum antibiotics were prescribed, thus increasing the risk of resistance. Antibiotics were being prescribed according to the guidelines; however, there is still a need for therapeutic drug monitoring to ensure the continuation of rational drug use. There was evidence of rational use of antibiotics in the public hospital (KwaZulu-Natal), in keeping with economic and availability factors.

The Relationship Between Self-Awareness of Rational Drug Use and Health Literacy in Adult Individuals: A Cross-Sectional Study

Giriş: Bireylerin sağlık okuryazarlık düzeylerinin yükseltilmesi ve akılcı ilaç kullanımı konusunda farkındalık kazandırılması sağlık sisteminin gelişmesinde ve etkin işleyişinde büyük önem taşımaktadır. Amaç: Bu çalışmanın amacı, yetişkin bireylerde akılcı ilaç kullanımı öz farkındalığı ile sağlık okuryazarlığı arasındaki ilişkinin belirlenmesidir. Yöntem: Tanımlayıcı ve kesitsel türde yürütülen bu araştırmanın örneklemini 3500 kişi oluşturdu. Veriler Demografik Bilgi Formu, Akılcı İlaç Kullanımı Farkındalığı ve Sağlık Okuryazarlığı Ölçeği kullanılarak Eylül 2022- Kasım 2022 tarihleri arasında çevrimiçi olarak toplanmıştır. Bulgular: Katılımcıların akılcı ilaç kullanımı farkındalığı ve sağlık okuryazarlık düzeyleri genel olarak yüksek düzeydedir. Ancak eğitim düzeyi azaldıkça ve yaş arttıkça sağlık okuryazarlık düzeyinin azaldığı görülmektedir. Ayrıca akılcı ilaç kullanımı farkındalığı ile sağlık okuryazarlık arasında pozitif yönlü bir ilişki olduğu saptanmıştır. Sonuç: Araştırma sonucunda, sağlık okuryazarlığı arttıkça, akılcı ilaç kullanımı öz farkındalığının arttığı belirlenmiştir. Toplumda tüm yaş grubundaki bireylere akılcı ilaç kullanımı farkındalığı kazandırılması ve sağlık okuryazarlığı düzeyinin yükseltilmesi sağlık sisteminin etkin işleyişi ve toplumsal sağlığın yükseltilmesinde oldukça önemlidir.

Investigation of Rational Drug Use and Health Perception Levels of Caregivers for Individuals with Chronic Diseases: A Hospital Example

Objective: This research aimed to determine the investigation of rational drug use and the health perception level of caregivers for individuals with chronic diseases. Materials and Methods: This descriptive study was conducted at the public hospital in Şırnak city centre between December 2022 and February 2023. The sample of the study consisted of 242 caregivers. The research data were gathered from the socio-demographic characteristics form, the rational drug use scale, and the health perception scale. In addition to descriptive analysis, independent t-test, ANOVA, correlation, and regression analysis were used in statistical analysis. Results: The average age of caregivers is 39.25±12.45, the average age of patients requiring care is 64.73±12.50, and the patient care duration is 3.39±2.03 years. Rational Drug Use Scale mean score was 37.29±5.62, Health Perception Scale mean score was 40.14±7.93, and there was a positive significant correlation between the Rational Drug Use and Health Perception mean scores (p&amp;lt;0.01). Their socio-demographic characteristics significantly affect caregivers' rational drug use and health perception (p&amp;lt;0.05). Conclusions: It was determined that caregivers had a moderate level of rational drug use and health perception. As a result, caregivers are an essential component of healthcare services, and health education should be provided.

Distribution characteristics of the Legionella CRISPR-Cas system and its regulatory mechanism underpinning phenotypic function.

Legionella is a common intracellular parasitic bacterium that infects humans via the respiratory tract, causing Legionnaires' disease, with fever and pneumonia as the main symptoms. The emergence of highly virulent and azithromycin-resistant Legionella pneumophila is a major challenge in clinical anti-infective therapy. The CRISPR-Cas acquired immune system provides immune defense against foreign nucleic acids and regulates strain biological functions. However, the distribution of the CRISPR-Cas system in Legionella and how it regulates gene expression in L. pneumophila remain unclear. Herein, we assessed 915 Legionella whole-genome sequences to determine the distribution characteristics of the CRISPR-Cas system and constructed gene deletion mutants to explore the regulation of the system based on growth ability in vitro, antibiotic sensitivity, and intracellular proliferation of L. pneumophila. The CRISPR-Cas system in Legionella was predominantly Type II-B and was mainly concentrated in the genome of L. pneumophila ST1 strains. The Type II-B CRISPR-Cas system showed no effect on the strain's growth ability in vitro but significantly reduced resistance to azithromycin and decreased proliferation ability due to regulation of the lpeAB efflux pump and the Dot/Icm type IV secretion system. Thus, the Type II-B CRISPR-Cas system plays a crucial role in regulating the virulence of L. pneumophila. This expands our understanding of drug resistance and pathogenicity in Legionella, provides a scientific basis for the prevention of Legionnaires' disease outbreaks and the rational use of clinical drugs, and facilitates effective treatment of Legionnaires' disease.

Tibetan medicine Bang Jian: a comprehensive review on botanical characterization, traditional use, phytochemistry, and pharmacology.

Tibetan medicine Bang Jian refers to a range of botanical drugs within the Gentiana genus. It serves as a prominent traditional Tibetan botanical drug primarily found in the ethnic minority regions of the Qinghai-Tibet Plateau in China. Traditionally, the dried flowers of Bang Jian, known as "Longdanhua" have been employed in Tibetan medicine to address detoxification, pharyngeal relief, acute and chronic bronchitis, bronchiectasis, lung infections, pulmonary fibrosis, and throat disorders. Surprisingly, there has been no comprehensive review published to date on Tibetan medicine Bang Jian. This passage systematically presents and critically assesses recent advancements in botanical characterization, traditional applications, phytochemistry, pharmacology, and clinical uses of Bang Jian, aiming to provide a scientific foundation for its reasonable use and further exploration. To date, researchers have isolated and identified 92 structurally diverse compounds, with a predominant presence of iridoids, flavonoids, xanthones, and triterpenoids. The crude extracts and metabolites derived from Bang Jian have been found to exhibit a wide range of pharmacological effects, encompassing anti-inflammatory, anti-tumor, anti-bacterial, antiviral, antioxidant, hepatoprotective properties, and protect the respiratory system. Nevertheless, detailed data on the biological effects, metabolic activities, and mechanistic research concerning active monomer metabolites remain insufficient. Consequently, there is a pressing need for comprehensive and in-depth research to guide rational clinical drug usage and evaluate the medicinal attributes of Bang Jian.