Development and pharmaceutical evaluation of oral fast dissolving thin film of escitalopram: A patient friendly dosage form.

The current study focused on the development, optimization and pharmaceutical evaluation of a mouth dissolving film of Escitalopram 5mg. The designing and optimization of the formulations have been carried out through Design-Expert ⌖ Ver. 9, using central composite response surface methodology. The software generated six optimized formulations have been fabricated via solvent casting method incorporated with HPMC and PEG 400 as Plasticizer. The developed formulations were assessed for various quality attributes including weight variation, drug-excipients interaction, dryness/ tack test, thickness, percent elongation, swelling index, disintegration, folding endurance, surface pH, content uniformity, assay, moisture uptake, stability, and organoleptic properties. A validated spectrophotometric method has been used to ascertain drug content. The formulations were subjected for stability studies for six months in accordance with ICH accelerated stability studies guidelines. No stability issue has been observed. All the test formulations have shown satisfactory in vitro release of escitalopram whereas most promising results have been exhibited by F5 and F6 formulations. The study concluded that a unique, novel, safe and stable formulation of oral fast dissolving thin films of escitalopram can be formulated with ease. The preparation method was simple and reproducible with scale-up tendency so that it can fulfill the need of the commercial manufacturing process.

High prevalence of DR-TB (drug-resistant tuberculosis): An Indicator of public health negligence.

Tuberculosis (TB) is among the 10 most common worldwide causes of mortality. In Pakistan, estimated 510,000 tuberculosis patients had been diagnosed with an occurrence of 276/100,000. As per most recent global TB report 2018, Pakistan is amongst the 30 countries high TB with drug-resistant Mycobacterium tuberculosis particularly MDR (multi-drug resistant strains). A retrospective study had been designed using DR-TB patients' records from January 2013 to the December 2017 year from a public sector hospital in Karachi. Overall 315 drug-resistant tuberculosis patient's data had been incorporated in the study. All data had been analyzed using SPSS version 16 software. Chi-square test had been used to analyze the data with CI (confidence interval) 95% and level of significance 5%. The study result showed that 64.1% MDR patients, 27.9% MTB rifampicin resistance, 4.8% mono-drug resistant , XDR(1.6%), 1% poly-drug resistant and only 0.6% are MDR suspects showing no association of DR-TB with gender (p-value 0.787), age group (p-value 0.757), treatment outcomes (p-value 0.549), year of registration( p-value 0.206), first line treatment history(p-value 0.643) with a 95% confidence interval. The drug resistance TB cases have been periodically rising every year. Early identification is required to reduce the percent mortality and inhibit the disease transmission.

Assessment of Clinicians' Satisfaction With Laboratories at a Public Sector Hospital in Karachi, Pakistan.

Objective The goal of this study was to assess the level of satisfaction of clinicians regarding the provision of information, accessibility, and services by clinical laboratories at a public sector hospital in Karachi, Pakistan. Methods We conducted a cross-sectional survey of 151 participants from a public sector hospital in Karachi to assess their satisfaction regarding the associated laboratories. A five-point Likert scale questionnaire, consisting of 18 study items total, was used. Apart from the sociodemographics, the questionnaire was divided into three main sections: Services, Accessibility, and Provision of Information. The study lasted six months from October 2018 to March 2019. Results Most study participants were women. Less than one-third of the participants were consultants (21.9%). The overall satisfaction score was 62/90, indicating that the respondents were satisfied with most of the items on the scale. Factors such as notification about abnormal test results and courier services provided by the laboratories had the lowest satisfaction score. Conclusion Laboratory services are lacking in certain areas, specifically notifications and courier services, that need development and improvement, both of which can be achieved through seminars and clear communication between the laboratory staff and the associated clinicians.

Hospital Antibiotic Stewardship Programs - Qualitative analysis of numerous hospitals in a developing country.

Antimicrobial stewardship programs (ASP) are an essential practice to prevent increasing resistance against antibiotics. A successful ASP monitors not only prescribing patterns and practices but also contributes in minimizing the toxic effects of antibiotics. Moreover, ASP also facilitates the selection of disease specific antibiotics and enforces rules and regulations to rationalize the use of antibiotics. The aim of the study is to highlight the core elements of Hospital Antibiotic Stewardship Programs in Karachi. The key elements proposed by center of disease control (CDC) such as; leadership, accountability, drug expertise, actions to support optimal antibiotic use, tracking (monitoring antibiotic prescribing, use and resistance), reporting information to staff on improving antibiotic use and resistance and education were evaluated on Yes/No scale. The data was collected from 44 hospitals of different categories in Karachi and all the major elements were studied. It was observed that all the hospitals in one setting failed to comply with all the guidelines. It has been concluded that efforts should be made to design ASP at each hospital and implemented through suitable policies and procedures.

Pharmaceutical quality evaluation of different glimepiride brands marketed in Karachi (Pakistan): In pursuance to global issue of availability and affordability of quality medicines.

Availability of economical quality medicines is always required for chronic disease management. Price differences among multiple brands of a product do not essentially displays low quality for the more affordable brand, however in a few occurrences it appears. Glimepiride, an oral anti-diabetic drug, is produced by several national and multinational industries in Pakistan with considerable cost variation. The study aimed to evaluate the quality and economy of various Glimepiride brands available in Karachi, specifically of public sector hospitals. For this, eight glimepiride brands were collected and analyzed for the pharmaceutical quality using physical parameters, disintegration test, dissolution profile, spectrophotometric assay and content uniformity. Pharmacoeconomic assessment was also carried out such as availability, affordability and price variation. A profound discrepancy was observed among the prices of selected brands. All of the products found to be equivalent to the reference product except G5, the most inexpensive and highest consumed product of a public sector hospital. Study concludes that products with higher quality and lesser price can be used as a substitute to the costly brands while availability of a substandard product looks for consideration of pertinent authorities to assure the distribution of quality medicines.

Prevalence of mecA: Genotyping screening of community acquired-MRSA isolates in Karachi, Pakistan.

Among resistant nosocomial and community pathogens, MRSA has become the most serious pathogen, causing life threatening infections worldwide. In S.aureus, quick and exact recognition of methicillin (cefoxitin) resistance has become essential. The benchmark for MRSA identification among S.aureus is the detection of the mecA gene that causes the expression of protein (PBP2a) culpable for classic ß-lactam resistance. However, the utter reliance on amplification of mecA gene as a hallmark in confirmation of methicillin (cefoxitin) resistant S. aureus is the matter of distrust by some investigators. The current investigation designed to analyse the prevalence of mecA gene among phenotypically positive MRSA isolates using molecular method and to correlate its prevalence to conventional techniques. Furthermore, antimicrobial sensitivity of mecA positive staphylococci was determined by Kirby Baeuer method. For this purpose, 201 clinical staphylococcal specimens were recovered from various diagnostic laboratories in Karachi City, Pakistan. Phenotypic existence of methicillin resistance in S. aureus was observed to be 51.7%. In contrast, when organisms were subjected for amplification of mecA gene by PCR, mecA positive isolates were 36/104 (35%) MRSA isolates. Current work raise question towards the usefulness of molecular identification of mecA gene in confirmation of methicillin resistance without correlating with conventional methods. Therefore, it is essential to consider the other possible resistance mechanisms for ß-lactams that may interact with mecA gene in the development of methicillin resistance mechanism in Staphylococcus.

MRSA: Prevalence and susceptibility pattern in health care setups of Karachi.

This assessment aims to determine the prevalence of methicillin resistance and multidrug resistance (MDR) among the clinical isolates of Staphylococcus aureus and antimicrobial susceptibility profile of methicillin resistant Staphylococcus aureus (MRSA) to the frequently prescribed antibiotics in Karachi. Isolates of MRSA, recovered from various clinical samples were included in this prospective, cross-sectional study from Jan 2015 to June 2017. Agar diffusion method was employed according to the protocols of Clinical Laboratory Standards Institute. Out of total 346 S. aureus strains, the frequency rate of MRSA was 52% (n = 180). MRSA infection was found higher among the age group 21-30 years i.e. 30% (n=54), followed by 20% (n=36) in 31-40 years. Frequency of MRSA percentage in male and female was and 70% and 30% respectively. MRSA was more frequently observed in blood 20% (n=36). MRSA showed high resistance (100%) to Oxacillin and Cefoxitin while 25% Vancomycin resistant S. aureus (VRSA) isolates and 25% Teicoplanin resistance were also reported. MRSA exhibited 16% resistance to Minocycline. It was concluded that MRSA pose a challenging threat to public health in Karachi. In addition, MDR should be periodically checked to avoid treatment failure.