Parental health-seeking behavior on self-medication, antibiotic use, and antimicrobial resistance in children.

Aim and Objectives: The study sought to identify parental trends in children's self-medication, health-seeking behavior, knowledge of self-medication, antibiotic use, and antimicrobial resistance in Asir, Saudi Arabia. Methods: A web-based cross-sectional study was carried out by a survey questionnaire. Snow Ball sampling technique was used to select the Eight hundred and sixteen parents with children in the Asir region by WhatsApp and email, and 650 participants who met the inclusion criteria consented to participate in the study. Results: There were 1809 episodes of childhood illnesses reported during the study period. The mean scores are on knowledge at 8.11 ±â€¯2.43, favorable attitude at 17.60 ±â€¯1.17, and practice was 7.72 ±â€¯1.72, and a significant correlation was found between knowledge, attitude, and practice (KAP) at p = 0.01. Out of 624, the majority of parents showed strong knowledge and proficiency in antibiotics. However, the attitude scores of over 50% towards the usage of antibiotics were subpar. Around 54% of parents were self-medicating their children and 43% were unaware that skipping doses contributes to anti-microbial resistance (AMR). The facilitators for self-medication were male gender (aOR: 2.13; 95% CI: 1.26-3.98, p < 0.05), having more children (aOR: 2.78; 95% CI: 1.27-4.12 p < 0.01), professional qualification (aOR:3.07; 95% CI 1.57- 4.68; p < 0.01), residing in urban area (aOR: 3.17; 95% CI: 2.13-5.61, p < 0.05), working in health care (aOR: 5.99; 95% CI: 1.78-18.2, p < 0.01) and high income (aOR: 3.57; 95% CI: 2.08-6.34, p < 0.05). Conclusions: The findings indicated that the majority of parents had unfavorable views and improper practices of antibiotic usage. Strategic education programs to the targeted population, especially to the parents about side effects of antibiotics, dangerous consequences of self-medication, and crucial AMR concerns must be addressed immediately.

Cardiovascular Disease-Related Health Promotion and Prevention Services by Pharmacists in Saudi Arabia: How Well Are They Prepared?

BACKGROUND: Cardiovascular diseases (CVDs) have been identified as the leading reason for morbidity and mortality in Saudi Arabia. Pharmacists play a major role in CVD prevention and health promotion. We aimed to assess the knowledge, attitudes, and involvement of pharmacists in CVD prevention and evaluate the influence of continuing medical education in CVD-prevention services in Saudi Arabia. METHOD: A cross-sectional study was conducted to evaluate the involvement of pharmacists in CVD-related prevention services along with their knowledge and attitudes. A 34-item questionnaire was developed and distributed among the participants. RESULTS: A total of 324 responses were included in the study. More than 60% of pharmacists had provided counseling regarding the importance of healthy lifestyles and self-monitoring CVD risk factors. About half of the participants (49.1%) had never received any CVD-related continuing medical education. Overall, more than 60% of the participants reported positively towards their role in CVD prevention. Lack of time (66%) and lack of educational materials and tools (41%) were the top perceived barriers for providing CVD-prevention and health-promotion activities, followed by lack of skills in using tools (36%) and lack of privacy/space (33%). CONCLUSIONS: The involvement of pharmacists in the prevention of CVD is limited in this study. Further education and capacity building are required to strengthen pharmacists' involvement in CVD-prevention and health-promotion activities.

Formulation of Intranasal Mucoadhesive Thermotriggered In Situ Gel Containing Mirtazapine as an Antidepressant Drug.

The purpose of the present work was to develop nanoemulsion-based formulations of mirtazapine for intranasal delivery using a spray actuator to target the brain for treating depression. Research on the solubility of medications in different oils, surfactants, co-surfactants, and solvents has been done. Using pseudo-ternary phase diagrams, the various ratios of the surfactant and co-surfactant mix were computed. Thermotriggered nanoemulsion was formulated using different concentrations of poloxamer 407 (i.e., 15%, 15.5%, 16%, 16.5% up to 22%). Similarly, mucoadhesive nanoemulsion using 0.1% Carbopol and water-based plain nanoemulsions were also prepared for comparative assessment. The developed nanoemulsions were analyzed for physicochemical properties, i.e., physical appearance, pH, viscosity, and drug content. Drug-excipient incompatibility was determined by Fourier transform infrared spectral (FTIR) analysis and differential scanning calorimetry (DSC). In vitro drug diffusion studies were conducted for optimized formulations. Among the three formulations, RD1 showed the highest percentage of drug release. Ex vivo drug diffusion studies were conducted on freshly excised sheep nasal mucosa with Franz diffusion cell simulated nasal fluid (SNF) for all three formulations up to 6 h, and the thermotriggered nanoemulsion (RD1) showed 71.42% drug release with 42.64 nm particle size and a poly dispersity index of 0.354. The zeta potential was found to be -6.58. Based on the above data, it was concluded that thermotriggered nanoemulsion (RD1) has great potential to be used as an intranasal gel for treating depression in patients. It can offer great benefits by reducing dosing frequency and improving bioavailability of mirtazapine by direct nose-to-brain delivery.

Antidepressant and Anxiolytic Potentials of the Chewing Stick, Salvadora persica.

Materials and Methods: Salvadora persica stem bark was extracted with two different solvents, i.e., ethyl acetate and water, and preliminary phytochemical screening was performed. Two behavioral models were used: an elevated plus maze test (EPM) and the light and dark model test for anxiolytic parameters, and a forced swim test (FST) for antidepressant effects. Healthy mice weighing 18-40 gms were treated orally in four groups (n = 6), i.e., negative control treated with normal saline and positive control with 1 mg/kg diazepam (EPM) and 30 mg/kg fluoxetine (FST), and the test groups were treated with 500 mg/kg of aqueous and ethyl acetate Sp extract. The number of entries and duration spent in the open arm for 5 minutes were the parameters for evaluating the anxiolytic activity (EPM). Duration of immobility was measured for 5 min in the FST model. Results: In EPM, both the Sp extracts significantly (p < 0.005) increased the number of entries and the time spent in the open arms and was much similar to those of diazepam. Similarly, these extracts and fluoxetine significantly (p < 0.005) decreased the immobility time in FST. Conclusion: The results suggest the therapeutic potential of Salvadora persica an alternative in the management of comorbid anxiety and depression.

Evaluation of Health Care Professionals' Knowledge, Attitudes, and Practice to Prevent the Pandemic Spread of COVID-19: A Questionnaire-Based Cross-Sectional Study from Abha, Saudi Arabia.

BACKGROUND: Pharmacists and other healthcare professionals (HCPs) are at risk of transmitting the lethal COVID-19 virus globally and increasing its prevalence. AIM: The aim of this study was to assess knowledge, attitudes, and practices (KAP) about coronavirus disease 2019 (COVID-19) among HCPs in the Asir region for the first time. METHODOLOGY: A cross-sectional analysis with 491 healthcare professionals was tested using a pre-tested questionnaire in a tertiary care facility. The association between research variables and questions was determined using Chi-square tests and Kruskal-Wallis tests. RESULTS: Pharmacists and other HCPs exhibited good knowledge, a positive attitude, and a negative practice pattern regarding COVID-19. There was a strong association between knowledge and attitude (correlation coefficient: 0.17; p < 0.001). However, healthcare practitioners had a suboptimal practice score of 2.09 ± 0.62 regarding COVID-19. CONCLUSION: This study discovered that despite relatively insufficient practices for adherence to recommended techniques regarding COVID-19 prevention during the outbreak, pharmacists and other healthcare professionals have a high level of awareness and a positive attitude towards COVID-19 as a medical condition. There is a need for more involved HCPs, improved COVID-19 management training, and approaches to make healthcare providers feel less anxious.

Medicinal Plants of Solanum Species: The Promising Sources of Phyto-Insecticidal Compounds.

Several medicinal plants have the potential to be a promising alternative pharmacological therapy for a variety of human illnesses. Many insects, including mosquitoes, are important vectors of deadly pathogens and parasites, which in the world's growing human and animal populations can cause serious epidemics and pandemics. Medicinal plants continue to provide a large library of phytochemicals, which can be used to replace chemically synthesized insecticides, and utilization of herbal product-based insecticides is one of the best and safest alternatives for mosquito control. Identifying new effective phyto-derived insecticides is important to counter increasing insect resistance to synthetic compounds and provide a safer environment. Solanum genus (Solanaceae family or nightshades) comprises more than 2500 species, which are widely used as food and traditional medicine. All research publications on insecticidal properties of Solanaceae plants and their phytoconstituents against mosquitoes and other insects published up to July 2020 were systematically analyzed through PubMed/MEDLINE, Scopus, EBSCO, Europe PMC, and Google Scholar databases, with focus on species containing active phytoconstituents that are biodegradable and environmentally safe. The current state of knowledge on larvicidal plants of Solanum species, type of extracts, target insect species, type of effects, name of inhibiting bioactive compounds, and their lethal doses (LC50 and LC90) were reviewed in this study. These studies provide valuable information about the activity of various species of Solanum and their phytochemical diversity, as well as a roadmap for optimizing select compounds for botanical repellents against a variety of vectors that cause debilitating and life-threatening human diseases.

Strategies to Improvise Organ Donor Pool: A Study on the Knowledge, Attitudes, and Performance of Higher Secondary School Teachers Towards the Organ Donation.

Introduction: This study aimed to assess higher secondary school teachers' knowledge, attitude, and performance levels towards organ transplantation and donation (OTD). Teachers have an essential role in giving knowledge to children and teenagers, and they can influence their views. Organ transplantation offers re-life to many patients, yet organ shortages are a global issue. Teachers who influence students' future attitudes regarding organ donation must have a favorable attitude and genuine knowledge. Materials and Methods: The research method was descriptive and cross-sectional. The sample size was 372 school teachers in Villupuram district of Tamilnadu, India, selected using a convenient sampling method. A survey questionnaire was used to assess the knowledge and attitude about OTD, the reason for donating/not donating organs. Multivariate analysis was performed to identify critical variables affecting intent to practice. Results: The teachers' mean scores with SD on knowledge, attitude, and performance were 7.61 ± 2.74, 8.81 ± 2.08, and 0.38 ± 0.11, respectively. The linear regression analysis showed that the knowledge (p < 0.001) and attitude (p < 0.05) of the participants were positively associated with organ donation performance. A significant relationship was also observed between gender (p < 0.036), age (p < 0.01), and education status (p < 0.001) with the performance of the teachers. Lack of family support was the most spelt reason for unwillingness for organ donation. Conclusion: The positive linear correlations underline that having more information may lead to a more optimistic mindset and, as a result, to better practices. Teachers should be provided with overall health teaching campaigns to increase the number of possible organ donors. Teachers serve as role models for students, families, and society by changing their attitudes.

Alternate Warm and Cold Therapy (AWCT) on Uricemia, Sleep, Pain, Functional Ability, and Quality of Life (USPFQoL) in Patients with Gout: A Path Forward.

Objective: To understand the impact of alternate warm and cold therapy (AWCT) on uricemia, sleep, pain, functional ability, and quality of life in gout patients. Methods: A quasiexperimental, nonequivalent control group, pre and posttest design was adopted among 120 gout patients. The data were collected on demographics, comorbidities, pain level, joint swelling/joint tenderness, patient global assessment of response to treatment (PGART), health-related quality of life (HRQoL) with SF-36, sleep quality by Pittsburgh Sleep Quality Index (PSQI), and serum uric acid and assessed. Descriptive and inferential statistics were used to analyze the data. Results: Patients had mean age of 58 and 61 years, mean number of comorbidities was 1.8 and 1.4, as well as presence of arthritic comorbidities except gout was 1.1 and 0.8 among study and control group participants, respectively. Pain (p < 0.001), PGART (p=-0.01), HRQoL, sleep quality, and level of SUA (mg/dl) improved significantly (p < 0.01) among the study group over study periods. It affirms that the AWCT is effective in reducing pain, functional disability, and SUA, as well as improving the sleep quality and HRQoL of the gout patients. There was a reduced incidence of gout flares (p < 0.001), and taking additional medicines for pain (p < 0.01) was statistically significant among study participants. Except social functioning, other domains of health were significantly (p < 0.05) affected by the comorbidities like hypertension, diabetes, heart disease, renal disease, and asthma/chronic obstructive pulmonary disease. Conclusions: Gout is independently associated with higher medical and arthritic comorbidity, and AWCT can be better and cost-effective alternative therapy for gout patients. In addition, it may lead to improved cardiac function, hypertension, and renal insufficiency.

Alleviation of neuropathic pain by trazodone in rats

Abstract Neuropathic pain is generally characterised by an abnormal sensation (dysesthesia), an increased response to painful stimuli (hyperalgesia), and pain in response to a stimulus that does not normally provoke pain (allodynia). The present study was designed to investigate the effect of trazodone (5mg/kg and 10mg/kg) on peripheral neuropathic pain induced by partial sciatic nerve ligation in rats. Mechanical hyperalgesia, cold allodynia and thermal hyperalgesia were assessed by performing the pinprick, acetone, and hot plate tests, respectively. Biochemically, lipid peroxidation level and total calcium levels were measured. However, trazodone administration (5 and 10 mg/ kg i.p.) for 21days significantly diminished partial sciatic nerve ligation-induced neuropathic pain along with areduction in oxidative stress and calcium levels. The results of the present study suggest that trazodone is effective in attenuating partial sciatic nerve ligation-inducedpainful neuropathic states, which may be attributed to decreased oxidative stress and calcium levels.

Association of Maternal Observation and Motivation (MOM) Program with m-Health Support on Maternal and Newborn Health.

Maternal and child nutrition has been a critical component of health, sustainable development, and progress in low- and middle-income countries (LMIC). While a decrement in maternal mortality is an important indicator, simply surviving pregnancy and childbirth does not imply better maternal health. One of the fundamental obligations of nations under international human rights law is to enable women to endure pregnancy and delivery as an aspect of their enjoyment of reproductive and sexual health and rights and to live a dignified life. The aim of this study was to discover the correlation between the Maternal Observation and Motivation (MOM) program and m-Health support for maternal and newborn health. A comparative study was done among 196 pregnant mothers (study group-94; control group-102 mothers) with not less than 20 weeks of gestation. Maternal outcomes such as Hb and weight gain and newborn results such as birth weight and crown-heel length were obtained at baseline and at 28 and 36 weeks of gestation. Other secondary data collected were abortion, stillbirth, low birth weight, major congenital malformations, twin or triplet pregnancies, physical activity, and maternal well-being. The MOM intervention included initial face-to-face education, three in-person visits, and eight virtual health coaching sessions via WhatsApp. The baseline data on Hb of the mothers show that 31 (32.98%) vs. 27 (28.72%) mothers in the study and control group, respectively, had anemia, which improved to 27.66% and 14.98% among study group mothers at 28 and 36 weeks of gestation (p < 0.001). The weight gain (p < 0.001), level of physical activity (p < 0.001), and maternal well-being (p < 0.01) also had significant differences after the intervention. Even after controlling for potentially confounding variables, the maternal food practices regression model revealed that birth weight was directly correlated with the consumption of milk (p < 0.001), fruits (p < 0.01), and green vegetables (p < 0.05). As per the physical activity and maternal well-being regression model, the birth weight and crown-heel length were strongly related with the physical activity and maternal well-being of mothers at 36 weeks of gestation (p < 0.05). Combining the MOM intervention with standard antenatal care is a safe and effective way to improve maternal welfare while upholding pregnant mothers' human rights.

School-Based Exercise and Life Style Motivation Intervention (SEAL.MI) on Adolescent's Cardiovascular Risk Factors and Academic Performance: Catch Them Young.

There are shreds of evidence of shared biological mechanisms between obesity and hypertension during childhood intoadulthood, and loads of research literature has proven that it will profoundly cost nations' economies and health if neglected. The prevention and early diagnosis of cardiovascular risk factors such as overweight and hypertension is an essential strategy for control, effective treatment and prevention of its' complications. The study aims to assess the effect of school-based Exercise and Lifestyle Motivation Intervention (SEAL-MI) on adolescents' cardiovascular risk factors and academic performance. An experimental study was conducted among 1005 adolescents-520 and 485 were randomly selected for the control and study groups, respectively.A structured interview questionnaire was used to collect demographic details and data related to dietary habits, physical activity, sleep qualityand academic performance. The study group adolescents were given the SEAL-MI for six months, including a school-based rope exercise for 45 min per day for 5 days a week and a motivation intervention related to dietary habits, physical activity, and sleep. Post tests-1 and 2 were done after 3 and 6 months of intervention.The prevalence of overweight among adolescents was 28.73%, and prehypertension was 9.26%. Among overweight adolescents, the prevalence of prehypertension was found to be very high (32.25%). There was a significant weight reduction in post-intervention B.P. (p = 0.000) and improvement in dietary habits, physical activity, sleep (p = 0.000), and academic performance. A significant positive correlation was found between BMI and SBP (p = 0.000) and BMI and academic performance (p = 0.003). The linear regression analyses revealed that the gender (ß: 0.47, 95% CI: 0.39, 0.81), age (ß: 0.39, 95% CI: 0.17, 0.46), family income (ß: 0.2, 95% CI: 0.41, 0.5), residence (ß: 0.19, 95% CI: 0.01, 0.27), and type of family (ß: 0.25, 95% CI: 0.39, 0.02) had the strongest correlation with the BMI of the adolescents. Additionally, Mother's education (ß: 0.35, 95% CI: 0.18, 0.59) had the strongest correlation with the SBP of the adolescents. In contrast, the DBP was negatively persuaded by age (ß: -0.36, 95% CI: 1.54, 0.29) and gender (ß: -0.26, 95% CI: 1.34, 0.12) of the adolescents. Regular practice of rope exercise and lifestyle modification such as diet, physical activity, and quality sleep among adolescents prevent and control childhood CVD risk factors such asoverweight and hypertension. The SEAL-MI may lead to age-appropriate development of adolescents as well as improve their academic performance and quality of life. Giving importance to adolescents from urban habitats, affluent, nuclear families, and catching them young will change the disease burden significantly.

Social Support, Self-Care Behaviour and Self-Efficacy in Patients with Type 2 Diabetes during the COVID-19 Pandemic: A Cross-Sectional Study.

Diabetes mellitus is a major public health issue that considerably impacts mortality, morbidity, and healthcare costs worldwide. The COVID-19 pandemic has created havoc in diabetes management, too, like other spectrums of life. A descriptive, cross-sectional study was adopted to determine the effect of Social Support, Self-Care Behaviour and Self-Efficacy in Type 2 Diabetes Mellitus (T2D) during this COVID-19 pandemic. Two hundred T2D patients who satisfied the inclusion criteria were chosen using a convenient sampling procedure. The tool consists of four sections, including socio-demographic characteristics, Multidimensional Scale of Perceived Social Support (MSPSS), revised Summary of Diabetes Self-Care Activities (SDSCA) Scale and modified Diabetes Management Self-Efficacy Scale (DMS). Descriptive and inferential statistics were used to analyze the obtained data. The mean and SD of diabetic management self-efficacy is 5.74 (1.95) and 4.37 (1.4), respectively, for patients with HbA1c < 6.5% and HbA1c ≥ 6.5%. The self-care activities of the patients who had good glycemic control were 4.31 (2.06) compared to 3.50 (1.73) who did not. The social support received by the patients was 6.13 (2.13) vs. 5.31 (1.67) among patients with glycemic control vs. no control. The results show that social support (p = 0.04), self-efficacy (p =0.01) and self-care activities (p = 0.001) were significantly related to the level of glycemic control of the T2D patients. A significant relationship was also identified between gender (p = 0.036), age (p = 0.001) and education status (p = 0.000) with HbA1c control of the participants. This study demonstrates a significant relationship between social support, self-care behaviours, self-efficacy and glycemic management in T2D patients. During this COVID-19 pandemic, interventions to enhance the self-care activities like exercise and social support to boost their self-efficacy; for better diabetes management, reducing diabetes complications or prolonging their onset are the need of the hour.

A Subset of Primary Polydipsia, "Dipsogneic Diabetes Insipidus", in Apparently Healthy People Due to Excessive Water Intake: Not Enough Light to Illuminate the Dark Tunnel.

Dipsogenic diabetes insipidus (DDI) is a subtype of primary polydipsia (PP), which occurs mostly in healthy people without psychiatric disease. In contrast, PP is characterized by a polyuria polydipsia syndrome (PPS) associated with psychiatric illness. However, the pathogenesis of DDI is not well established and remains unexplored. In order to diagnose DDI, the patient should exhibit excessive thirst as the main symptom, in addition to no history of psychiatric illness, polyuria with low urine osmolality, and intact urine concentrating ability. Treatment options for DDI remain scarce. On this front, there have been two published case reports with successful attempts at treating DDI patients. The noteworthy commonalities in these reports are that the patient was diagnosed with frequent excessive intake of water due to a belief that drinking excess water would have pathologic benefits. It could therefore be hypothesized that the increasing trend of excessive fluid intake in people who are health conscious could also contribute to DDI. Hence, this review provides an overview of the pathophysiology, diagnosis, and treatment, with a special emphasis on habitual polydipsia and DDI.