Role of the External Pharmacy in the drug distribution system in public healthcare facilities in Tunisia.

INTRODUCTION: Access to medication is a major public health issue worldwide and can be considered as an indicator of the quality of public health services in a country. AIM: To evaluate patient satisfaction with the services provided by the external pharmacy in the drug distribution circuit in public healthcare facilities in Tunisia. METHODS: To achieve this goal, a satisfaction survey was conducted on a sample of 200 patients at the external pharmacies of two university hospitals in Tunis, namely the La Rabta University Hospital and the Charles Nicolle University Hospital. RESULTS: This survey revealed that despite the efforts made by the state and the importance of the drug market in Tunisia, 80% of patients reported difficulties in finding their medication in the healthcare facilities where they consult, and more than 60% are forced to obtain them from private pharmacies. The survey also highlighted a contrast between the quality of services provided by the external hospital pharmacy and those of private pharmacies. Indeed, only 25% of the surveyed patients were satisfied with the services provided by the external pharmacy. Although this satisfaction was conditioned by several factors, the main concern of the patients remained the availability of medication. In fact, with little difference in terms of care, 80.5% of the participants favored the idea of transferring the services provided by the external pharmacy to private pharmacies. CONCLUSION: In summary, this study has highlighted the need to rethink the drug supply and distribution system and to explore alternative approaches to significantly improve access to medication and the quality of services provided by external pharmacies in Tunisian public hospitals.

Comparative subcutaneous repeated toxicity study of enoxaparin products in rats.

Enoxaparin is a low-molecular-weight heparin widely used for the prevention and treatment of thromboembolism. With the development of several enoxaparin biosimilars, real medical concerns about their safety and efficacy have been raised. This repeated dose toxicity study consists of preclinical toxicological evaluation of a biosimilar biological version of enoxaparin, the drug product "Enoxa", compared to the enoxaparin reference drug product, "Lovenox". Eighty white Wistar rats were treated with "Enoxa" versus the reference product, using subcutaneous therapeutic and toxic doses, varying from 3.5 to 100 mg/kg/day. Dose levels were adjusted and ultimately fixed at 3.5 and 20 mg/kg/day as therapeutic and toxic doses, respectively. A sodium chloride solution (0.9%) was used as the control, and the comparative study was conducted over periods of 14 and 28 days. Comparable effects were observed with few adverse effects at the administration dose of 20 mg/kg/day, for both enoxaparin biosimilar and reference products. Interestingly, mortality started only at high doses of 40 mg/kg/day and reached 25% at 100 mg/kg/day for both products. These results, as part of the recommended biosimilarity monitoring, demonstrated comparable toxicity profiles of "Enoxa" and "Lovenox" products in rats. Continuing investigation of biosimilarity on humans to confirm safety and efficacy is suggested.

Screening of analgesic and anti-inflammatory activities of Citrullus colocynthis from southern Tunisia.

ETHNOPHARMACOLOGICAL RELEVANCE: Inflammations and immune-related diseases such as rheumatoid arthritis are growing global concerns. Most of the drugs from plants which have become important in modern medicine had a folklore origin and are traditional in systems of medicine. Citrullus colocynthis Schrad. (cucurbitaceae), endemic in Southern Tunisia, is used in folk medicine to treat many inflammation diseases. AIM OF STUDY: To evaluate the acute toxicity of different parts of Citrullus colocynthis and then to screen the analgesic and anti-inflammatory activities of aqueous extracts from roots and stems of the plant and from fruits and seeds at different maturation stages. MATERIALS AND METHODS: After identification and acute toxicity assay Citrullus colocynthis Schrad. aqueous extracts were screened for analgesic and anti-inflammatory activities using, respectively, the acetic acid writhing test in mice and the carrageenan-induced paw edema assay in rats. RESULTS: All extracts displayed analgesic and anti-inflammatory activities at different doses without inducing acute toxicity. Topic results were obtained with immature fruits followed by seeds. The stem and root extracts were shown to possess the less significant inhibitory activity against analgesic and anti-inflammatory models. CONCLUSIONS: Based on this study, we confirmed that Citrullus colocynthis Schrad. is a potentially useful drug suitable for further evaluation for rheumatoid arthritis, and its folk medicinal use as an analgesic and anti-inflammatory agents is validated.

Antibacterial and anticandidal screening of Tunisian Citrullus colocynthis Schrad. from Medenine.

ETHNOPHARMACOLOGICAL RELEVANCE: Resistance to current antibacterial drugs and the rise of opportunistic fungal infections are growing global concerns. Traditional medicine is a potential source of new antibacterials and antifungals. Citrullus colocynthis Schrad. (Cucurbitaceae) endemic in Southern Tunisia, is used in folk medicine against dermatological, gynaecological and pulmonary infections. AIM OF STUDY: To assess in vitro antibacterial and anticandidal activity of aqueous and diluted acetone extracts of Citrullus colocynthis Schrad. MIC and MBC/MFC were determined for plant organs at different maturation stages. MATERIALS AND METHODS: Citrullus colocynthis Schrad. was harvested and its identification was verified. Aqueous and diluted acetone extracts (from the plant's roots, stems, leaves and three maturation stages of its fruit and seeds) were screened for activity against Gram-negative and Gram-positive bacteria (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecalis)-and various Candida spp. (Candida glabrata, Candida albicans, Candida parapsilosis and Candida kreusei). RESULTS: All extracts showed activity against all strains. The highest MICs and MBCs/MFCs were obtained from the fruit aqueous extracts (MIC 0.10mg/ml against Candida albicans and Candida glabrata, 0.20mg/ml against Escherichia coli and Pseudomonas aeruginosa), lowest activity from the root extracts. CONCLUSIONS: Citrullus colocynthis Schrad. shows antibacterial and anticandidal properties. The folk medicinal use as a broad-spectrum antimicrobial agent is validated.