Background The role of a pharmacist in primary health care settings of Pakistan is still obscure. Thus, we aimed to demonstrate the pharmacist-led improvements in glycemic, blood pressure and lipid controls in type 2 diabetes mellitus (T2DM) patients of Lahore, Pakistan. Methods The first open label, randomized control trial conducted at a primary health care facility of Lahore, Pakistan by enrolling 244 uncontrolled type 2 diabetes (hemoglobin A1 c, (HbA1c); 10.85 ± 1.74) patients. The pharmacological intervention included identification of drug related problems, drug interactions, change in dose, frequency and therapy switches in collaboration with physician, while non-pharmacological intervention consisted of diet, lifestyle and behavior counseling. Outcome measures were glycemic (HbA1c), blood pressure and lipid controls. Results In intra-group comparison, compared to control arm ( C , n = 52), subjects in the intervention arm ( I , n = 83) demonstrated significant differences in process outcome measures; baseline vs final, such as HbA1c ( C ; 10.3 ± 1.3 vs 9.7 ± 1.3, p <  0.001, I ; 10.9 ± 1.7 vs 7.7 ± 0.9, p <  0.0001), systolic blood pressure (SBP) ( C ; 129.9 ± 13.9 vs 136 ± 7.1, p = 0.0001, I ; 145 ± 20.4 vs 123.9 ± 9.9 mmHg, p <  0.0001), diastolic blood pressure (DBP) ( C ; + 4, p = 0.03, I ; − 7 mmHg, p <  0.0001), cholesterol ( C ; 235.8 ± 57.7 vs 220.9 ± 53.2, p = 0.15, I ; 224 ± 55.2 vs 153 ± 25.9 mg/dL, p < 0.0001), triglycerides ( C ; 213.2 ± 86.6 vs 172.4 ± 48.7, p = 0.001, I ; 273 ± 119.4 vs 143 ± 31.6 mg/dL, p < 0.0001) and estimated glomerular filtration rate (eGFR) ( C ; 77.5 ± 18.6 vs 76 ± 14.2, p = 0.5, I ; 69.4 ± 21.3 vs 93.8 ± 15.2 ml/min/1.73m 2 , p < 0.0001). Likewise, inter-group improvements were more significant in the subjects of intervention group at final follow up in comparison to control for various process outcome measures; HbA1c ( p < 0.001), SBP ( p < 0.0001), DBP ( p = 0.02), cholesterol ( p < 0.0001), triglycerides ( p < 0.0001), SCr ( p < 0.001), eGFR ( p ...

Mesenchymal stem cells hold the promise to treat not only several congenital and acquired bone degenerative diseases but also to repair and regenerate morbid bone tissues. Utilizing MSCs, several lines of evidences advocate promising clinical outcomes in skeletal diseases and skeletal tissue repair/regeneration. In this context, both, autologous and allogeneic cell transfer options have been utilized. Studies suggest that MSCs are transplanted either alone by mixing with autogenous plasma/serum or by loading onto repair/induction supportive resorb-able scaffolds. Thus, this review is aimed at highlighting a wide range of pertinent clinical therapeutic options of MSCs in the treatment of skeletal diseases and skeletal tissue regeneration. Additionally, in skeletal disease and regenerative sections, only the early and more recent preclinical evidences are discussed followed by all the pertinent clinical studies. Moreover, germane post transplant therapeutic mechanisms afforded by MSCs have also been conversed. Nonetheless, assertive use of MSCs in the clinic for skeletal disorders and repair is far from a mature therapeutic option, therefore, posed challenges and future directions are also discussed. Importantly, for uniformity at all instances, term MSCs is used throughout the review.

Background In Pakistan, drug promotion practices, ethical or unethical, have rarely been in the spotlight. We aimed to assess the perception and barriers of medical representatives (MRs) and doctors (MDs) regarding ethical promotion of pharmaceuticals in Pakistan. Methods A cross sectional survey was conducted in seven major cities of Pakistan for 6-months period. Self-administered questionnaire was used for data collection. Logistic regression and five-point Likert scale scoring was used to estimate the perceptions and barriers. Results Compared to national companies (NCs), the medical representatives (MRs) of multinational companies (MNCs) strongly believed that their companies follow World Health Organization (WHO) (OR; 5.31, p = 0.0005), International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) (OR; 6.45, p = 0.0005) and national codes of ethics (OR; 5.84, p = 0.0005). MNCs trained their MRs (OR; 6.68, p = 0.0005), provide accurate and valid scientific data (OR; 4.01, p = 0.007) with adequate system of accountability and controls on product samples (OR; 1.96, p = 0.047), while, NCs sponsor social or entertainment activities, seminars and conferences, and all sort of facilitation in form of gifts of their choice and clinic renovation for medical doctors (MDs). MDs perceptions were similar to MRs mentioned above, yet strongly agreed that companies offer cash payments or equivalents to MDs. The MRs of NCs/MNCs and MDs agreed/strongly agreed that no external accountability, profiteering, pressure on sale targets, job insecurity, condoning unethical promotion by high-ups’ and business promotion by junior MDs were the predominant barriers. Conclusion In conclusion, MRs of MNCs and MDs believed that MNCs follow certain codes of ethics in the promotion of pharmaceuticals, while NCs tend to be more profit oriented and even condone unethical promotion. All stakeholders, MRs, MDs and companies, might pose certain barriers, intentionally or unintentionally, in ethical promotion.

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Abstract:The current study was aimed to formulate a continuous release mucoadhesive buccal tablet containing propranolol HCl. The type and quantities of polymers as well as method of compression were set in a preliminary study (F1-F13). Direct compression method was employed in the main study (F14-F24) using Carbopol ® 934P (CP), ethylcellulose (EC), sodium alginate (SA), hydroxypropyl methylcellulose (HPMC k4M) and carboxymethylcellulose (CMC) as mucoadhesive polymers and were tested for physicochemical tests i.e. swellability, surface pH, mucoadhesive time, mucoadhesive strength, in vitro release etc. Results obtained from the study were optimized using NeuralPower ® 3.1, an artificial intelligence approach. Against the desirability of physicochemical parameters, the software optimized the ingredients as HPMC (150mg), CMC (25mg), CP (20mg) and EC (20mg). Outcome revealed that HPMC primarily contributed to the physicochemical properties of mucoadhesive formulation. To compare prediction, optimized ingredients were formulated (F25) and tested. The swellability index of confirmation formulation (F25) was 102% at 6 h. As predicted, similar release pattern was of F25 was obtained as 26% (0.5h), 34% (1h), 40% (2h), 45% (3h), 50% (4h), 62% (5h), 76% (6h), 85% (7h) and 97% (8h) respectively. For release kinetics, DD solver ® suggested the release of the drug to be non-Fickian.