Original Research article

Anticoagulants are used to treat different thrombotic conditions, and patients should be educated on administration, safety, and adverse reactions associated with their medication to achieve the optimum therapeutic effect. Pharmacists are an essential part of providing pharmaceutical care and a reliable source of information for patients; therefore, their knowledge of medications must be up-to-date. This study aimed to assess Urmia’s community pharmacists’ knowledge about the utilization, safety, and interactions of commonly prescribed anticoagulants.

This questionnaire-based cross-sectional study was conducted from September 1st, 2020, to February 31st, 2021, in Urmia, Iran. A 35-item questionnaire was designed based on previous studies and researchers’ experience. The questionnaire was validated, and its final version was presented to randomly selected community pharmacists in Urmia. Filled-out forms were collected and analyzed in the context of three main areas of safety, adverse reactions, and administration.

Ninety-five participants filled out the questionnaire, for whom a mean score of 16.53±4.56 was calculated. Out of 95 pharmacists, only 30 scored ≥50% correct answers. No significant correlation was observed between age, years of employment, and pharmacists' competency in correctly answering the questions (p-value>0.05). The participants' overall knowledge was more reliable for warfarin than for enoxaparin and DOACs, with a p-value<0.001.

The results of this study suggest a lack of sufficient knowledge among Urmia’s community pharmacists concerning commonly prescribed anticoagulants. This puts patients at risk for therapy complications and should be addressed accordingly.

Toward a Recognition of Key Role players in Community Pharmacy

Monireh Afzali, Ali Rajabzadeh, Soroush Ahmadi, Fatemeh Soleymani, Abbas Kebriaeezadeh, Shekoufeh Nikfar

International Pharmacy Acta, , , Page e2: 1-8

Although private community pharmacies are identified as health care facilities, they are highly affected by business management issues. As an example of public-private partnership in the health sector, private community pharmacies have multiple key stakeholders. This study is a comprehensive stakeholder analysis which aims to identify, classify, and analyze multiple key stakeholders involved in the community pharmacy business and their interests, relationship, and behavior. This understanding of the context and evaluation of the above factors will help community pharmacy managers develop suitable strategies to properly manage the stakeholders in order to better achieve organizational goals. A focus group was conducted with key informants. The first phase of the focus group identified stakeholders through brainstorming techniques. In the second phase, stakeholder analysis and classification were performed using a three-dimensional matrix. Identified stakeholders were differentiated by levels of relationship with community pharmacies. They were analyzed regarding three attributes of power, legitimacy, and urgency, and were grouped into eight classes including definitive, dormant, dominant, discretionary, dependent, demanding, and dangerous stakeholders and non-stakeholders. The results of the focus group were converted to a structured questionnaire and confirmed in several face-to-face interviews until reaching a consensus. Four main levels of relationship and eight categories of stakeholders were identified by qualitative analysis through conducting a focus group with key informants. The core stakeholders include pharmacy licensee, licensee-owner, responsible pharmacist, customer, prescriber, health insurance, regulatory body, and staff. The core stakeholders possess three saliences of power, legitimacy, and urgency. Therefore, they are directly involved in decision making. Further deliberations are necessary to analyze the behavior of stakeholders and investigate the communication model.

Antibacterial Effect of Aqueous and Ethanol Extracts of Moringa oleifera Leaves on Methicillin Resistant Staphylococcus aureus (MRSA) Isolates obtained from sampled in a University Community.

Methicillin Resistant Staphylococcus aureus (MRSA) are strains of the Staphylococcus aureus that are resistant to the action of methicillin and related beta-lactam antibiotics. MRSA infections have now become a major public health concern and its prevalence is also increasing globally. This study focused on the prevalence of MRSA obtained from clinical samples. The failed antibacterial agent conventional used for treatment necessitated the investigation of Antibacterial Effect of Aqueous and Ethanol Extracts of Moringa oleifera Leaves on Methicillin Resistant Staphylococcus aureus (MRSA) Isolates. A total of 296 samples were collected from Armpit, Ear, High Vaginal, Mouth, Nose swabs, Urine and Semen, from which 143 (48.3%) isolates of S. aureus were obtained. The MRSA prevalence 105(35.5%). There were no association (no significant difference P>0.05) in the prevalence of S. aureus and MRSA with regards to Age distribution, Sex and Sample types. A Total of 35 selected isolates of MRSA were analyzed for their antibiotic susceptibility and effect of Aqueous and Ethanol Extracts of Moringa oleifera Leaves. They were highly susceptibility to Ciprofloxacin 26(74.3%), Gentamicin 31(88.6%), Streptomycin 32(91.4%) and Levofloxacin 32(91.4%). However, low levels of MRSA susceptibility were recorded for Vancomycin 21(60%) and Ampiclox 31(88.6%). Multidrug resistant (isolates resistant to drug agents ≥ 4) recorded is 9(25.7%) of the 35 isolates studied. Comparing the anti-MRSA property of Moringa oleifera leave extracts between aqueous at ≤ 12.5 mg/mL and 70% ethanol extracts at 25 mg/mL on 35 selected MRSA isolates using Mann Whitney test their Mean ± SD zones of minimal inhibition are (1.86 ± 5.91 mm) and (0.54 ± 2.16 mm) respectively. Statistically at P˂0.0.5 the null hypothesis was rejected P= 0.047. Meaning aqueous extract mean zones of inhibition is higher than that of 70% ethanol extracts. Therefore, aqueous extraction of M. oleifera leaves should be studied intensively as a potential source for drug development for the treatment of MRSA infections.

Diuretic Activity of the Flavonoid Pinostrobin Previously Identified from the Species Renealmia alpinia

Carolina Lopera-Londoño, Cristhian Melan, Julieta Vásquez, Alejandro Serna, Arley C. Patiño, Dora M. Benjumea

International Pharmacy Acta, , , Page e4: 1-6

Renealmia alpinia is a plant traditionally employed as antiophidic, pain reliever, antipyretic, and antiemetic. Its main metabolites are flavonoids, with pinostrobin as the most abundant compound of this plant species. In this study, we determined the diuretic activity of pinostrobin, previously identified from the species Renealmia alpinia in normal mice.

The evaluation of the diuretic activity of the flavonoid pinostrobin was carried out at doses of 5, 10, and 20 mg/kg of body weight. The diuretic activity was evaluated using the Kau et al. (1984) method with modifications made by Benjumea et al. (2005), using mice instead of rats. Metabolic cages equipped with graduated cylinders were used to measure the volume of urine excretion at 2, 4, and 6 hours. At 6 hours, pH and conductivity were measured, and the concentration of excreted sodium, potassium, magnesium, and calcium ions was estimated by ion chromatography. Creatinine, albumin, blood urea nitrogen, and urea of mice blood were analyzed.

There was an increase of 32% and 38% at a dose of 10 and 20 mg/kg, respectively, in the urinary excretion of water by pinostrobin, an elimination of sodium concentration similar to furosemide at 5 and 10 mg/kg, An increase in potassium concentration of 52% at 10 mg/kg and a higher magnesium excretion of 85% at 5 mg/kg, were statistically significant compared to furosemide.

Pinostrobin showed a diuretic effect increasing the volume of urinary excretion in mice and excretion of sodium, potassium, magnesium, and calcium ions, with a possible mechanism in the loop of Henle.

Many drugs and regular exercise may have effect on male fertility. Therefore in the present study we investigated the effect of Atorvastatin and Endurance training on serum levels of testosterone,Leydig ,spermatogonia, Spermatocyte cells numbers and testicular morphology and  morphometric evaluation in rats. 30Wistar rats(230±10g)were randomly divided into 6 groups:control, endurance training,atorvastatin(5 mg/kg and 10 mg/kg),the endurance training + atorvastatin (5 mg/kg and 10 mg/kg),5 rats per group. Drug intervention groups received atorvastatin for 4 weeks using gavage.Training groups also run a rodent treadmill 5 days a week for 4 weeks(speed of 10 m/min for 10 min in first week and other week: 16 m/min for 50 min) Serum testosterone level was measured by ELISA Kit.The results showed in the endurance training+atorvastatin 10 mg/kg, morphological disruption of testicular was observed.The number of Leydig, spermatogonia and Spermatocyte as well as blood testosterone level and germinal epithelium thickness were significantly decreased in the endurance training+atorvastatin 10 mg/kg compared to the control group(p< 0.05). In conclusion,the results of this study showed the negative effect of the combination of endurance training and  high dose atorvastatin (10 mg/kg ) on testicular tissue and male reproductive system due to decreased levels of testosterone in rats.