Abstract Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here. fails However patches cases out aneurysm symptoms

resumo: Sob explosões de contato, as estruturas de concreto armado podem se comportar de forma frágil com danos altamente localizados, como crateras de concreto, “spalling” e ruptura de reforço. A fragmentação em alta velocidade resultante de “spalling” de concreto pode causar graves mortalidades e ferimentos. Por isso, é importante conter fragmentos de concreto e melhorar a resistência ao colapso da laje. Uma nova técnica de reabilitação é proposta neste artigo que impede completamente a fragmentação. Para mitigar os efeitos da explosão nas estruturas civis, um novo tipo de material concreto chamado Ultra-High-Performance-Concrete (UHPC) é agora amplamente estudado e aplicado. O material UHPC é conhecido por sua alta resistência à compressão e tração, grande capacidade de absorção de energia, bem como boa trabalhabilidade e resistência à abrasão em comparação com o concreto de resistência normal (NRC). Todos os trabalhos publicados experimentais recentes sobre o desempenho das lajes UHPC consideram o efeito de uma explosão longe ou muito perto, por outro lado, os testes de explosão de contato são relativamente limitados experimentalmente e quase impossíveis devido a restrições de segurança e dispendiosos em termos de preparação e medições. Assim, os modelos reais e precisos de elementos finitos são necessários para resolver essa lacuna e entender o comportamento real de explosão de contato das lajes NRC e UHPC. As análises numéricas permitem obter informações sobre os complexos mecanismos de falha que ocorrem na laje e não diretamente observáveis. Neste estudo, o método de hidrodinâmica de partículas suavizadas (SPH) e o método de elemento finito são utilizados para simular os testes de explosão de contato. Os resultados numéricos são comparados com as observações experimentais, e a viabilidade e a precisão do modelo numérico são validadas. O modelo numérico validado forneceu uma ferramenta útil para projetar soluções potenciais de adaptação de explosão que podem evitar danos e fragmentações de materiais locais em ambas as lajes NRC e UHPC submetidas à explosão de contato. Este estudo introduziu uma solução de proteção adequada e muito eficiente para ambas as lajes NRC e UHPC expostas à explosão de contato (1 kg de TNT) utilizando a interação composta gerada entre lajes e placas de aço ligados. As chapas de aço coladas de 2 mm e 1 mm em ambas as faces das lajes NRC e UHPC, respectivamente, obtiveram uma resistência superior à explosão de contato.

abstract: Under contact explosions, the reinforced concrete structures can behave in a brittle manner with highly localized damage like concrete cratering, spalling, and reinforcement rupturing. High-speed fragmentation resulting from concrete spall may cause severe casualties and injuries. It is therefore important to restrained concrete fragments and improve collapse resistance of the slab. A new retrofitting technique is proposed in this paper which completely prevents fragmentation. To mitigate blast effects on civil structures, a new kind of concrete material named Ultra-High-Performance-Concrete (UHPC) is now widely studied and applied. UHPC material is known for its high compressive and tensile strength, large energy absorption capacity as well as good workability and anti-abrasion ability compared to normal strength concrete(NRC). All of recent experimental published work concerning blast performance of UHPC slabs under far or near explosion effect, on the other side, the contact explosion tests are relatively limited experimentally and nearly impossible because of security restrictions and costly in terms of both preparation and measurements. So, the real and accurate finite element models are needed to address this gap and understanding the real contact-explosion behavior of both NRC and UHPC slabs. The numerical analyses allow gaining insight into the complex failure mechanisms occurring in the slab and not directly observable. In this study, coupled smoothed particle hydrodynamics (SPH) method and finite element method is utilized to simulate the contact blast tests. Numerical results are compared with the experimental observations, and the feasibility and accuracy of the numerical model are validated. The validated numerical model provided a useful tool for designing potential blast-retrofitting solutions which can prevent the local material damage and fragmentations in both NRC & UHPC slabs subjected to contact explosion. This study introduced adequate and very efficient protection solution for both NRC & UHPC slabs exposed to contact explosion (1 kg of TNT) by utilizing the composite action generated between slabs & bonded steel plates. The 2 mm and 1 mm bonded steel plates at both faces of the NRC and UHPC slabs respectively attained a superior resistance to contact explosion.

ABSTRACT A pneumatic olive harvester was developed and evaluated in this study. The components of the developed machine were the limb clamp, vibrating unit, control elements, main tube, air-pressured hoses, control valve, and power source. The measurements that related to the development of the harvester were fruit and limb damage, and some physical and mechanical properties of the olives fruit-stem system. The results demonstrated that the effectiveness of the developed machine to harvest olive fruits. The appropriateness of the developed machine was evaluated by some criteria: machine productivity, fruit removal, fruit damage, limb damage depth at the contact point with the clamp of the machine, breakage of shaken limb, and consumed energy. The suitable values of these criteria were achieved at 27 Hz frequency and 60 mm stroke.

Background: Pharmacists have the unique position of providing safe and effective care. Hence, addressing their feelings about their working life is crucial to provide good pharmacy services. Objective: this study aimed to assess job satisfaction among Iraqi community pharmacists and determine the effect of pharmacist characteristics on job satisfaction. Methods: A cross-sectional study was conducted among community pharmacists in Baghdad, the capital of Iraq. A simple random sample technique was adopted to select community pharmacists. A survey questionnaire using Warr-Cook-Wall satisfaction scale (ranging from extremely dissatisfied to extremely satisfied) was used to assess job satisfaction. Results: Community pharmacists experienced moderate satisfaction with their jobs. The mean satisfaction score for all pharmacists was 20.4 (SD 3.7). The lowest mean scores occurred for recognition (1.4; SD 0.7), public respect (1.8; SD 0.9), and pharmacy regulations (1.9; SD 0.9). Job satisfaction was significantly affected by pharmacist characteristics, including gender (p<0.001), age (p<0.001), degree level (p=0.003), years in practice (p<0.001), working patterns (p< 0.001), and working hours (p<0.001). Regression analysis indicated pharmacist gender and age had the highest effect on job satisfaction, while, years in practice, working hours, and working pattern had the lowest effect. Conclusions: Community pharmacists expressed moderate satisfaction with their jobs with satisfaction levels being affected by gender, age, years in practice, working patterns, and working hours. New strategies will require support for Iraqi pharmacists by the Ministry of Health and Syndicate of Iraqi Pharmacists before being included in extended pharmacy services.

ABSTRACT. In situ bags made from microfiber fabrics have a greater surface area and filtration efficiency that retains the fine particles and reduce the variation in the results. Also, it is more durable than that made from traditional fabrics. This work aimed to study the effect of filament denier on the performance of in situ bags. Two polyester microfilaments with 0.4 and 0.7 deniers were used in manufacturing of four fabrics. Physical and mechanical properties of manufactured fabrics were measured before and after incubation to show the efficiency of the manufactured samples. In vitro trail was conducted to estimate ruminal degradability after 24 and 48 hours for three feedstuffs using three cannulated rams as replicates. The mechanical properties of manufactured in situ bags were significantly affected with both denier per filament and weft densities. According to the statistical analysis of radar chart, sample 2 remarked the highest value which achieved the acceptable ruminal dry matter disappearance compared with Ankom bags in different incubation times.

Abstract Objective To examine the factors affecting the transitions through treatment interventions after failure of non-surgical root canal treatment (NS-RCT). Methodology Insurance enrollment and claim information for enrollees of Delta Dental of Wisconsin (DDWI), USA were analyzed for 438,487 initial NS-RCT procedures to determine the effect of initial provider type and other covariates on additional treatments (no additional treatment, nonsurgical retreatment, surgical retreatment and extraction). A multi-state model was created using the “mstate” R package. Transitions between the four states identified by Code on Dental Procedures and Nomenclature were analyzed. Cox proportional Hazards regression stratified by transition type was used to estimate the effect of provider type on the risk of each transition, adjusting for covariates. Results The overall survival rates for all teeth that were treated by NS-RCT was 82.8% [95% CI 82.57%, 83.11%] at 10 years. Approximately, 7% of cases changed from the first state of initial NS-RCT during the 13-year study period with ultimately 0.9%, 0.4% and 5% of cases receiving non-surgical retreatment, surgical retreatment or extraction, respectively. Teeth are more likely to be retreated non-surgically than surgically, and to be extracted than retreated. In general, the probability of a tooth having non-surgical retreatment was higher if the initial provider was not an endodontist (Hazard Ratio (HR)=3.2). Molars were more likely to be non-surgically retreated (HR=2.0) or extracted (HR=2.8) when compared to anterior teeth. The probability of non-surgical retreatment (HR=0.93) or extraction (HR=0.50) was lower when a crown was placed within 90 days after NS-RCT. Conclusion Most teeth remained in the same state after treatment with no additional treatment transitions. When a transition occurred, it was more likely to be an extraction. Type of provider, age, location of the tooth, gender, and time to placement of final restoration significantly influence treatment transitions.

Resumo A colite ulcerativa é uma das DII. Sua etiologia e patogênese permanecem indefinidas; a interação entre fatores ambientais, genéticos e imunológicos é a explicação mais aceita. Vários estudos recentes avaliaram a expressão de microRNA no sangue e tecidos periféricos em pacientes com DII. O presente estudo teve como objetivo avaliar a expressão do miR-16 sérico em pacientes com colite ulcerativa e sua correlação com a extensão, atividade e gravidade da doença. Foram incluídos 30 pacientes de colite ulcerativa, com diferentes apresentações, que ainda não haviam sido submetidos a nenhum tipo de tratamento. A expressão sérica de miR-16 foi avaliada usando transcrição reversa seguida de reação em cadeia da polimerase quantitativa (RT-qPCR) e, em seguida, correlacionada com a de um grupo de 20 indivíduos saudáveis para avaliar seu papel no diagnóstico de colite ulcerativa. Além disso, foi feita uma correlação com a extensão da doença (proctite, colite do lado esquerdo, colite extensa) e com os índices de atividade e gravidade da doença (critérios de Truelove e Witts, calprotectina fecal e UCEIS). Trinta pacientes com colite ulcerativa foram incluídos no estudo, classificada como leve em 53%, moderada em 37% e grave em 10%. Quanto à extensão endoscópica, oito apresentavam proctite, 14 apresentavam colite do lado esquerdo e oito apresentavam colite extensa. A expressão sérica de miR-16 nos 30 pacientes foi comparada à dos indivíduos controle saudáveis. No, grupo de pacientes, a expressão sérica de miR-16 foi de 1,91 (grupo controle: 1,13), uma diferença estatisticamente significativa entre os dois grupos. Não foi observada relação significativa entre a expressão sérica de miR-16 e a extensão, atividade e gravidade da doença. A partir do presente estudo, pode-se concluir que o aumento da expressão sérica do miR-16 está associado à colite ulcerativa, apesar de não haver relação significativa com a extensão ou gravidade da atividade da doença.

Abstract Ulcerative colitis is one of the IBDs. Its etiology and pathogenesis remain undefined with an interaction between environmental, genetic and immunological factors is the most accepted explanation. Several recent studies have examined microRNA expression in the peripheral blood and tissues from IBD patients. The study aims at assessing the expression of serum miR-16 in ulcerative colitis patients and its correlation with disease extent, activity and severity. It included 30 treatment naïve ulcerative colitis patients of different presentations. Serum miR-16 expression was assessed using reverse transcriptase quantitative real time PCR (RT-qPCR), and then correlated with that of a group of 20 healthy subjects to assess its role in diagnosis of ulcerative colitis. Also, it was correlated with disease extent (proctitis, left sided colitis, extensive colitis) and disease activity and severity indices (Truelove and Witts criteria, fecal calprotectin and UCEIS). Thirty ulcerative colitis patients were enrolled, 53% had mild, 37% had moderate, while 10% had severe disease. Concerning endoscopic extent, 8 had proctitis, 14 had left sided colitis and 8 had extensive colitis. Serum expression of miR-16 in the 30 patients were compared to that of the healthy control subjects. The patients’ group showed median serum miR-16 expression of 1.91, 1.13 for the control group with a significant difference between both groups. Correlation between serum miR-16 expression with disease extent, activity and severity showed no significant relation. From the current study we can conclude that increased serum expression of miR-16 is associated with ulcerative colitis despite no significant relation to disease activity extent or severity.

ABSTRACT. Microfiber fabrics are more efficiency in retaining fine-particles that increase the variation in in situ degradability. The aim of this was to examine the performance of in situ bags made from different microfiber fabric for meeting the required specification and their ruminal degradability compared with standard Ankom in situ bags. Four fabrics were manufactured using polyester microfiber with 1.04 denier, weft yarn counts (150 and 300), weft density (22 and 28 picks / inch), plain 1/1 textile structure. Physical and mechanical properties of manufactured fabrics were measured before and after incubation. Ruminal degradability was measured for three feedstuffs (soybean meal, wheat bran and berseem hay) using three rumen-fistulated rams as a replicates after 24 and 48 hours. Fabric's pore size was significantly decreased as either yarn weft count or density increased. Yarn weft count had a significant effect on all fabric's properties. Air permeability was significantly decreased as fabric's weft yarn count increased. Sample (1) meet the specific requirements for in situ bags and showed the nearest degradability values to those observed using Ankom bags for all feedstuffs in most incubation times. Microfiberin situ bags could be used in in situ ruminal degradation trials to reduce the variation in results due to the present of the fine particles.

Abstract Background: Because community pharmacists are the most accessible healthcare professionals, they are often involved in managing minor ailments within the community setting. Objective: This study evaluated the community pharmacists’ history taking practice, medicine dispensing and advice in response to acute diarrhea. Methods: Authors conducted a simulated-patient study in 75 community pharmacies in Baghdad, Iraq from February to May 2015. The female simulated-patient complained of acute diarrhea that had lasted for one day and requested for medicine to treat her condition. After exiting each pharmacy, she then assessed the practices of the community pharmacists through the use of a specially designed checklist adopted with modifications from relevant guidelines. For history taking, a maximum total of eight was the highest obtainable score. Data collected was quantitatively analyzed and Mann-Whitney, Chi-square or Fishers exact tests were used at an alpha level of 0.05. Results: All of the 75 pharmacies visited were managed by professionally qualified pharmacists. The most common questions asked during history taking were number of diarrheal episodes (n=62; 82.7%); duration of symptoms (n=59; 78.7%) and presence of other diseases and if any drug had been taken (n=58; 77.3%). Female pharmacists had a higher total mean score (6.45, SD=1.33) for history taking when compared to their male counterparts (4.34, SD=2.13); p <0.001. Medicine combination of diphenoxylate HCl 2.5mg + atropine sulphate 0.025mg (n=34; 27.9%) was most frequently dispensed while the least was oral rehydration salt (n=1; 0.8%). Around 20% (n=15) of pharmacists dispensed antimicrobial agents. Over half (n=46; 61.3%) of pharmacists indicated the frequency of use on the medicine packet. Conversely, less than half (n=33; 44.0%) gave any advice on food and fluid intake. Conclusions: Majority of the community pharmacists asked at least four questions while taking patient history and was very likely to recommend antidiarrheal medicines as first line treatment options. The authors recommend the development of a minimum standard of practice as well as enhanced training for Iraqi community pharmacists.

Dextromethorphan hydrobromide (DM) sustained release matrix pellets containing 10% w/w drug were prepared by an extrusion/spheronization technique. The effect of mixing different concentrations of ethyl cellulose (EC), hydroxypropyl methylcellulpse (HPMC K10), and Carbopol 934 with Avicel PH101 on the rheological properties of pellet wet mass was evaluated using mixer torque rheometry (MTR). The prepared pellets were characterized for size, drug content, and in-vitro DM release rate. The results showed that increasing the concentration of the hydrophobic polymer (EC) with Avicel PH101 decreased wet mass consistency, represented by mass mean line torque. Lower binder ratio was required for optimum wet massing, while mixing with swellable polymers (HPMC and Carbopol) caused a noticeable increase in both mean line torque and binder ratio. Combinations of HPMC and Carbopol at higher concentrations resulted in controlled in vitro release of DM from the prepared pellets. Furthermore, mathematical treatment of the in vitro release data of DM from the prepared pellets showed that all formulations except those containing 5% Carbopol plus 5% HPMC (F10) follow first order release. n values of these formulation were in the range of 0.09-0.40, which support an anomalous non-Fickian release.

Objective: To evaluate Qatari pharmacists’ prescribing, labeling, dispensing and counseling practices in response to acute community-acquired gastroenteritis. Methods: The simulated patient method was used in this study. Thirty pharmacies in Doha were randomly selected and further randomized into two groups: Face-to-Face (n=15) vs. Telephone-call (n=15) per simulated patient; 2 simulated patients were involved. Prescribing, labeling, dispensing and counseling practices were assessed. Data analysis was performed using Mann-Whitney and chi square tests at alpha=0.05. Results: Most pharmacists prescribed and dispensed medicines (96%), including antimicrobials (43.9%), antidiarrheals (36%), antiemetics (5.1%) and antipyretics (3%). Counseling practices were poor (62.1% in the face-to-face group vs 70% in the telephone-call group did not counsel simulated patients about the dispensed medicines; p-value=0.50). In more than one-third of the encounters, at least one labeling parameter was missing. The duration of each interaction in minutes was not significantly different between the groups [median (IQR); 3(4.25) in the face-to-face group versus 2(0.25) in the telephone-call group; p-value=0.77]. No significant differences in prescribing or dispensing behaviors were present between groups (p-value>0.05). Conclusion: Qatar community pharmacists’ labeling, dispensing, and counseling practices were below expectation, thus urging the need for continuous professional development.

Abstract INTRODUCTION: We studied the potential in vitro antischistosomal activity of Cerastes cerastes venom on adult Schistosoma mansoni worms. METHODS: Live specimens of the horned viper snake, C. cerastes were collected from the Aswan Governorate (Egypt). Venom was collected from snakes by manual milking. Worms of S. mansoni were obtained from infected hamsters by perfusion and isolated from blood using phosphate buffer. Mortality rates of worms were monitored after 3 days of exposure to snake venom at LC50 and various sublethal concentrations (10, 5, 2.5µg/ml). Scanning electron microscopy was used to investigate tegumental changes in treated worms after exposure to LC50 doses of venom. RESULTS: The LC50 of C. cerastes venom was 21.5µg/ml. The effect of C. cerastes venom on Schistosoma worms varied according to their sex. The mortality rate of male and female worms after 48-h exposure was 83.3% and 50%, respectively. LC50 of C. cerastes venom induced mild to severe tegumental damage in Schistosoma worms in the form of destruction of the oral sucker, shrinkage and erosion of the tegument, and loss of some tubercle spines. CONCLUSIONS: The present study demonstrated that C. cerastes venom exerts potential in vitro antischistosomal activity in a time and dose-dependent manner. These results may warrant further investigations to develop novel schistosomicidal agents from C. cerastes snake venom.

RESUMO Recentes avanC'os em sistemas de liberaC'C#o de fC!rmacos novos visam C obtenC'C#o de melhor adesC#o do paciente. Um destes avanC'os C) a formulaC'C#o de comprimidos de desintegraC'C#o oral (ODTs), que se dissolvem instantaneamente, liberando o fC!rmaco, em alguns segundos, sem a necessidade de C!gua. O principal objetivo deste trabalho foi preparar e desenvolver ODTs de clopidogrel. Os ODTs foram preparados pelo mC)todo de compressC#o direta. Estudou-se o efeito de vC!rias concentraC'C5es de diferentes agentes de desintegraC'C#o, tais como super-crospovidona, croscarmelose de sC3dio, glicolato de amido de sC3dio no tempo de desintegraC'C#o e velocidade de dissoluC'C#o. Os comprimidos preparados foram avaliados quanto C dureza, C friabilidade, ao tempo de desintegraC'C#o e C liberaC'C#o do fC!rmaco in vitro. AlC)m disso, estudou-se a interaC'C#o de clopidogrel com os excipientes de formulaC'C#o, utilizando calorimetria de varredura diferencial (DSC). Estudos de DSC revelaram nC#o haver interaC'C#o entre o fC!rmaco e os excipientes utilizados. Todos os comprimidos possuC-am dureza na faixa de 4,0-5,2 kp e a friabilidade inferior a 1%. A variaC'C#o de peso e o teor de fC!rmaco de todas as formulaC'C5es mostraram-se dentro do limite oficial, de acordo com a BP. O estudo de liberaC'C#o do fC!rmaco in vitro de comprimidos ODTs mostrou que mais de 90% do fC!rmaco foram liberados em10 minutos. O teste de palatabilidade em voluntC!rios humanos mostrou sabor e sensaC'C#o na boca aceitC!veis. Assim, os resultados obtidos demonstraram, conclusivamente, a rC!pida e bem-sucedida desintegraC'C#o dos comprimidos formulados e a palatabilidade aceitC!vel.

ABSTRACT Recent advances in drug delivery systems have aimed to achieve better patient compliance. One of these advances is the formulation of orally disintegrating tablets (ODTs) that dissolve instantaneously, releasing drugs within a few seconds without the need of water. The main objective of this paper was to prepare and develop ODTs of clopidogrel. The ODTs were prepared by direct compression. The effect of three superdisintegrants, namely crospovidone, croscarmellose sodium, and sodium starch glycolate, using three different disintegration times on the dissolution rate was investigated. The prepared tablets were evaluated for hardness, friability, disintegration time and in vitro drug release. Furthermore, the interaction of clopidogrel with the formulation excipients was studied using differential scanning calorimetry (DSC). DSC studies revealed that there were no interactions between the drug and the excipients used. All tablets had hardness values in the range 4.0-5.2 kp and friability lower than 1%. The weight and drug content uniformity of all formulations was within official limits according to BP. In vitro drug release studies of the ODTs showed that more than 90% of the drug was released within ten minutes. A palatability test in human volunteers showed acceptable taste and mouth feel. Thus, the obtained results conclusively demonstrated successful rapid disintegration of the formulated tablets and acceptable palatability.

Background: Therapeutic drug monitoring (TDM) makes use of serum drug concentrations as an adjunct to decision-making. Preliminary data in our hospital showed that approximately one-fifth of all drugs monitored by TDM service were gentamicin. Objective: In this study, we evaluated the costs associated with providing the service in patients with bronchopneumonia and treated with gentamicin. Methods: We retrospectively collected data from medical records of patients admitted to the Hospital Universiti Sains Malaysia over a 5-year period. These patients were diagnosed with bronchopneumonia and were on gentamicin as part of their treatment. Five hospitalisation costs were calculated; (i) cost of laboratory and clinical investigations, (ii) cost associated with each gentamicin dose, (iii) fixed and operating costs of TDM service, (iv) cost of providing medical care, and (v) cost of hospital stay during gentamicin treatment. Results: There were 1920 patients admitted with bronchopneumonia of which 67 (3.5%) had TDM service for gentamicin. Seventy-three percent (49/67) patients were eligible for final analysis. The duration of gentamicin therapy ranged from 3 to 15 days. The cost of providing one gentamicin assay was MYR25, and the average cost of TDM service for each patient was MYR104. The average total hospitalisation cost during gentamicin treatment for each patient was MYR442 (1EUR approx. MYR4.02). Conclusion: Based on the hospital perspective, in patients with bronchopneumonia and treated with gentamicin, the provision of TDM service contributes to less than 25% of the total cost of hospitalization.

Antecedentes: La monitorización sérica de medicamentos (TDM) utiliza las concentraciones séricas como un elemento para la toma de decisiones. Los datos preliminares de nuestro hospital indican que aproximadamente un quinto de todos los medicamentos seguidos por TDM fue la gentamicina. Objetivo: En este estudio evaluamos los costes asociados con la provisión del servicio en pacientes con bronconeumonía y tratados con gentamicina. Métodos: Recogimos retrospectivamente datos de las historias clínicas de los pacientes ingresados en el Hospital Universidad de Sains Malasia durante 5 años. Estos pacientes estaban diagnosticados con bronconeumonía y estaban con gentamicina como parte de su tratamiento. Se calcularon 5 costes de hospitalización: (i) costes del laboratorio y análisis clínicos, (ii) costes asociados con cada dosis de gentamicina, (iii) costes fijos y operativos del servicio de TDM, (iv) coste de proporcionar atención médica, y (v) costes de la hospitalización durante el tratamiento con gentamicina. Resultados: Hubo un total de 1920 pacientes ingresados con bronconeumonía de los que 67 (3,5%) tuvieron servicio de TDM para la gentamicina. El 73% (49/67) de los pacientes estaban incluidos en el análisis final. La duración del tratamiento de gentamicina osciló entre 3 y 15 días. El coste de realizar cada prueba de gentamicina era de 25 MYR, y el coste medio del servicio de TDM por paciente fue de 104 MYR. El coste medio de hospitalización por paciente durante el tratamiento con gentamicina fue de 442 MYR (1 EUR aprox. 4.02 MYR). Conclusión: Desde la perspectiva hospitalaria, los pacientes con bronconeumonía tratados con gentamicina, la provisión del servicio de TDM contribuye menos del 25% al total de costes de hospitalización.

Objective: The study aimed to document the state of insomnia management at community pharmacies in Pakistan. Methods: A cross-sectional study was conducted at randomly selected 371 pharmacies in three cities of Pakistan. Simulated patient visits were performed to collect information on case management of insomnia in terms of history taking and patient counseling at community pharmacies. The data was coded, entered and analyzed by using SPSS Version 16. Kruskal-Wallis and Mann Whitney tests (p<0.05) were performed to find out differences. Results: The patients were mainly handled by salesman 83.8% (n=311), by pharmacist 3.5% (n=13) and pharmacy assistants 12.7% (n=47). The mean dispensing time was 1.11 minutes (SD=5.61) with the range of 0.5-6 minutes. Of the 371 simulated patients who visited the pharmacies, 72.8% (n=270) subjects were given medicines and 24.3% (n=90) subjects were referred to the doctor for treatment of insomnia. 61.8% (n=193) of the subjects were given benzodiazepines, 35.6% (n=111) antihistamines and 2.6% (n=8) NSAIDs at community pharmacies in the three cities. The mean cost of treatment in case of insomnia was PKR12.7 (SD=10.13, median=10). Conclusions: The disease management of insomnia by community pharmacies in Pakistan is not appropriate. The overall process of history taking, medication counselling and referral practices at community pharmacies either located in rural or urban setting and irrespective of the provider type and location of pharmacies, in the three cities is limited.

Objetivo: El estudio trato de documentar el estado de la gestión del insomnio en farmacias comunitarias en Pakistán. Métodos: Se realizó un estudio transversal en 371 farmacias aleatoriamente seleccionadas en tres ciudades de Pakistán. Se realizaron visitas de pacientes simulados para recoger información sobre la gestión del insomnio en relación a recogida de historia y asesoramiento del paciente en farmacias comunitarias. Los datos fueron codificados, introducidos y analizados en un SPSS versión 16. Se realizaron tests de Kruskal-Wallis and Mann Whitney (p<0.05) para determinar diferencias. Resultados: Los pacientes eran fundamentalmente atendidos por un vendedor 83,8% (n=311), por farmacéuticos 3,5% (n=13) y auxiliares de farmacia 12,7% (n=47). La media de tiempo de dispensación fue de 1,11 minutos (SD=5,61) con un rango de 0,5 - 6 minutos. De los 371 pacientes simulados que visitaron las farmacias, el 72,8% (n=270) recibieron los medicamentos y el 24,3% (n=90) fue remitido al médico para tratamiento del insomnio. El 61,8% (n=193) recibió benzodiacepinas, el 35,6% (n=111) antihistamínicos y el 2,6% (n=8) AINEs en las farmacias comunitarias de las tres ciudades. El coste medio del tratamiento para el insomnio fue de 12,7PKR (SD=10,13; mediana=10). Conclusiones: La gestión del insomnio en farmacias comunitarias de Pakistán no es apropiada. El proceso general de recogida de historial, asesoramiento sobre medicación y remisión al médico en las farmacias comunitarias es pobre tanto en farmacias rurales como en las urbanas, y es independiente del proveedor y de la localización de las farmacias en las tres ciudades.