Muhammad Zahid Iqbal

Background: Effective notifiable disease surveillance depends on healthcare providers’ ability to identify and report cases. Evidence on factors associated with surveillance performance remains limited in high-risk regions such as Jazan, Saudi Arabia. Objective: This study examined factors associated with healthcare providers’ notification and case management skills, prevention and training competencies, and perceptions toward the Notifiable Disease Surveillance System (NDSS). Methods: A cross-sectional analytical study was conducted among 420 healthcare providers working in government hospitals and primary healthcare centers in Jazan. Data were collected using an adapted self-administered questionnaire. Composite scores were analyzed using t-tests, ANOVA, and linear regression. Results: Higher NDSS-related scores were associated with professional category, HESN+ training, epidemiology or surveillance training, and years of experience. In multivariable analyses, HESN+ training, formal epidemiology or surveillance training, professional category, and experience remained associated with notification and prevention-related outcomes. Notification and case management skills were also associated with more favorable NDSS perceptions. Conclusions: NDSS-related competencies and perceptions were associated mainly with training exposure, professional role, and experience. Strengthening HESN+ training and integrating surveillance education into workforce development programs may support disease reporting and surveillance capacity in Jazan.

Myeloproliferative neoplasms (MPNs) present a fundamental paradox: despite sharing a small set of canonical driver mutations in JAK2, CALR, or MPL, patients exhibit striking heterogeneity in disease latency, clinical presentation, and evolutionary trajectories to myelofibrosis or secondary acute myeloid leukemia. This review synthesizes recent advances in single-cell and spatial multi-omic technologies that are resolving this paradox by moving analysis from bulk averages to individual cells and their microenvironmental ecosystems. We examine how targeted single-cell DNA sequencing reconstructs clonal architectures and phylogenies, revealing that driver mutations arise within complex mosaics where mutation order, co-mutation context, and cellular ancestry determine phenotypic outcomes. Integrated single-cell transcriptomic and epigenomic profiling exposes within-clone heterogeneity, lineage biases, and functional states that explain variable penetrance and therapy responses. Spatial transcriptomics, especially when integrated with single-cell transcriptomics, histopathology, and multiplex proteomics, further demonstrates that malignant hematopoietic stem and progenitor cells actively remodel bone marrow niches, creating localized inflammatory and fibrotic microenvironments that select for aggressive subclones. Together, these approaches support a new ecological model of MPN pathogenesis in which early epigenetic hits create permissive stem cell reservoirs, clonal competition and cooperation shape disease progression, and non-cell-autonomous niche and immune signals drive malignant metamorphosis. We discuss how this framework refines prognostication, informs rational combination therapies targeting both malignant cells and their ecosystem, and enables real-time monitoring of clonal dynamics, ultimately charting a course from descriptive atlases to actionable clinical strategies.

Objective: This review looked at how different pharmacist-led services influence medication spending and other economic outcomes for people living with long-term illnesses. Methods: To gather the evidence, we followed the PRISMA 2020 approach and a comprehensive search was conducted using multiple sources, including Web of Science, ProQuest, Scopus, the Directory of Open Access Journals, ScienceDirect, PubMed, and Google Scholar. We included studies that examined pharmacist involvement in medication management such as MTM, medication reconciliation, deprescribing efforts, or full medication reviews and that reported some form of cost or economic outcome in chronic disease care. We left out non-English work, conference abstracts, case reports, and papers without accessible full text. After screening all records, 1420 studies met the inclusion criteria. These ranged from randomized trials to cohort studies, pre–post designs, and a few economic modeling analyses. We evaluated methodological quality using the MMAT (2018), and for the modeling work, we applied the Drummond checklist. Results: Across the different study types, pharmacist involvement generally led to fewer medication-related problems, better adherence, and more appropriate medication use. Several studies showed that these changes translated into lower overall costs for example, through fewer adverse drug events, fewer hospital visits, or by switching patients to more affordable but clinically appropriate therapy options. Some economic evaluations even suggested that these interventions saved more money than they cost. Programs that combined medication review with patient education, deprescribing, and follow-up tended to show the clearest benefits. Conclusion: Taken together, the findings indicate that involving pharmacists more directly in the medication management of individuals with chronic conditions leads to better clinical results and more favorable economic outcomes. These findings support the idea of involving pharmacists more closely within chronic-care teams.

Background and Objectives: Osteoporosis risk in real-world, outpatient settings is shaped by intersecting socio-demographic, environmental, and clinical factors. We evaluated predictors of fracture risk status among adults seeking care in community pharmacies in Lahore, Pakistan. Materials and Methods: We conducted a cross-sectional study across urban and suburban pharmacies using a validated questionnaire aligned with international guidelines. Participants were classified as lower risk (osteopenia/osteoporosis without fragility fracture) or high risk (≥1 fragility fracture with clinical osteoporosis). Associations between candidate factors and risk status were examined using univariate and multivariable logistic regression analyses. Results: Of 286 participants, 53.1% were classified as lower risk. After adjustment, most sociodemographic characteristics were not independently associated with fracture risk status, except monthly income. Strong associations were observed for diabetes (AOR = 0.005, 95% CI 0.0007–0.040; p < 0.001), short-term glucocorticoid use (AOR = 32.33; p = 0.004), current smoking (AOR = 14.23; p = 0.002), ex-smoking (AOR = 4.95; p = 0.042), and lack of sunlight exposure (AOR = 7.09; p = 0.019). CKD, rheumatoid arthritis, and vitamin D insufficiency demonstrated borderline non-significant trends. Multivariable modeling did not include “not tested” categories or sparse variables. Conclusions: In Lahore’s community pharmacies, diabetes, CKD, RA, glucocorticoid exposure, smoking, and sunlight/vitamin D-related factors were the dominant correlates of osteoporosis fracture risk status, whereas most socio-demographic factors exerted limited independent effects. Pharmacy-anchored screening and counseling focused on these high-yield clinical indicators alongside timely BMD referral and guideline-concordant therapy may help identify individuals at elevated fracture risk.

Background: Diabetes Mellitus (DM) represents a significant public health challenge in Pakistan, with a high prevalence exacerbated by various socio-demographic, clinical, and environmental factors. Community pharmacies offer an accessible setting for managing chronic diseases, yet the combined influence of these factors on diabetes control within Pakistani community settings remains underexplored. Objective: This study aimed to assess the impact of socio-demographic, environmental, and clinical factors on diabetes control among patients attending community pharmacies in Lahore, Pakistan. Methods: A cross-sectional study was conducted involving 321 patients with type 2 diabetes recruited from community pharmacies across three regions of Lahore. A structured questionnaire, developed based on international guidelines, was used to collect data on socio-demographic characteristics, clinical history, lifestyle behaviors, and environmental factors. Diabetes control was categorized as controlled, partially controlled, or uncontrolled. Data were analyzed using descriptive statistics, chi-square tests, and multiple logistic regression in SPSS version 26.0. Results: Key socio-demographic predictors of better diabetes control included higher education levels (AOR = 1.317–2.338, p ≤ 0.006) and non-obese status (AOR = 1.057, p = 0.006). Significant clinical and lifestyle predictors were treatment adherence (AOR = 1.287, p < 0.001), regular physical activity (AOR = 1.387, p < 0.001), healthy dietary patterns (AOR = 1.317, p < 0.001), and longer duration of diabetes (>5 years, AOR = 1.277, p = 0.008). Conversely, a family history of diabetes (AOR = 1.967, p < 0.001) and the presence of comorbidities were associated with poorer control. Rural residence showed lower odds of good diabetes control (AOR = 0.857, p = 0.001). Smoking status was also influential, with ex-smokers demonstrating better control than current smokers. Conclusions: Diabetes control is multifactorial, strongly influenced by education, residence, obesity, lifestyle behaviors, and treatment adherence. Interventions targeting modifiable risk factors through patient education, lifestyle counseling, and personalized care are essential to improve diabetes outcomes in community settings. These findings underscore the critical role of community pharmacists in providing holistic diabetes management.

Background: Diabetes Mellitus (DM) represents a significant public health challenge in Pakistan, with a high prevalence exacerbated by various socio-demographic, clinical, and environmental factors. Community pharmacies offer an accessible setting for managing chronic diseases, yet the combined influence of these factors on diabetes control within Pakistani community settings remains underexplored. Objective: This study aimed to assess the impact of socio-demographic, environmental, and clinical factors on diabetes control among patients attending community pharmacies in Lahore, Pakistan. Methods: A cross-sectional study was conducted involving 321 patients with type 2 diabetes recruited from community pharmacies across three regions of Lahore. A structured questionnaire, developed based on international guidelines, was used to collect data on socio-demographic characteristics, clinical history, lifestyle behaviors, and environmental factors. Diabetes control was categorized as controlled, partially controlled, or uncontrolled. Data were analyzed using descriptive statistics, chi-square tests, and multiple logistic regression in SPSS version 26.0. Results: Key socio-demographic predictors of better diabetes control included higher education levels (AOR=1.317-2.338, p≤0.006), rural residence (AOR=0.857, p=0.001), and non-obese status (AOR=1.057, p=0.006). Significant clinical and lifestyle predictors were treatment adherence (AOR=1.287, p< 0.001), regular physical activity (AOR=1.387, p< 0.001), healthy dietary patterns (AOR=1.317, p< 0.001), and longer duration of diabetes (>5 years, AOR=1.277, p=0.008). Conversely, a family history of diabetes (AOR=1.967, p< 0.001) and the presence of comorbidities were associated with poorer control. Smoking status was also influential, with ex-smokers demonstrating better control than current smokers. Conclusion: Diabetes control is multifactorial, strongly influenced by education, residence, obesity, lifestyle behaviors, and treatment adherence. Interventions targeting modifiable risk factors through patient education, lifestyle counseling, and personalized care are essential to improve diabetes outcomes in community settings. These findings underscore the critical role of community pharmacists in providing holistic diabetes management.

Candida infections pose a significant health threat, and conventional antifungal drugs like nystatin are limited due to poor solubility, skin permeability, and frequent dosage requirements. Nystatin effectively targets Candida species by disrupting cell membranes, but formulation issues hinder clinical use. Lipid-based vesicular carriers, or novasomes, provide controlled, prolonged drug release and enhanced skin penetration. This study focuses on developing nystatin-loaded novasomal gels as an advanced drug delivery system to enhance therapeutic efficacy, bioavailability, and patient compliance. The formulation was prepared using a modified ethanol injection technique, combining stearic acid, oleic acid, Span 60, cholesterol, and Carbopol to produce a stable transdermal gel. Comprehensive in vitro characterization using FTIR, SEM, XRD, and thermal analysis confirmed the chemical compatibility, morphological uniformity, and physical stability of the nystatin-loaded novasomal gel. Entrapment efficiency differed significantly among the formulations (p < 0.05), with F7 achieving the highest value (80%). All formulations maintained pH levels within the skin-friendly range of 5.5 to 7.0. Viscosity measurements, ranging from 3900 ± 110 to 4510 ± 105 cP, confirmed their appropriate consistency for dermal use. Rheological analysis showed a dominant elastic response, as indicated by storage modulus values consistently higher than the loss modulus. Particle size ranged from 4143 to 9570 nm, while PDI values remained below 0.3, reflecting uniform particle distribution. Zeta potential values were strongly negative, supporting physical stability. XRD studies indicated reduced crystallinity of nystatin within the formulations, while FTIR confirmed drug-excipient compatibility. SEM images showed spherical particles within the micrometer range. In vitro release studies demonstrated sustained drug release over 12 h, with F6 releasing the highest amount. The novasomal gel formulations-maintained stability for 30 days, with no notable alterations in pH, viscosity, or entrapment efficiency. Antifungal evaluation showed a larger inhibition zone (23 ± 2 mm) compared with the plain drug solution (15 ± 1.6 mm), while the MIC value was reduced (4.57 µg/mL), indicating greater potency. Skin irritation assessment in rats revealed only minor, temporary erythema, and the calculated Primary Irritation Index (0.22) confirmed a non-irritant profile. These findings suggest that the developed novasomal gel offers a promising approach for enhancing the treatment of fungal infections by enabling prolonged drug release, minimizing dosing frequency, and improving patient compliance.

Diabetes-a life style based chronic metabolic disease if left untreated and unmanaged can lead to various complications among diabetics. To improve the health-related quality of life of diabetics, health care providers are classically placed to present suitable interventions. The objective of the present study was to evaluate the effect of pharmacist-led educational intervention on the diabetic patient-reported quality of life upon all the domains of EQ-5D. The study subjects selected for the present study were divided among two equal study arms after being recruited from the hospitals randomly. The controlled group consisted of 200 diabetic patients getting regular treatment from the hospitals. Whereas, the interventional group comprised of those 200 diabetic patients who were receiving the pharmacist collaborative care from DMTAC clinics along with the routine diabetic management and treatment. The study duration was of 1 year and consisted of two follow up visits for both study arms. A generic health related quality of life tool EQ-5D was used for exploring and examining the study data. However, to determine the setbacks in all the individual EQ-5D domains and VAS average scores involving ANOVA and T test analysis have been used. The mean glycated haemoglobin-HbA1c was decreased to 1.44% in control group, whereas, a decrease of 2.84% was seen in interventional study arm. A statistically significant betterment in glycated haemoglobin level was seen in the interventional study arm i.e., p < 0.05. However, all the domains of the questionnaire-EQ-5D 5 L conferred significant association with the health related quality of life parameters (p < 0.05). Moreover, in control study arm a statistically significant enhancement is seen related to average scores of health related quality of life reported by patients on the Visual Analogue Scale (VAS) from 55.89 ± 7.52 to 64.86 ± 5.04. Moreover, the average scores have been ranged from 54.45 ± 8.81 to 72.23 ± 6.41 among interventional study arm, presenting the statistically significant values i.e., F statistics 118.67 (1, 292) along with p < 0.001. The effect of pharmacist involvement in the form of intervention provision presented a positive improvement and statistically significant enhancement on every domain of the questionnaire-EQ-5D. The pharmacist collaborative care in the form of intervention turned out effective in enhancing the patient reported quality of life as well as in improving glycated haemoglobin (HbA1c) levels.

Background and Objective: A lifestyle-associated disease, diabetes mellitus, mandates compliance with established policies by physicians and patients to achieve optimal glycemic control. Collaborative care from health care providers and patients is essential for effective management, which slows disease progression, improves quality of life, and reduces medication costs. This study assessed the effectiveness of pharmacist-led educational initiatives provided to patients on clinical outcomes and direct treatment costs for those with diabetes in two public hospitals in Malaysia. Methods: Four hundred type 2 diabetes patients included in this study were randomly allocated to two corresponding groups. The control group, consisting of 200 patients (100 from each hospital), received standard treatment using the Malaysian Clinical Practice Guideline 2015, while the intervention group, also comprising 200 patients (100 from each hospital), received pharmacist-led care through Diabetic Medication Therapy Adherence Clinics (DMTACs), including pharmacist-provided education, alongside conventional treatment. The patients were equally selected from both hospitals based on the sample size calculation. The pharmacists provided educational interventions emphasizing dietary adjustments, lifestyle modifications, the significance of physical activity, and appropriate medication storage. Among these, 143 control patients and 156 intervention patients completed this one-year study, which comprised an initial and two follow-up visits. Clinical outcomes and treatment expenses were evaluated, and a data analysis was performed utilizing version 24 SPSS. Descriptive statistics were presented as the mean ± standard deviation, including normality assessed using the skewness, kurtosis, and Kolmogorov–Smirnov test. Independent t-tests were applied for hypothesis testing when the data showed normal distribution. Paired t-tests were used for cost assessments. Results: After the research, the group receiving intervention had a much higher decrease in HbA1c levels relative to the control group (3.59% versus 2.17%; p < 0.001). The intervention group had considerable decreases in systolic blood pressure (9.29 mmHg) and similarly in diastolic blood pressure (7.58 mmHg; with p < 0.005). Additionally, the levels of cholesterol in the intervention group improved significantly (0.13 mmol/L; p < 0.001). Moreover, treatment expenses for the pharmacist-led intervention group showed a substantial reduction (p < 0.001). By the second follow-up, the additional cost per patient since baseline was MYR 236.07 (Malaysian Ringgit), approximately 53.45 USD, in the control group, compared to only MYR 47.33 per patient, approximately 10.72 USD, in the intervention group with pharmacist involvement. Only medication costs were considered, and all unnecessary medications were discontinued as patient clinical outcomes improved sufficiently with pharmacist intervention, allowing for management through lifestyle changes alone. Counseling costs were not included since the pharmacists providing education were already employed in these hospitals, and no additional pharmacists were appointed for this purpose. Conclusion: Pharmacist-led interventions led to a significant improvement in HbA1c levels. While medication expenses increased in both groups from the initial follow-up, the control group exhibited a significantly greater increase in costs and HbA1c levels than the intervention group.