Background: Work-related stress is a significant issue among nurses globally, impacting their well-being and the quality of healthcare services. This study focuses on assessing the risks of work-related stress among nurses at King Fahad Hospital in Jeddah, Saudi Arabia. King Fahad Hospital was chosen for its status as one of the largest and busiest tertiary care hospitals in the region, representing the high-pressure healthcare environments typical of many Saudi hospitals, which are known to contribute to nurse stress due to heavy patient loads and long working hours. Objective: The primary objectives of this research were to estimate the risks of work-related stress hazards, explore the differences between demographics and workplace characteristics, and identify predictors of work-related stress among the nursing staff at King Fahad Hospital. Methods: A quantitative cross-sectional study was conducted, involving 262 registered nurses from non-critical wards at King Fahad Hospital. Data were collected using the Health and Safety Executive Management Standards Indicator Tool (HSE-IT), which measures potential stress hazards across seven dimensions: demands, control, manager support, peer support, relationships, role, and change. Statistical analyses, including the Mann-Whitney U test and logistic regression, were performed using SPSS to identify significant differences and predictors of work-related stress Results: The study revealed high levels of work-related stress among the nurses, with the highest risk factors being demand (Mean = 3.2, SD = 0.5) and role clarity (Mean = 3.7, SD = 0.8). Logistic regression analysis identified several significant predictors of work-related stress. Male nurses were 3.02 times more likely to experience stress related to job demands compared to female nurses (AOR = 3.02, 95% CI: 1.55–5.87, p = 0.001). Younger nurses (≤30 years) had 2.38 times higher odds of experiencing stress from job demands compared to older nurses (AOR = 2.38, 95% CI: 1.28–4.43, p = 0.006). Additionally, nurses with higher educational attainment (undergraduate or above) were 2.21 times more likely to report stress due to lack of job control compared to those with a diploma (AOR = 2.21, 95% CI: 1.14–4.27, p = 0.019). Nurses working longer hours (48 hours per week) had 3.14 times higher odds of experiencing stress related to peer support (AOR = 3.14, 95% CI: 1.68–5.87, p < 0.05), and shift workers were 5.17 times more likely to experience stress compared to those working fixed hours (AOR = 5.17, 95% CI: 2.14–10.82, p < 0.01). These findings suggest that targeted interventions are needed to support younger nurses, male nurses, and those working longer hours or shifts. Conclusions: The findings highlight the urgent need for targeted interventions to mitigate work-related stress among nurses at King Fahad Hospital. Broader implications extend beyond this hospital, as the challenges faced by nurses in Saudi Arabia are reflective of similar issues in other high-pressure healthcare environments globally. Addressing work-related stress through supportive policies, improved workplace relationships, clear role definitions, and organizational changes is crucial for enhancing nurse well-being and ensuring the delivery of high-quality patient care across the healthcare sector. Keywords: Work-related stress, nurses, healthcare, King Fahad Hospital, Saudi Arabia, HSE Management Standards, risk assessment, demographic predictors, workplace characteristics.

BACKGROUND: The COVID-19 pandemic significantly affected healthcare professionals, including community pharmacists in Malaysia, who faced increased workloads and emotional strain while continuing to provide essential services. However, limited research has been conducted on the health-related quality of life (HRQoL) of community pharmacists, particularly in the post-pandemic period. This study aims to assess the HRQoL of Malaysian community pharmacists to better understand the effects of the pandemic on their physical, mental, and social well-being. METHODS: A cross-sectional survey was conducted among 394 eligible community pharmacists in Malaysia, with 209 respondents completing the online questionnaire. The study utilized the RAND SF-36 for HRQoL assessment, the Fatigue Severity Scale (FSS) to evaluate fatigue, and the Epworth Sleepiness Scale (ESS) to assess daytime sleepiness. Data analysis was performed using SPSS, with t-tests, ANOVA, and multivariate regression applied to identify factors influencing HRQoL. Ethical approval was obtained, and informed consent was collected from all participants. RESULTS: Of the 209 pharmacists who participated, 46% were aged between 31-40 years, and 88% were female. Regarding HRQoL, 33.4% rated their health as "excellent" and 37.8% as "very good," while 20.1% reported their health had worsened compared to the previous year. A significant portion of participants (36.8%) reported limitations in physical activity, and half of them cut down on work hours. Emotional health issues impacted 52.6% of participants' performance, and 35.9% experienced health-related interference with social activities. Additionally, 67.5% reported severe fatigue, and 32.1% showed excessive daytime sleepiness. CONCLUSION: The findings reveal that HRQoL among Malaysian community pharmacists is significantly impacted by fatigue, emotional exhaustion, and physical strain. These challenges affect their overall well-being and productivity. The results highlight the urgent need for targeted interventions to improve the working conditions and support systems for pharmacists, aiming to enhance both their personal health and the quality of healthcare services they provide. KEYWORDS: Health-related quality of life, community pharmacists, COVID-19 pandemic, fatigue, daytime sleepiness, emotional exhaustion, Malaysia, post-pandemic well-being.

Utilisation of Non-Steroidal Anti-Inflammatory Drugs Among the Paediatric Patients of a Private Tertiary Care Hospital Introduction Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are widely prescribed, yet there is a lack of published research investigating their utilisation in the paediatrics population. This study aims to address this gap by examining the prescribing patterns of prescribers at a private tertiary hospital in Malaysia. Additionally, the study explores the actual and potential drug-related problems (DRPs) associated with NSAIDs use, based on all prescriptions collected during the study period. Methods This single-centred, ambi-directional cohort study was conducted at Sunway Medical Centre, Bandar Sunway from January to December 2024. The inclusion criteria included all prescriptions containing at least one NSAIDs, with the patients being less than 18 years old on the date of dispensing. The prescription data and patient progress notes were analysed for the indication for NSAIDs use. In addition to descriptive analysis, chi-squared tests were performed to examine relationships between NSAIDs use, the occurrence of DRPs, and patient demographics. Results There were no statistically significant differences in gender, race, age distribution, allergy status, and medical conditions among the study population with p-values more than 0.05. 93.26% of prescriptions were prescribed by the emergency, paediatrics and orthopaedic departments. Most NSAIDs were indicated for pain or fever relief, with aspirin specifically prescribed for conditions such as Kawasaki Disease or Systemic Lupus Erythematosus. Oral liquid formulations of NSAIDs (55.21%) were the most commonly prescribed due to their dosing convenience, palatability, and suitability for the younger children. Ibuprofen (58.69%) was the most frequently prescribed NSAID, followed by diclofenac (13.03%). As patient age increased, a broader range of NSAID options and formulations, including COX-2 inhibitors, were observed. Aspirin was prescribed mainly for patients under 5 years old, likely due to the prevalence of Kawasaki Disease in this age group. Paracetamol was the most common concomitant medication, consistent with its use for pain or fever relief. No severe adverse events associated with NSAIDs use were identified, indicating appropriate prescribing practices within this population. Dose-related potential DRPs were the most frequent type of DRP observed, occurring more often in patients between 6 to 11 years of age. Conclusion This study has identified the prescribing patterns and potential DRPs associated with NSAIDs use among the paediatric population of a private tertiary hospital. NSAIDs were predominantly prescribed for analgesic and antipyretic purposes. Future research could focus on investigating the knowledge, attitude, and perceptions of NSAIDs use among prescribers and pharmacy personnel. Such studies could provide insights into the practicality and challenges of prescribing medications for this young population. Keywords: Prescription, drug use, medications, prescriber, paediatric, analgesics.

BACKGROUND Antimicrobial resistance (AMR) is a critical global health challenge, necessitating widespread antimicrobial stewardship (AMS) across all healthcare sectors, including community pharmacies. Community pharmacists (CPs) play a key role in AMS by ensuring responsible antimicrobial dispensing, educating patients, and collaborating with prescribers. However, barriers such as limited training, unclear professional roles, and regulatory challenges hinder AMS implementation. This study aims to assess the extent of AMS application among CPs in Malaysia, identify key facilitators and barriers to AMS implementation, and evaluate the perception of AMS among CPs nationwide. Ultimately, our research can help to design a suitable AMS programme for CPs in Malaysia. METHODS A nationwide cross-sectional survey was conducted among 401 registered CPs across Malaysia, selected through convenience sampling. A structured, self-administered questionnaire assessed perceived AMS awareness, antimicrobial dispensing practices, and implementation barriers. The survey was distributed via a Google survey link and disseminated through Whatsapp. Data were analysed and statistical analyses were performed using SPSS (version 28). Descriptive statistics summarised responses, while the Mann–Whitney U and Kruskal–Wallis tests examined associations between demographic factors and AMS-related attitudes, practices, and barriers. Dunn’s post hoc test with Bonferroni correction was pplied for multiple comparisons (p = 0.050). RESULTS Among 401 respondents, 89.0% adhered to prescription regulations, 66.8% consulted national guidelines, and 97.3% educated patients on unnecessary antibiotic use. Collaboration with prescribers was common, with 97.0% encouraging physician consultations. CPs emphasised patient education, with 93.0% raising AMR awareness and 97.8% reinforcing full-course completion. Facilitators included ethical commitment, with 81.0% ensuring valid prescriptions and 89.0% prioritising patient safety over revenue. Barriers included AMS training gaps (28.7%), unclear AMS roles (31.2%), and logistical constraints (29.4%). CPs with 3–10 years of experience were more proactive in AMS, while hospital-trained CPs had greater perceived AMS awareness. CONCLUSION This study underscores the crucial role of CPs in AMS, with strong adherence to AMS principles. However, gaps in training, role clarity, and structured protocols remain. Addressing these barriers through targeted training, clear guidelines, and CP-GP collaboration will enhance AMS application, empowering CPs to combat AMR effectively in community settings. Keywords AMR; Antimicrobial Resistance; AMS; Antimicrobial Stewardship; Community Pharmacists

Epstein-Barr virus (EBV) is a class I carcinogen human herpes virus which has infected 90% of humanity and most prevalent among Asians, especially Chinese. After primary infection, EBV establishes the lifelong virus carrier state. EBV can be detected in two different tissues namely, B lymphocytes and epithelial cells. EBV is linked to the pathogenesis of a variety of human tumors and disorders, such as Burkitt’s lymphoma, and nasopharyngeal carcinoma. Algae are a potential source of antiviral compounds; however, there have been very few reports on the antiviral activity of microalgae extracts against EBV. The objective of this study was to investigate the antiviral activity of extracts from three microalgae, namely Ankistrodesmus convolutus UMACC 101, Synechococcus elongatus UMACC 105 and Spirulina platensis UMACC 161 against EBV in Burkitt’s lymphoma (BL) cell lines. Three EBV-positive BL cell lines, namely Akata, B95-8 and P3HR-1 were used as in vitro study model. A bioassay-guided fractionation approach was used for the screening of antiviral activity. The antiviral activity of the microalgae extracts was elucidated based on their inhibition efficacy in reducing number of cell-free viral particles being released by chemically induced lytic BL cells. This was assessed by quantifying the cell-free DNA using real-time PCR technique. In addition, the inhibition activity of microalgae extracts against the expression of the viral proteins LMP1, EBNA1 and ZEBRA in BL cells was assessed using immunocytochemistry technique. Two antiviral drugs namely acyclovir and foscarnet were chosen as positive controls. Methanol extracts from Ankistrodesmus convolutus and Synechococcus elongatus displayed low cytotoxicity (IC50 >200 µg/mL) and reduced the cell-free EBV viral load most effectively (EC50 <0.01 µg/mL) and thus, displayed high therapeutic index (>28000). The extracts decreased the expression of EBNA1 (>45%), LMP1 (>38%) and ZEBRA (>67%) effectively in P3HR-1 cells. After column chromatography fractionation, the non-polar fraction of the extract from Synechococcus elongatus (SEF1) reduced the amount of cell-free EBV DNA most effectively (EC50= 2.9μg/mL; therapeutic index >69) with low cytotoxicity (IC50 >200 μg/mL). SEF1 inhibited the expression of EBNA1 and ZEBRA (>40%) effectively in P3HR-1 cells. When SEF1 was further fractionated using HPLC, the sub-fraction SEF1’a was most active in reducing the cell-free EBV DNA (EC50= 1.38µ/mL; therapeutic index >14.5). It inhibited the expression of LMP1 moderately (25%) in P3HR-1 cells. The microalgae extracts did not interact with the cytoskeleton components (actin and tubulin) of BL cells during the release of cell-free EBV particles as revealed by the immunofluorescence study. The active constituents in the microalgae extracts tested might consist of pigments such as chlorophylls, carotenoids, phaeophytins and phycobilins. In conclusion, methanol extracts from Ankistrodesmus convolutus, Synechococcus elongatus and Spirulina platensis showed antiviral activity by inhibiting the release of EBV from the BL cells and the expression of the viral proteins LMP1, EBNA1 and ZEBRA in the host cells. The potential of the microalgae as a source of antiviral drugs against EBV is worth exploring.

Introduction: Currently there is an uptrend in the provision of Extended Pharmacy Services (EPS) among community pharmacists (CPs). EPS referred to various services that beyond the traditional pharmacists’ roles of dispensing medicines such as public health educational program, clinical services and medicine use review. However, such services were only reported in other developed countries but not in Malaysia. Within this context, the present study aimed to explore the types of EPS available, CPs’ perceptions and attitudes towards the provision of EPS. This study also identified the perceived barriers and facilitators towards the provision of EPS. Methods: A descriptive cross-sectional study was conducted. A total of 236 samples were collected through convenience sampling around Selangor and Kuala Lumpur region. The questionnaire consisted of 6 domains including demographic profile, the type of EPS, pharmacist’s perception, perceived barriers, perceived facilitator and pharmacist attitude towards the provision of EPS. All questions were scored using five-point Likert Scale. All the data were analysis through SPSS using descriptive statistics analysis, Mann-Whitney and Kruskal Wallis test. Results: CPs are willing to provide EPS in near future. For the time being, health screening test were the most performed EPS. CPs often/always performed blood pressure test, (97.8%), glucose test (96.6%) and cholesterol test (83.0%). Besides that, the often/always performed counselling sessions for cough and cold (95.8%) and nutritional supplement (94.5%). However, other advanced services like smoking cessation and weight management services were not frequently performed. The top 5 perceived barriers identified includes the lack of standardized practice model for EPS (87.3%), high pressure on generating sales (86.4%), lack of patient awareness (84.4%), 4 lack of access to patient medical record (83.5%) and shortage of time (80.5%). Whereas the support and encouragement from government and other pharmacy organization were identified as the most prominent facilitator towards the implementation of EPS. Conclusion: CPs showed a positive attitude towards the provision of EPS. For the time being, there are various EPS that had already been developed and implemented. However, the identified barriers should be intervened, and facilitators should be executed to implement EPS successfully in near future. Keywords: Pharmaceutical Care Services, Extended Pharmacy Services, Expanded Pharmacy Services, Enhanced Pharmacy Services, Barriers, Facilitators, Community Pharmacy

Dietary fat when consumed reduces hunger and impairs food intake by eliciting satiety signals and these signals are evoked by entry of triacylglycerol after hydrolization to fatty acids into the small intestine. 1,3-dipalmitoyl-2-oleoyglycerol (POP-), 1,3-distearoyl-2-oleoylglycerol (SOS-) and 1,2,3-triolein (OOO-) type of fats have different melting characteristics that may affect postprandial blood lipids, gut hormone concentrations, insulinemic response and selected cardiovascular disease markers in human volunteers. The main objective of this study is to compare the effects of edible fats with either palmitic acid (16:0) (palm mid-fraction) or stearic acid (18:0) (shea stearin) predominantly at the sn-1 and sn-3 positions on postprandial lipemia and gut hormone concentrations. A randomized, double-blind crossover (3 × 3 arms) orthogonal Latin-square design was used on 36 healthy adults (18 males, 18 females; mean age = 23 years). Each subject received 3 different test muffins (each containing 53 g of test fat) in random order separated by 2 weeks over a 6-week period. The test fats of different melting points were palm mid- fraction (PMF; POP-rich), shea stearin (SS; SOS-rich) and high- oleic sunflower oil (HOSF; OOO-rich) During a postprandial test, each subject was provided with a test muffin plus milkshake (total 3.67 MJ or 876 kcal) in the morning and blood samples were collected at half-hourly intervals until 4.0 hours. No significant difference (p>0.05) was observed between the 3 test meals for postprandial responses in plasma TC, Lp(a), apo(B), NEFA, GLP-1, PYY, ghrelin, VAS, PAI-1, IL-6, TNF-α, glucose, insulin and satiety (VAS scores). Plasma TAG peaked at about 4 hours; levels in the PMF- and HOSF- subjects were significantly higher (p<0.05) compared with SS-subjects after 90 minutes. PMF and HOSF exerted a higher postprandial GIP response (p<0.05) as compared to SS. Plasma C-peptide levels, as a measure of insulinemic response, rose sharply 5.5- folds in all groups, peaking after 90 minutes; levels in the SS group declined at a faster rate (p<0.05) than in the PMF- and HOSF- groups. The POP- and OOO- fats induced similar effects on all the biochemical/physiological outcome measures investigated. In contrast, the SOS- type fat (shea stearin) induced a slower rise (p<0.05) in postprandial TAG and GIP levels and a faster return of plasma C-peptide levels to baseline.

Multidrug resistance (MDR) is a serious problem that causes failure in chemotherapy. P-glycoprotein (P-gp) is widely distributed in the intestine, liver and kidneys contributing as one of the major mechanism that causes efflux of chemotherapeutic agents, resulting in ineffective therapeutic level during treatment. However, recent advances in drug delivery systems have made it possible to circumvent MDR issues. In this study, an attempt was made to develop Poly-lactide co-glycolide (PLGA) nanoparticles for oral chemotherapy by co encapsulating doxorubicin (Dox) as the chemotherapeutic agent and cyclosporine-A (CysA) as the chemosensitizer that will function to inhibit P-gp to increase uptake of Dox. High Performance Liquid Chromatography (HPLC) methods were developed and validated for detection and quantification of Dox and CysA. Optimized Dox-CysA nanoparticles were reported to be in 214±4.56 nm of size, zeta potential of -30.1±9.42 and polydispersity index of 0.139±0.09.Transmission Electron Microscopy (TEM) image shows spherical nanoparticles. Differential Scanning Calorimetry (DSC) thermogram indicates Dox and CysA exist in amorphous form in PLGA nanoparticles. Dox and CysA nanoparticles were formulated separately alongside optimized nanoparticle for comparison purposes in drug release and cytotoxicity studies. Dox released slowest from Dox-CysA nanoparticles whilst CysA from CysA nanoparticles in Phosphate Buffer Saline (PBS), promising a controlled release. Cytotoxicity studies conducted on Caco 2 cell line, showed the lowest cell viability of 34%, for Dox-CysA loaded nanoparticles and 76.8% for Dox loaded nanoparticles while a combination of Dox loaded nanoparticles and CysA loaded nanoparticles at the same concentration gave a cell viability of 47.1%, with all treatment containing Dox at 0.71μg/ml. Co-administration of CysA together with Dox in the same nanoparticles formulation proves to increase the uptake of Dox in vitro.