THE PANACEAPharmacy in the Age of Innovation: Addressing Global Challenges and
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T H E P A N A C E ACCOONNTTEENNTTSSI I IDean, Faculty of PharmacyI VEditorial-in-ChiefV I IEDITORIAL COMMITTEEFOREWORDS1 Application of ATR-FTIR Spectroscopy inPharmaceutical Sciences: BridgingResearch and Education at the Faculty ofPharmacy Universiti MalayaBridging Borders Through Science: MyResearch Journey from China to MalaysiaConnecting with Gen Z and AlphaThrough Digital HealthDeprescribing in older adults: A path tosafer medication useEpitopes and T Cells: Tiny Warriors AgainstPathogensBridging Disciplines, Shaping Futures:Geriatrics Masterclass 3.0 Cultivates TeamBased Care at Universiti MalayaGreen Pharmacy Practice in EnhancingEnvironmental Sustainability: Are WeThere Yet?Faculty of PharmacyResearch Highlights368101314
T H E P A N A C E ACCOONNTTEENNTTSSCurcuHeal: Science, Innovation anda Shot at the Big StageDouble Trouble: The Rising Trend ofDual Cigarette and E-Cigarette UsePharmacy Students Lead DiabetesFight in Underserved CommunitiesRepositioning DiabetesManagement in Nigeria: The Role ofCommunity Pharmacists towardsPatient-Centered CareRobotic Technologies in ModernPharmacy Practice: Trends andProspectsThe Impact of Combination Therapyon Wound HealingThe Preparedness Paradox:Pharmacy Perspective of the NextGlobal Health EmergencyFaculty of PharmacyResearch HighlightsFaculty of PharmacyResearch HighlightsFaculty of PharmacyActivities HighlightsServices in Faculty ofPharmacyStaff Excellence Award16172124303334394446
FOREWORDIt gives me great pleasure to present The PanaceaBulletin, Volume 4 of 2025. This year’s theme,“Pharmacy in theAge of Innovation: Addressing Global Challenges and Shapingthe Future,”captures the spirit of transformation shaping ourprofession and our faculty. Pharmacy stands at the crossroadsof science, technology, and human health.The rapid evolution of digital health, artificialintelligence, advanced therapeutics, and precision medicine isredefining how we deliver care and how we educate futurepharmacists. In this dynamic landscape, our faculty remainssteadfast in its mission to nurture competent, compassionate,and forward-thinking pharmacy professionals who canrespond to both local and global healthcare needs.This edition of The Panacea celebrates the creativity,resilience, and impact of our academic and studentcommunities. It showcases research excellence, communityengagement, and collaborative initiatives that exemplify ourcommitment to innovation and social responsibility. As weconfront global challenges such as antimicrobial resistance,access to essential medicines, and the integration of digitalhealth solutions, we recognise that pharmacists play a pivotalrole in shaping sustainable, patient-centred healthcaresystems.I extend my sincere appreciation to the editorial team,contributors, and all who have made this publication possible.May the stories and reflections in these pages inspire us tocontinue pushing boundaries, embracing innovation, andleading change together as we shape the future of pharmacy.Dean, Faculty ofPharmacyDr. Nusaibah Abdul RahimDeanFaculty of PharmacyUniversiti MalayaTHE PANACEA / VOLUME 4 2025 / III
FOREWORD“Where there is a will, there is a way”, a timeless sayingthat reflects the very essence of Panacea, our Faculty ofPharmacy’s flagship publication. It gives me great pleasure topresent this latest edition, themed “Pharmacy in the Age ofInnovation: Addressing Global Challenges and Shaping theFuture.” Much like its name, Panacea embodies our collectivepursuit of knowledge, innovation, and compassion, the veryingredients that define the soul of pharmacy.The theme could not be more fitting for our times. Asthe world faces complex health challenges, the role ofpharmacists continues to evolve, not only as dispensers ofmedicine but as innovators, researchers, and changemakers inglobal healthcare. This edition celebrates that transformation,highlighting ideas and initiatives that push the boundaries ofwhat pharmacy can achieve.Though young, our faculty has already established astrong legacy, one of academic excellence, researchinnovation, and community engagement. Each page ofPanacea reflects this growth, showcasing voices that will oneday define the future of pharmacy and healthcare. Ourresearchers, staff, and students continue to demonstrate thatlearning extends beyond lectures and laboratories; it lives indialogue, collaboration, and shared inspiration. As the Malayproverb wisely says,“Sedikit-sedikit, lama-lama menjadi bukit”— small steps, taken with persistence, build outstandingachievements.Panacea stands as proof of that spirit. It is both ourmirror and our milestone, a celebration of how far we’ve come,and a promise of how far we can go together.My heartfelt appreciation goes to the editorial team, writers,and all contributors for their creativity, dedication, and hardwork in making this publication possible. May this editioninspire curiosity, spark ideas, and remind us that innovationbegins with the courage to imagine.Editorial-in-chiefDr. Kayatri GovindarajuEditor-in-ChiefPanacea CommitteeFaculty of Pharmacy, Universiti MalayaTHE PANACEA / VOLUME 4 2025 / IV
Dr. Nusaibah Abdul RahimAdvisorTHE PANACEA / VOLUME 4 2025 / VIIEEDDIITTOORRIIAALLCCOOMMMMIITTTTEEEEDr. Kayatri A/P GovindarajuEditor-in-ChiefDr. Wan Safwani WanKamarul ZamanAssociate EditorDr. Sagir MustaphaAssociate EditorNoor AkmaKamaruddinSecretriatRustini KarimSecretariat A/P. Rozana OthmanAdvisorDr. Izyan Abdul WahabAdvisor
APPLICATION OF ATR-FTIR SPECTROSCOPY IN PHARMACEUTICALSCIENCES: BRIDGING RESEARCH AND EDUCATION ATTHEFACULTYOF PHARMACY UNIVERSITI MALAYAAttenuated Total Reflectance Fourier TransformInfrared (ATR-FTIR) spectroscopy has become anessential analytical tool in pharmaceuticalsciences, offering rapid, accurate, and nondestructive characterization of pharmaceuticalcompounds. This study highlights the integrationand multifaceted utility of ATR-FTIR spectroscopyat the Faculty of Pharmacy, Universiti Malaya. Theinstrument supports a broad range of researchapplications, including qualitative identification ofactive pharmaceutical ingredients (APIs) andexcipients, drug-excipient compatibility studies,polymorphic analysis, and stability profiling underhydrolytic, oxidative, and photolytic conditions.Beyond its analytical role in research, the systemis deeply embedded in educational and trainingactivities. It is incorporated into undergraduateand postgraduate curricula, including coreanalytical technique courses, and serves as a keyplatform for final year projects and postgraduateresearch. Moreover, it facilitates experientiallearning for international students participating inmobility programs from countries such as India,China, and Indonesia, who apply FTIR analysis intheir academic projects. Regular hands-ontraining sessions further enhance operationalproficiency and spectral interpretation skillsamong students and researchers. The integrationof ATR-FTIR into both academic and researchframeworks exemplifies its dual function as arobust analytical method and a criticalpedagogical tool. Through this dualimplementation, the faculty fosters a strongfoundation in analytical competencies whilesimultaneously contributing to researchinnovation. The findings underscore thesignificant role of ATR-FTIR spectroscopy inenhancing pharmaceutical analysis capabilitiesand preparing future professionals equipped withessential technical and interpretive skills.Chanthiriga RamasindarumCentre of Advanced Materials,Department of Mechanical Engineering,Faculty of Engineering, Universiti [email protected] Transform Infrared (FTIR) spectroscopyis a widely utilized technique in pharmaceuticalsciences. FTIR spectroscopy operates bymeasuring the absorption of infrared radiation bya sample, providing insight into the vibrationalmodes of molecular bonds and the presence ofspecific functional groups [1]. These molecularinteractions generate a distinctive infraredspectrum that shows as a unique fingerprint ofthe material [1]. This information can be used toidentify a sample’s specific chemicalcomponents, determine the material’s purity, andeven detect trace amounts of impurities. makingFTIR an invaluable tool in both qualitative andsemi-quantitative pharmaceutical analyses [1].The Attenuated Total Reflectance (ATR) modehas become integral in routine and advancedpharmaceutical evaluations. Recent literatureemphasizes its increasing application in drugformulation analysis, process monitoring, andquality control [2-4]. The technology’s capacityto detect drug-excipient interactions, monitorpolymorphic forms, and evaluatephysicochemical stability supports its relevancein current pharmaceutical workflows [4-5]. Theuse of an ATR accessory, particularly with adiamond crystal, permits direct sample analysiswith minimal preparation. It allows the sample tobe in direct contact with an internal reflectionelement (IRE) made of a high refractive indexmaterial. This mode is suitable for a wide rangeof sample types including solids, semi-solids,gels, and liquids. The FTIR spectroscopy used atFaculty of Pharmacy, Universiti Malaya foranalysis of various samples is shown in Figure 1.Figure 1 : FTIR Spectroscopy with ATR accessorThe Use of FTIR Spectroscopy atFaculty of PharmacyThe Spectrum Two FTIR system is extensivelyutilized in pharmaceutical research due to itsversatility and precision in analysing molecularstructures. One of its primary applications is thequalitative identification and authentication ofactive pharmaceutical ingredients (APIs) andexcipients. This process ensures the accuracy andpurity of raw materials used in drug development[2]. The system is also instrumental in conductingdrug-excipient compatibility studies, which areessential during the formulation phase to identifypotential chemical interactions that maycompromise the stability or therapeutic efficacy ofpharmaceutical products [4].At the Faculty of Pharmacy, Universiti Malaya,the Spectrum Two FTIR system is deeplyembedded within the teaching and trainingframework. It plays a central role in theanalytical techniques course, where studentsdevelop hands-on skills in spectralinterpretation and the characterization ofpharmaceutical substances. Additionally, theSpectrum Two FTIR system plays a vital role insupporting International Mobility Programs,which host students from countries such asIndia, China, and Indonesia. These studentsactively utilize the ATR-FTIR system as part oftheir research and academic projects, gaininghands-on experience in ATR-FTIR analysis.Through their involvement in laboratory workand data interpretation using the SpectrumTwo FTIR system, mobility students not onlyenhance their technical competencies but alsocontribute to ongoing research initiatives. Thisintegration fosters meaningful cross-culturalacademic exchange and strengthenscollaborative learning, reinforcing the Faculty ofPharmacy’s commitment to providing a globallyrelevant and research-driven educationalenvironment.Additionally, ATR-FTIR facilitates polymorphicand crystallinity analysis, allowing researchersto distinguish between different solid-stateforms of a compound; an important factorinfluencing solubility, bioavailability, andpatentability [3,5]. Another critical applicationis in stability profiling, where the system is usedto monitor degradation pathways under stressconditions such as hydrolysis, oxidation, andphotodegradation. These analyses provideinsights into the chemical robustness and shelflife of pharmaceutical formulations [6]. Overall,the system’s broad analytical capabilities makeit an asset in advancing pharmaceuticalscience and ensuring product quality.Figure 2: (a) Mobility student from Karpagam Academyof Higher Education (KAHE), India. (b) Mobility studentfrom Universitas Gadjah Mada, Indonesia.THE PANACEA / VOLUME 4 2025 / 1Faculty of Pharmacy ResearchHighlights
The Spectrum Two FTIR system is also widelyutilized in postgraduate and final yearundergraduate research projects enablingstudents to apply ATR-FTIR in experimentalinvestigations involving formulation studies,material analysis, and quality control. Thisintegration not only enhances the learningexperience but also prepares students forprofessional roles in research andpharmaceutical industries. The integration ofATR-FTIR into both research and educationillustrates the instrument’s multifaceted value. Itnot only supports cutting-edge research but alsoplays a pedagogical role in preparing students forcareers in analytical and formulation sciences.The Spectrum Two system’s ease of use andversatility make it ideal for educationalenvironments were hands-on trainingcomplements theoretical instruction. AbstractIn conclusion, the ATR-FTIR spectroscopy is aprerequisite for both research advancement andstudent development at the Faculty of Pharmacy,Universiti Malaya. Its broad application spectrumand educational utility affirm its essential role inmodern pharmaceutical practice.References1. Cherniienko, A., Lesyk, R., Zaprutko, L., &Pawełczyk, A. (2024). IR-EcoSpectra: Exploringsustainable ex situ and in situ FTIR applicationsfor green chemical and pharmaceuticalanalysis. Journal of Pharmaceutical Analysis.2.Saleem, A., et al. (2023). ATR-FTIRspectroscopy as a tool for pharmaceuticalcharacterization: From qualitative analysis toprocess control. Journal of Pharmaceutical andBiomedical Analysis, 227, 115204.3.Zhang, Q., et al. (2023). Application of ATR-FTIRand chemometrics in identifying polymorphictransitions in pharmaceuticals. SpectrochimicaActa Part A: Molecular and BiomolecularSpectroscopy, 287, 122049.4.Singh, N., et al. (2022). Role of ATR-FTIR inquality control of drug delivery systems: Areview. Materials Today: Proceedings, 61, 345–351.5.Ramesh, S., et al. (2024). ATR-FTIR in thedetection of drug polymorphism: An emergingtool in preformulation studies. Journal ofApplied Spectroscopy, 91(2), 189–198.6.Bhattacharya, D., et al. (2024). Advances in FTIRspectroscopy for pharmaceutical analysis: Afocus on formulation and stability assessment.International Journal of PharmaceuticalSciences, 156, 112045.THE PANACEA / VOLUME 4 2025 / 2Faculty of Pharmacy ResearchHighlights
BRIDGING BORDERS THROUGH SCIENCE: MYRESEARCH JOURNEY FROM CHINA TOMALAYSIAAs part of my short-term attachment at theUniversiti Malaya, I participated in a researchproject focused on developing a pH-dependentextended-release metformin formulation for themanagement of type 2 diabetes. From studyingoverseas at China Pharmaceutical University to aresearch program at Universiti Malaya, thisexperience allowed me to bridge the differentresearch cultures between China and Malaysia,further enriching my scientific approach. Underthe guidance of Mr. Farhan and Dr. Riyanto, Iexplored innovative drug delivery strategies whileimmersing myself in Malaysia’s dynamicacademic environment. Beyond immediateachievements, this attachment also laid thegroundwork for future cross-border collaborationin healthcare innovationTeng Chang Ching , Mohamad Farhan Roslan , Riyanto Teguh Widodo1 2 2*China Pharmaceutical University, Nanjing, People's Republic of China1Department of Pharmaceutical Technology, Faculty of Pharmacy, Universiti Malaya,50603 Kuala Lumpur, Malaysia2SynopsisBackgroundDuring the “2 CPU Belt and Road InternationalConference on Cooperation and Integration ofPharmaceutical Industry, Education, Researchand Application, and the Inaugural Meeting: Beltand Road Pharmacy Cooperation andApplication” held by China PharmaceuticalUniversity from 16 to 18 May 2024, I served as astudent representative responsible for hostingthree distinguished scholars from the UniversitiMalaya. Throughout the three-day academicevent, these experienced professorsdemonstrated remarkable academic expertise,engaging in profound discussions withparticipating students while sharing insightfulperspectives and forward-looking predictionsregarding pharmaceutical development in bothMalaysian and Chinese contexts, as well as theglobal landscape. It was during this conferencethat I developed my aspiration for academicexchange at the Universiti Malaya. Fortuitously, Ihad the privilege of meeting my currentsupervisor, Dr. Riyanto, whose research interestsexhibit significant alignment with mine, ultimatelymotivating my decision to pursue an academicexchange at the Universiti Malaya.ndWhile selecting our research focus, we found thatMalaysia has one of the highest diabetesprevalence rates in Asia. This compelling statisticmotivated us to develop an improved therapeuticapproach to support public health initiatives inthe region. During my research attachment at theUniversiti Malaya, we designed a pH-dependentextended-release formulation of metforminhydrochloride for type 2 diabetes management.Current antidiabetic regimens often requirefrequent dosing, which contributes to poorpatient adherence. Our extended-releaseformulation is designed to maintain a sustaineddrug release, reducing the need for frequentdosing while preserving therapeuticeffectiveness. Additionally, this system mayenhance bioavailability by minimizing first-passmetabolism. The optimized pharmacokineticprofile could also lead to better glycaemiccontrol and improved patient compliance, whichare the key factors in chronic diseasemanagement.Metformin is the most popular and optimalfoundation therapy for patients with type 2diabetes mellitus, especially in individuals who areunable to achieve adequate glycaemic controlthrough dietary and lifestyle interventions alone. Itswidespread use is attributed to its effectiveglucose-lowering ability, low cost, weight-neutralprofile, and overall favourable safety characteristics,notably the minimal risk of hypoglycaemia.Metformin exerts its therapeutic effects primarilyby triggering the inhibition of hepatic glucoseproduction and enhancing insulin sensitivity inperipheral tissues such as skeletal muscles, whichfurther increases its suitability for patients withdeclining β-cell secretory capacity. Importantly, itdoes not stimulate insulin secretion frompancreatic β-cell, and therefore does not lead toexcessive insulin levels, which results in a lower riskfor hypoglycaemia. As a result, it remains effectiveeven in individuals with declining endogenousproduction .[1]The addition of hydrochloride allows the formationof a hydrochloride salt, which significantlyenhances the solubility of the drug in thegastrointestinal (Gl) tract. This improvement iscrucial for the pharmacokinetic performance oforally administered tablets, as increased solubilityand stability contribute to a more efficientabsorption within the Gl tract. Enhanceddissolution facilitates the active transportmechanisms across biological membranes, therebysupporting its therapeutic efficacy throughimproved bioavailability .[2]The use of pH-sensitive polymers enablescontrolled drug release in response to the variablepH conditions of the GI tract. It can demonstratedistinct swelling and drug release characteristicsdepending on the surrounding pH environment.This mechanism plays a crucial role in optimizingmetformin’s absorption and distribution, especiallysince it relies on specific transporters for cellularuptake.In this study, microcrystalline cellulose (MCC)is used to help the active pharmaceuticalingredient remain relatively compact in acidicconditions, specifically pH1.2, such as thosepresent in the stomach, thereby minimizingpremature drug release. In contrast, underneutral to slightly alkaline conditions,specifically pH6.8 to pH7.4, typical of theintestinal environment, the polymer matrixswells significantly, facilitating enhancedmetformin release. This pH-dependentbehaviour protects metformin from prematuregastric release and potential acid-mediateddegradation, enabling targeted and moreeffective absorption in the intestines,enhancing its bioavailability. The results of thedissolution study conducted in this researchconfirm this pH-responsive behaviour.The addition of hydrochloride and pHdependent polymers to metformin extendedrelease formulations serves to enhance thedrug's bioavailability, reduce dosing frequencyand enable controlled release, thereby ensuringa more consistent therapeutic effect.Metformin hydrochloride is a highly solublecompound, while its extended-releaseformulation aims to maintain therapeutic levelsover an extended period while minimizingcommon side effects such as Gl discomfort.The use of pH-dependent polymers helps inachieving a controlled drug release byresponding to the pH variations along the Gltract, thus optimizing the drug's releaseprofile . Metformin absorption is facilitated bytransporters such as the plasma membranemonoamine transporter (PMAT), which is pHdependent. This transporter is more active inacidic environments, suggesting that pHdependent formulations can enhancemetformin uptake by optimizing the local pHconditions . Extended release formulationsoffer additional benefits, including improvedpatient compliance, as the reduced dosingfrequency simplifies treatment regimens .Furthermore, controlled drug release ofmetformin helps in reducing side effects byminimizing gastrointestinal side effects, whichare common with immediate-releaseformulations. This is achieved by avoiding highpeak concentrations of the drug in thebloodstream.[3][4][5]IntroductionTHE PANACEA / VOLUME 4 2025 / 3Faculty of Pharmacy ResearchHighlights
Extended-release metformin tablets of differentformulations are prepared and evaluated for precompressed characteristics, post-compressedcharacteristics and tablet release characteristics.In this research, six different formulations aredeveloped to seek the difference caused byvarying the concentration of ethylcellulose,chitosan and Hydroxypropyl methylcellulose(HPMC). The detailed compositions are shown inthe table below, and a wet granulation methodwas adopted to prepare the tablets.Experimental, Results andDiscussionPre-compression studiesPre-compression studies were performed toevaluate the characteristics of formulatedpowder mixtures, their covering angle of repose,compressibility index (Carr’s index), Hausner ratioand moisture content, Fourier Transform InfraredSpectroscopy (FTIR) analysis and DifferentialScanning Calorimetry (DSC) analysis.The angle of repose test was carried out todetermine the friction between the powder,which further indicates the flowability. Atriangular funnel was set up, and 25g of thepowder of each formulation was droppedthrough the funnel, allowing it to fall freely onto acircular plane and stay on it. The height of thepeak is measured, and the angle of repose iscalculated using the height of the peak and theradius of the round plane. The angle of reposevaries from 33.69° to 35.57°, indicating that thepowder flows well, which aids in contentuniformity.Bulk and tapped density were determined bypouring the formulation powder into a graduatedcylinder to a volume of 15cm . The cylinder wasthen tapped repeatedly until the volume becameconstant. Theirs values were of them were thenused to calculate Carr’s indexand the HausnerRatio. The Carr’s index varies from 17.7734g/cmto 23.3406g/cm while the Hausner Ratio variesfrom 1.2162g/cm to 1.3045g/cm , indicating a fairflowability for tablet compression aftergranulation. Their moisture content wasdetermined by a moisture analyser. And found tobe in the range from 4.79% to 5.11%, indicating afairly high moisture, but acceptable, which mightfurther affect the tablet stability and might causemicrobial issues (Table 2).3333 3In Fourier Transform Infrared Spectroscopy (FTIR)analysis, the FTIR spectrum of pure metforminand the formulations was recorded. Significantpeaks for metformin were preserved, indicatingno major interactions (Table 3) The FTIR spectraof pure metformin and the formulations wererecorded.In Differential Scanning Calorimetry (DSC)analysis, it was performed to detect thermaltransitions. The formulation’s melting point wasobserved near 235°C, close to pure metformin’speak at 236.22°C, indicating no significantincompatibility (Figure 2 and Table 4).Post-compression studiesUniformity of WeightTablet size and hardness6 tablets were measured using a digital calliper,and the thickness consistency was calculated. Adeviation of 5% of the weight is allowed. Most ofthe formulations have passed the test, indicatinguniform drug content, which facilitates patientacceptance due to high swallowability andensures proper packaging.The hardness test was conducted by placing 6tablets from each formulation individually intothe hardness test machine, and the averagecrushing strength was calculated. The averagecrushing strength varies from 45.846N to79.759N, which is considered acceptable, but atthe border of being too soft, which can causeinconsistent dosing. Tablets being fragile can alsolead to breakage during packaging andtransportation.Friability test15 tablets from each formulation were trembledfor 100 revolutions at 25rpm. The weight lossvaries from 0.21% to 0.35%, which is within theacceptable limit of less than 1% specified by theBP . This indicates that the tablets possessadequate mechanical strength and are resistantto abrasion during handling and packaging[6]THE PANACEA / VOLUME 4 2025 / 4Faculty of Pharmacy ResearchHighlights
In vitro dissolution studiesIn pH6.8, Formulations 1, 2, 3, and 5 show a stablerelease, achieving a near 90.00% release rate bythe end of the test. Formulation 4 shows a rapidrelease at 66.20% in the first hour and reachesthe peak plasma concentration by the third hour,which is very fast for an extended release andcan cause a burst release that becomesthreatening if dose dumping occurs. Formulation6 shows a stable release but only reaches70.50% release rate by the end of the test,indicating a fairly low release rate as compared tothe others. In pH 1.2, all formulations show stablerelease and achieve less than 20.00% releaserate by the end of the test, indicating a goodresult.In comparison, Formulation 3 achieves thehighest release rate of 88.99% in pH6.8 and arelatively low release rate of 16.17% in pH1.2 at the8 hour, indicating a successful pH-sensitiveformulation and a stable release, achieving aprotection of the drug in gastric environment anda good release in the targeted site in the intestinewhere metformin is primarily absorbed.thStandard curve preparationDissolution testConclusionIn this study, pH-dependent extended-releasemetformin tablets were successfully formulatedand evaluated through a series ofphysicochemical and performance tests. Thetablets demonstrated acceptable flowproperties, uniform weight and content, andadequate mechanical strength with low friability.The dissolution profile showed 80.00% to90.00% drug release within 8 hours in a neutralenvironment, with a lower release rate in anacidic environment, aligning with the desiredsustained-release characteristics. FTIR and DSCanalysis confirmed the absence of chemicalinteractions between the drug and theexcipients. Overall, the formulation metpharmacopeial standards and achieved theintended release profile. Future work could focuson improving powder flow and reducing moisturecontent to enhance stability. Increasing thesample size and exploring alternative polymersmay also help refine the release profile andensure consistency for large-scale production.References[1] E. Sanchez-Rangel and S. E. Inzucchi,“Metformin: clinical use in type 2 diabetes,”Diabetologia, vol. 60, no. 9, pp. 1586–1593, Sep.2017, doi: 10.1007/s00125-017-4336-x.[2] L. F. Diniz, P. S. Carvalho, J. E. Gonçalves, R.Diniz, and C. Fernandes,“Solid-statelandscape and biopharmaceutical implications ofnovel metformin-based salts,”New Journal of Chemistry, vol. 46, no. 28, pp.13725–13737, 2022, doi:10.1039/D2NJ00453D.[3] M. Zhou, L. Xia, and J. Wang,“MetforminTransport by a Newly Cloned Proton-StimulatedOrganic Cation Transporter (Plasma MembraneMonoamine Transporter) Expressed in HumanIntestine,” Drug Metabolism and Disposition, vol.35, no. 10, pp. 1956–1962, Oct. 2007, doi:10.1124/dmd.107.015495.[4] J. H. Kim, S. H. Song, S. H. Joo, G. H. Park,and K.-Y. Weon,“Formulation of a GastroretentiveIn Situ Oral Gel Containing Metformin HCl Basedon DoE,” Pharmaceutics, vol. 14, no. 9, p. 1777, Aug.2022, doi: 10.3390/pharmaceutics14091777.[5] S. Noreen et al.,“Formulation, StatisticalOptimization, and In Vivo Pharmacodynamics ofCydonia oblonga Mucilage/AlginateMucoadhesive Microspheres for the Delivery ofMetformin HCl,” ACS Omega, vol. 8, no. 6, pp.5925–5938, Feb. 2023, doi:10.1021/acsomega.2c07789.[6] The British Pharmacopoeia Commission,British Pharmacopoeia 2023, 2023rd ed. London:The Stationery Office (TSO), 2023.THE PANACEA / VOLUME 4 2025 / 5Faculty of Pharmacy ResearchHighlights
CONNECTINGWITH GEN Z AND ALPHATHROUGH DIGITAL HEALTHThe healthcare landscape has transformedsignificantly over the past two decades. As aMillennial (Gen Y) pharmacist, I’ve seen first-handhow the delivery of care has evolved from manualprescription logs and physical patient charts toelectronic records, mobile apps, and AI-poweredrecommendations. Today, Gen Z and Gen Alphaare growing up in a world where healthcare isaccessed through smartphones, managedthrough wearable devices, and often delivered viavideo consultations. We’re living in the age ofdigital health full of new opportunities, but alsochallenges that call on each of us to adapt, learn,and guide the next generation.Irma Wati NgadimonDepartment of Pharmaceutical Life Sciences, Faculty ofPharmacy, Universiti Malaya, 50603 Kuala Lumpur*Corresponding author: Irma Wati Ngadimon([email protected])When I Guided Gen ZA while back, my 16-year-old daughter, who’s inboarding school, shared that she was havingtrouble sleeping and feeling anxious aboutexams. She’d heard her friends talk aboutmeditation apps but wasn’t sure which ones totrust. When she came home for the weekend, welooked at a few together, checked reviews andprivacy settings, and chose one by a non-profitgroup. She’s been using it since and says it helpsher sleep and feel calmer.Later, she showed me her smartwatch stats andasked why her heart rate spikes when she’s justsitting. That led to a chat about stress, moodtracking, and data privacy. It was more than ateaching moment. It became a two-wayexchange. She reminded me how naturally Gen Zturns to tech, and I reminded her that tech worksbest when paired with real awareness.Globally, digital health is becoming a cornerstone ofmodern healthcare. The World HealthOrganization’s Global Strategy on Digital Health2020–2025 envisions a future where all individualscan benefit from accessible, person-centereddigital services (World Health Organization, 2021). InIndia, the eSanjeevani telemedicine network hasalready facilitated over 275 million consultations(Boston Consulting Group, 2024). In my ownpharmacy practice experience, I’ve seen patientsuse mobile apps to manage medication adherence,receive blood pressure readings via connecteddevices, and consult doctors virtually, all withoutleaving their homes.Technologies such as AI-powered diagnostics,mental health chatbots, digital pillboxes, andremote monitoring tools are no longer “extras”.They’re becoming standard. Since the COVID-19pandemic, the uptake of telehealth and digital caresolutions has grown exponentially, driven byconvenience, access, and changing expectations(Jiang et al., 2019).A New Era of HealthEngagementA Moment with Gen AlphaRecently, my 10-year-old son mentioned feelingtired a lot. We checked his smartwatch andhydration app, and found he’d been staying uplate playing games and barely drinking water.That led to a light, age-appropriate conversationabout screen time, sleep, and healthy habits.Now he checks his bedtime himself and evenreminds me to drink more water. A smallmoment, but proof that even Gen Alpha canbuild good habits with the right nudge.Gen Z and Gen Alpha:Health in a Digital WorldGen Z and Gen Alpha:Health in a Digital WorldGen Z (born ~1995–2009) are digital natives whointegrate technology into their health behaviorswith ease. Research shows that over 60% usewellness apps or wearables and prefer digital-firstinteractions with healthcare providers (WorldEconomic Forum, 2023; Chou et al., 2021). They’realso more open about mental health, proactiveabout self-care, and expect personalization andinstant access.Generation Alpha (born ~2010–2024), meanwhile, isgrowing up with even deeper exposure to tech.From a young age, they’re using smartwatches,voice assistants, and gamified health apps. Expertspredict they’ll expect AI-driven, fully personalizedcare. But they may also face unique risks: shorterattention spans, screen overexposure, and relianceon unverified content (Cecconi et al., 2025; UNICEF,2023). That’s where guidance becomes essential.What Can Boomers,Gen X, and Gen Y Do?As Baby Boomers, Gen X and Millennials, we maynot have grown up as digital natives, but we bringsomething just as critical: life experience,professional judgment, and the opportunity tomentor younger generations in using digital healthwisely.Research shows that younger people oftenoverestimate their ability to evaluate online healthinformation, while older adults tend to approach itmore cautiously but may lack technical fluency(Papp-Zipernovszky et al., 2021). That creates asweet spot for us to step in, not as gatekeepers, butas guides.Here are several research-supported ways oldergenerations can make a difference:Stay curious and lead by exampleDigital health adoption is more effective when olderadults engage with the same tools (Cecconi et al.,2025). Exploring apps that younger users are using,whether for mental health, hydration, or symptomchecking helps open up conversations and allowsshared evaluation of features like developercredibility and privacy settings.Talk about digital hygieneA review by Chou et al. (2021) highlights how Gen Zis especially vulnerable to health misinformation onsocial media due to high exposure and lowverification skills. Discussing popular online healthtrends (e.g., detox teas or TikTok “hacks”) canbecome meaningful teachable moments focusingnot on criticism, but on how to think critically andfact-check. Digital hygiene is especially importantfor Gen Z and Gen Alpha, who rely heavily on appsand social media for health-related information.Without proper guidance, they may fall for trendsthat are unproven, unsafe, or exploitative.Encourage digital literacy skillsYoung users benefit from learning how todistinguish user-generated content from evidencebased health advice. Comparing trusted sourceslike the WHO or Mayo Clinic to trending content onsocial media helps develop this discernment.Make real-world moments educationalInvolving children or teens in pharmacy visits byshowing how to use medication tracking apps,scanning barcodes, or setting medicationreminders can help normalize digital health tools(OECD, 2023).Support digital–real life balancesA UNICEF (2023) report raised concerns aboutrising screen time among children aged 8–14, linkedto poor sleep and reduced physical activity.Caregivers and educators can model healthy habitsby setting device boundaries, encouraging outdoortime, or using wearables together for step-countgoals.THE PANACEA / VOLUME 4 2025 / 6Faculty of Pharmacy ResearchHighlights
Ultimately, our role isn’t to master every new toolbut to be approachable, informed, and openminded. When we ask questions, stay curious,and share our own learning journey, we giveyoung people permission to explore health toolsthoughtfully and safely. In the end, it’s not aboutknowing every app or feature out there. It’s aboutkeeping the conversation open, learning together,and building smart, lasting habits.As educators and caregivers, we are in a uniqueposition to bridge digital literacy from the hometo the classroom. The same guiding principles weuse with our children asking questions, coexploring technology, and encouraging healthyscreen habits can be applied in academicsettings. In the pharmacy classroom, we can helpstudents engage critically with health apps,wearable tech, and digital content. This not onlyprepares them to be informed users but alsoempowers them to guide future patients inmaking safe, thoughtful choices in a tech-drivenhealthcare environment. Early guidance at home,paired with reinforcement in the classroom canshape healthier, more informed digital habits forthe next generation (Figure 1).Figure 1 Introducing the safe and effective use ofdigital tools for health and well-being starts athome and continues in the classroom. Guidingthe next generation in digital health literacy cantransform screen time into meaningful, lifelonglearning.Looking AheadDigital health is more than a trend it’s the newlanguage of healthcare. Gen Z and Alpha speak itfluently, but fluency doesn’t always equalwisdom. They need role models, not justmonitors. In my role as a pharmacist-educatorand parent, I’ve learned that the most meaningfulimpact I can make is to guide without controlling,and support without preaching. Sometimes, all ittakes is sitting down together, exploring a newapp, or asking a simple question to startsomething meaningful. Those everyday momentswhen we pause, connect, and guide can shapehabits that last a lifetime. The same principleapplies in the classroom: nurturing digitalcuriosity and critical thinking equips our studentsto become both informed users and trustedhealth advisors.References1.Boston Consulting Group. (2024). The futureof digital health 2024.https://www.bcg.com/publications/2024/thefuture-of-digital-health2.Cecconi, C., Adams, R., Cardone, A., Declaye, J.,Silva, M., Vanlerberghe, T., Guldemond, N.,Devisch, I., & van Vugt, J. (2025). Generationaldifferences in healthcare: The role oftechnology in the path forward. Frontiers inPublic Health, 13, Article 1546317.https://doi.org/10.3389/fpubh.2025.15463173.Chou, W. Y. S., Gaysynsky, A., & Vanderpool, R.C. (2021). The COVID-19 misinformationchallenge for public health communication.Health Education & Behavior, 48(1), 7–10.https://doi.org/10.1177/1090198120980675.4.Grajales, F. J., Sheps, S., Ho, K., NovakLauscher, H., & Eysenbach, G. (2014). Socialmedia: A review and tutorial of applications inmedicine and health care. Journal of MedicalInternet Research, 16(2), e13.https://doi.org/10.2196/jmir.29125.Jiang, X., Ming, W. K., & You, J. H. S. (2019). Thecost-effectiveness of digital healthinterventions on the management ofcardiovascular diseases: Systematic review.Journal of Medical Internet Research, 21(6),e13166. https://doi.org/10.2196/131666.OECD. (2023). Health at a glance 2023: OECDindicators. https://doi.org/10.1787/4dd50c09-en7.Papp-Zipernovszky, O., Horváth, M. D., Schulz,P. J., & Csabai, M. (2021). Generation gaps indigital health literacy and their impact onhealth information seeking behavior andhealth empowerment in Hungary. Frontiers inPublic Health, 9, 615942.https://doi.org/10.3389/fpubh.2021.6359438.UNICEF. (2023). Children’s digital lives:Findings from a global analysis.https://www.unicef.org/globalinsight/reports/childrens-digital-lives9.World Economic Forum. (2023). How Gen Zare reshaping the healthcare industry.https://www.weforum.org/stories/2023/09/how-gen-z-are-reshaping-the-healthcareindustry10.World Health Organization. (2021). Globalstrategy on digital health 2020–2025.https://iris.who.int/handle/10665/344249THE PANACEA / VOLUME 4 2025 / 7Faculty of Pharmacy ResearchHighlights
DEPRESCRIBING IN OLDER ADULTS: A PATH TOSAFER MEDICATION USEMalaysia is set to become an aged nation soonerthan expected. By 2040, more than 17% of thepopulation will be aged 60 and above, and by2057, the country is expected to transition into asuper-aged society, with over 20.5% of itspopulation comprising older adults [1]. This rapiddemographic shift presents pressing challengesto the healthcare system, especially in themanagement of chronic diseases, polypharmacy,and long-term care.Sheron Sir Loon Goh , Pauline Siew Mei Lai1 2Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy,Universiti Malaya, 50603 Kuala Lumpur, Malaysia1Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya,50603 Kuala Lumpur, Malaysia2Corresponding author: Dr Sheron Sir Loon Goh ([email protected])Malaysia’s Rapidly AgeingPopulationWith increased age comes a higher prevalence ofmultimorbidity, frequent medication use and arise in medication-related harm. Publishedliterature found that older persons are more likelyto develop chronic diseases, with 55% to 98% ofolder people having ≥2 chronic conditions [2]. InMalaysia, the prevalence of multimorbidityamong older persons was 40.6% in 2021. To makeageing a positive experience, opportunities forhealth, participation, and security must bemaintained.Deprescribing is defined as “the process ofwithdrawal of an inappropriate medication,supervised by a healthcare professional” [8]. It aimsto improve the quality use of medications, enhancepatient treatment outcomes, and reduce the risk ofmedication-related harm associated withpolypharmacy [9, 10].Reduces overall morbidity and mortalityOptimising pharmacotherapy throughdeprescribing decreases the risks associatedwith inappropriate medications, ultimatelyimproving long-term health outcomes andsurvival rates.What Is Deprescribing?Multimorbidity and ItsImpact on Older AdultsMedication Use and theChallenge of PolypharmacyThe optimal use of prescribed medications isvital in the management of patients with chronicdiseases. Studies found that one in fiveprescribed medications in older persons may beinappropriate [3, 4]. Polypharmacy is defined as“taking five or more regular prescribedmedications” and has been associated withincreased morbidity and mortality, especially inolder persons with multiple chronic conditions [5,6]. In Malaysia, about 20% of older personspresented in primary care clinics received atleast one potentially inappropriate medication(PIM) [7]. The risks associated with polypharmacyare substantial, including adverse drug events,medication errors, hospitalisations, functionaldecline, and poor adherence due to pill burden.Age-related physiological changes also affectdrug metabolism and excretion, making olderadults more susceptible to harmful effects. Theseconcerns underscore the urgent need for regularmedication reviews and careful monitoring toensure that all medications prescribed to olderadults are truly necessary, safe, and beneficial.What Is Deprescribing?Deprescribing offers multiple benefits when donesystematically:Reduces the risk of adverse drug events (ADEs)Minimising unnecessary medications helps preventside effects such as dizziness, constipation,gastrointestinal discomfort, and confusion,common causes of discomfort and hospitaladmissions among older persons.Decreases falls and associated injuriesMany inappropriate medications, such as sedatives,benzodiazepines, and antihypertensives, canincrease the risk of falls. Deprescribing thesemedications reduces the likelihood of falls,fractures, and fall-related complications.Lowers hospital admissions and length of stayBy preventing medication-related harm,deprescribing can reduce avoidablehospitalisations and shorten the duration ofinpatient care.Improves cognitive functionDiscontinuation of anticholinergic drugs, sedatives,or centrally acting medications has beenassociated with better cognitive clarity, reducedconfusion, and improved mental alertness.Improves medication adherenceWith fewer medications to manage, older adults aremore likely to take their medications correctly andconsistently.Cost savings for patients and the healthcaresystemReducing unnecessary prescriptions leads to lowerout-of-pocket costs and helps contain nationalhealthcare expenditure on medication-relatedservices.Enhances quality of life and functional statusA simplified medication regimen can reduce pillburden, ease anxiety, and improve day-to-dayfunctioning, especially for those managing multiplehealth conditions.Tools forIdentifying PotentiallyInappropriate Medications inMalaysiaSeveral established screening tools are available toassist healthcare professionals in identifyingpotentially inappropriate medications (PIMs)among older adults. Commonly used tools inMalaysia include the 2023 Beers Criteria, which listsmedications that may be harmful or ineffective inolder populations [11], and the STOPP (ScreeningTool of Older Persons' Prescriptions) and START(Screening Tool to Alert to Right Treatment) criteria,which help detect inappropriate prescribing andomissions in therapy, respectively [12]. Additionally,MALPIP (Malaysia Potentially InappropriatePrescribing), a locally developed tool tailored to theMalaysian context, is increasingly used in clinicalpractice. These tools support evidence-baseddecision-making in deprescribing efforts and helpoptimise medication use among older patients.Common Targets forDeprescribing in Older AdultsExamples of drug classes frequently considered fordeprescribing in older adults due to their riskprofiles:THE PANACEA / VOLUME 4 2025 / 8Faculty of Pharmacy ResearchHighlights
The deprescribing practice will be part of a newservice, the Medication Counselling Service(MediCoS) at the Rawatan Utama Klinik Am(RUKA) Clinic, University of Malaya MedicalCentre. It will be conducted by a team of clinicalpharmacists from the Faculty of Pharmacy. Thisinterdisciplinary collaborative service betweenthe Faculty of Pharmacy and the Department ofPrimary Care Medicine, Faculty of Medicine,Universiti Malaya is established to addressmedication-related issues in a structured andpatient-centred manner.This clinic aims to provide comprehensivemedication counselling, optimisepharmacotherapy, and support deprescribingwhen appropriate, especially for older adults orpatients with polypharmacy. This new serviceseeks to reduce the risks associated withinappropriate medication use, improvemedication adherence, and empower patientsthrough education and shared decision-making.This service will operate from Monday to Friday(except Tuesdays), from 2:00 PM to 5:00 PM, andis integrated into routine primary care services atthe RUKA Clinic.Concerns regarding ConclusiondeprescribingDespite its benefits, deprescribing faces severalcommon barriers [13]:Overcoming these challenges requires education,clinical support tools, and interdisciplinarycollaboration, particularly involving pharmacists,primary care physicians, and geriatricians.The Role of Pharmacists andHealthcare TeamsPharmacists are crucial in conducting medicationreviews, identifying PIMs, and educating patients.A team-based, patient-centred approachcombining pharmacists, doctors, and otherhealthcare professionals can help ensuredeprescribing is done safely and effectively.Discontinuing unnecessary drugs is nowrecognised as an essential aspect of appropriateprescribing. However, both prescribing anddeprescribing are complex clinical decisionsrequiring thoughtful evaluation to minimisewithdrawal effects and optimise patient safety[14, 15].The Medication CounsellingService (MediCoS)ReferencesDeprescribing is a proactive, evidence-basedapproach to medication management in olderadults. By regularly reassessing theappropriateness of medications and prioritisingpatient safety and preferences, healthcareproviders can reduce the risks associated withpolypharmacy and enhance the overall wellbeing of older adults. As populations age globally,integrating deprescribing into routine clinicalpractice is not just good medicine; it’s essentialfor safer and smarter healthcare.1. Department of Statistics Malaysia,Population & Demography. 2024.2. Marengoni, A., et al., Aging withmultimorbidity: a systematic review of theliterature. Ageing Research Reviews, 2011. 10(4): p.430-9.3. Roughead, E.E., B. Anderson, and A.L.Gilbert, Potentially inappropriate prescribingamong Australian veterans and warwidows/widowers. Internal Medicine Journal,2007. 37(6): p. 402-405.4. Opondo, D., et al., Inappropriateness ofMedication Prescriptions to Elderly Patients inthe Primary Care Setting: A Systematic Review.PLOS One, 2012. 7(8): p. e43617.5. Gnjidic, D., et al., Polypharmacy cutoff andoutcomes: five or more medicines were used toidentify community-dwelling older men at risk ofdifferent adverse outcomes. Journal of ClinicalEpidemiology, 2012. 65(9): p. 989-95.6. Harriman, K., L. Howard, and R. McCracken,Deprescribing medication for frail elderlypatients in nursing homes: A survey of Vancouverfamily physicians. British Columbia MedicalJournal, 2014. 56(9).7. Kua, K.P., N.N. Hamzah, and S.W.H. Lee,Potentially inappropriate medication prescribedamong older patients in a primary care setting inMalaysia. Pharmacoepidemiology and DrugSafety, 2020. 29(3): p. 363-364.8. Reeve, E., et al., A systematic review of theemerging definition of 'deprescribing'withnetwork analysis: implications for future researchand clinical practice. British Journal of ClinicalPharmacology, 2015. 80(6): p. 1254-1268.9. Liacos, M., A.T. Page, and C. Etherton-Beer,Deprescribing in older people. AustralianPrescriber, 2020. 43(4): p. 114.10. Frank, C. and E. Weir, Deprescribing forolder patients. Canadian Medical AssociationJournal, 2014. 186(18): p. 1369-1376.11. American Geriatrics Society Beers Criteria®Update Expert Panel, American Geriatrics Society2023 updated AGS Beers Criteria® for potentiallyinappropriate medication use in older adults.Journal of the American Geriatrics Society, 2023.12. O’Mahony, D., et al., STOPP/START criteria forpotentially inappropriate prescribing in olderpeople: version 3. European Geriatric Medicine,2023.13. Goh, S.S.L., et al., Weighing the necessitiesand concerns of deprescribing among olderambulatory patients and primary care trainees: aqualitative study. BMC Primary Care, 2023. 24(1):p. 136.14. Page, A.T., et al., The feasibility and effect ofdeprescribing in older adults on mortality andhealth: a systematic review and meta‐analysis.British Journal of Clinical Pharmacology, 2016.82(3): p. 583-623.15. Duncan, P., M. Duerden, and R.A. Payne,Deprescribing: a primary care perspective.European Journal of Hospital Pharmacy, 2017.24(1): p. 37-42.THE PANACEA / VOLUME 4 2025 / 9Faculty of Pharmacy ResearchHighlights
EPITOPES AND T CELLS:TINYWARRIORSAGAINST PATHOGENSYour body is a fortress under constant siege byinfectious agents from viruses lurking in a sneeze,bacteria clinging to a doorknob. The immunesystem, a sophisticated network of cells andsignals, stands vigilant to repel these invaders. Itnot only fights off pathogens but also remembersthem, ensuring a faster, fiercer response upontheir return. Recovering from influenza, and thenext encounter triggers a rapid defense, thanks tothis immunological memory. At the core of thisdefense against infectious diseases are epitopes.Epitopes are molecular signatures of pathogensand T cells, the lymphocytes that hunt andeliminate them. Together, they form a precise,powerful alliance to keep infections at bay.Yvonne Jing Mei Liew1Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, UniversitiMalaya, 50603 Kuala Lumpur, Malaysia1*Corresponding author: Yvonne Jing Mei Liew ( [email protected])T cells, or T lymphocytes, are the immunesystem’s frontline warriors, born in the bonemarrow and honed in the thymus. There aretwo main types: cytotoxic T cells, which destroyinfected cells, and helper T cells, whichorchestrate the broader immune response.Each T cell carries a T-cell receptor (TCR) thatlocks onto a specific epitope-MHC complex.When a cytotoxic T cell binds an infected cell’sepitope say, from a flu virus, it unleashesperforin and granzymes, puncturing anddismantling the target. Helper T cells amplifythis effort by signalling B cells to produceantibodies and rallying macrophages to cleardebris. This coordinated assault is critical tohalting the spread of infection. After the battle,some T cells transform into memory T cells,lingering as vigilant sentinels. These cellsrecognize past epitopes, launching a swiftcounterattack if the pathogen returns, as seenwith measles, where one infection grantslifelong protection. Vaccines, like the flu shot orthe smallpox vaccine that eradicated the virusby 1980 (Kayser & Ramzan, 2021), exploit thismemory by delivering safe epitopes to train Tcells without causing illness.Scientists are also developing epitope-basedtherapies for HIV, seeking to expose hiddenviral markers to T cells (Xu et al., 2018). Theseinnovations hinge on understanding howepitopes signal infection and how T cellsrespond. However, challenges persist: HIVexhausts T cells, weakening defences;influenza’s epitope shifts demand yearlyvaccine updates; and bacteria likeMycobacterium tuberculosis hide within cells,masking epitopes.Yet these hurdles spurprogress. Computational tools predict epitopechanges to speed vaccine updates, while geneediting techniques like CRISPR could enhanceT-cell precision. For COVID-19, epitopefocused studies improved booster designs,refining our arsenal against infectious threats.T Cells: The Immune System’sElite ForcesEpitopes: The Molecular CluesThat Expose InvadersEpitopes are the immune system’s key toidentifying infectious foes. These short aminoacid chains, typically 8 to 20 units long, arefragments of a pathogen’s proteins, like pieces ofa shattered mask. When a virus like influenzainfects a cell, the cell processes the invader anddisplays these epitopes on its surface via MajorHistocompatibility Complex (MHC) molecules.These MHC-epitope complexes act as distresssignals, alerting the immune system to infection.The power of epitopes lies in their specificity ofeach pathogen. For example, from a commoncold virus to tuberculosis bacteria, carries uniqueepitopes, enabling the immune system to targetinfected cells while sparing healthy ones. Withoutepitopes, T cells would be blind to infection,leaving diseases unchecked. Yet pathogens fightback, with viruses like HIV mutating epitopes toevade detection and influenza shifting themyearly, challenging vaccine design. Thisadaptability fuels an ongoing microscopic armsrace, but it also guides solutions. By mappingepitopes, scientists pinpoint a pathogen’sweaknesses, as seen with SARS-CoV-2, whereepitope studies accelerated mRNA vaccinedevelopment.Imagine a future where every infectious diseasehas a known epitope to target. Vaccines couldprevent emerging viruses by training T cellswith predicted epitopes, as explored forcoronaviruses (Meyers et al., 2021). T-celltherapies might tackle chronic infections likehepatitis B, amplifying responses to persistentpathogens (Mak et al., 2022). Today’ssuccesses such as flu vaccines and COVID-19immunity, offer a glimpse of this potential. Astools like epitope sequencing advance,epitopes and T cells could make pandemicsrare, their precision reshaping our fight againstinfectious diseases.Epitopes and T cells may be small molecularfragments and single cells but their impact oninfectious diseases is monumental. They haveeradicated smallpox, curbed flu pandemics,and offered hope against HIV. Their cycle ofdetection, destruction, and memory plays outin every fever broken and every vaccine’striumph. As science unlocks their secrets, theirinfluence grows, promising a future whereinfections falter against their might. The nexttime you recover from a cold, consider thesilent war waged by these tiny but mightydefenders a testament to their triumph overinfectious disease.Fight Against PathogensConsider an influenza invasion in your airways.Infected cells process the virus, presenting itsepitopes on MHC class I molecules. Cytotoxic Tcells detect these signals, bind the complexes,and release perforin and granzymes toeliminate the infected cells. Simultaneously,dendritic cells display epitopes on MHC class IImolecules, activating helper T cells, whichboost antibody production and summonmacrophages to clear the battlefield. Withindays, the virus retreats, and memory T cellsstand guard, ready for future threats. Thisdynamic response helped tame the 2009 H1N1pandemic, with T cells targeting conservedepitopes across flu strains, showcasing theircritical role in controlling infectious diseases(De Groot et al., 2009).The synergy of epitopes and T cells drivesbreakthroughs in infectious disease control.Modern vaccines, such as mRNA shots forCOVID-19, encode viral epitopes to train T cellsefficiently, reducing severe illness (Fang et al.,2022). Tuberculosis research targets bacterialepitopes to strengthen T-cell responses, aimingto combat antibiotic resistance (Tian et al.,2018).The Future of Tiny Defendersin Infection ControlTHE PANACEA / VOLUME 4 2025 / 10Faculty of Pharmacy ResearchHighlights
ReferencesKayser, V., & Ramzan, I. (2021). Vaccines andvaccination: history and emerging issues. Humanvaccines & immunotherapeutics, 17(12), 5255-5268.De Groot, A. S., Ardito, M., McClaine, E. M., Moise, L.,& Martin, W. D. (2009). Immunoinformaticcomparison of T-cell epitopes contained in novelswine-origin influenza A (H1N1) virus with epitopesin 2008–2009 conventional influenza vaccine.Vaccine, 27(42), 5740-5747.Fang, E., Liu, X., Li, M., Zhang, Z., Song, L., Zhu, B., ... &Li, Y. (2022). Advances in COVID-19 mRNA vaccinedevelopment. Signal transduction and targetedtherapy, 7(1), 94.Tian, Y., da Silva Antunes, R., Sidney, J., LindestamArlehamn, C. S., Grifoni, A., Dhanda, S. K., ... & Sette,A. (2018). A review on T cell epitopes identifiedusing prediction and cell-mediated immunemodels for Mycobacterium tuberculosis andBordetella pertussis. Frontiers in Immunology, 9,2778.Xu, K., Acharya, P., Kong, R., Cheng, C., Chuang, G. Y.,Liu, K., ... & Kwong, P. D. (2018). Epitope-basedvaccine design yields fusion peptide-directedantibodies that neutralize diverse strains of HIV-1.Nature medicine, 24(6), 857-867.Meyers, L. M., Gutiérrez, A. H., Boyle, C. M., Terry, F.,McGonnigal, B. G., Salazar, A., ... & Moise, L. (2021).Highly conserved, non-human-like, and crossreactive SARS-CoV-2 T cell epitopes for COVID-19vaccine design and validation. npj Vaccines, 6(1), 71.Mak, L. Y., Cheung, K. S., Fung, J., Seto, W. K., & Yuen,M. F. (2022). New strategies for the treatment ofchronic hepatitis B. Trends in Molecular Medicine,28(9), 742-757.THE PANACEA / VOLUME 4 2025 / 11Faculty of Pharmacy ResearchHighlights
BRIDGING DISCIPLINES, SHAPING FUTURES: GERIATRICSMASTERCLASS 3.0 CULTIVATES TEAM-BASED CARE ATUNIVERSITI MALAYAAs Malaysia prepares to enter aging nation statusby 2030, the need for healthcare providers whocan work collaboratively to address the complexneeds of older adults has never been greater. Inresponse to this growing challenge, students fromthe Faculties of Medicine, Pharmacy, Nursing, andDentistry at Universiti Malaya joined forces toorganise the Geriatrics Masterclass 3.0, held atthe Clinical Auditorium, Faculty of Medicine.This student-led initiative carried the theme“Perpetual Synergy: Navigating Care for the OlderPerson by Uniting Disciplines” and broughttogether over 100 undergraduate students for ahalf-day of interactive learning, cross-disciplinaryengagement, and critical reflection on ethical andclinical challenges in geriatric care.Jim Chai , Sheron Sir Loon Goh , Terence Ing Wei Ong , Wan Ling Lee , JacobJohn Chiremel Chandy1 1 2 34Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, 50603Kuala Lumpur, Malaysia1Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia2Department of Nursing, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia3Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, 50603 Kuala Lumpur, Malaysia4Correspondence: Dr Jim Chai ([email protected])The masterclass was strongly supported byfaculty advisors and endorsed by the MalaysianSociety of Geriatric Medicine (MSGM),reflecting its solid academic foundation.Associate Prof. Terrence Ong (Department ofMedicine, Faculty of Medicine), Dr. Lee WanLing (Department of Nursing, Faculty ofMedicine), Associate Prof. Dr. Jacob John(Faculty of Dentistry), and Dr. Jim Chai (Facultyof Pharmacy) were key advisors in leading thisevent. Among the main academic contributorswere Dr. Jim Chai, who also served as afacilitator; Dr. Sheron Goh (Faculty ofPharmacy); Dr. Kwa Schee Li (Department ofMedicine, Faculty of Medicine); Sr. KhairulNadiah binti Ismail (Department of Nursing,Faculty of Medicine); and Dr. AnandRamanathan (Faculty of Dentistry). Theseindividuals took on dual roles as panellists andfacilitators, each bringing valuable insights fromtheir respective disciplines.The masterclasswas strongly supported by faculty advisors andendorsed by the Malaysian Society of GeriatricMedicine (MSGM), reflecting its solid academicfoundation. Associate Prof. Terrence Ong(Department of Medicine, Faculty of Medicine),Dr. Lee Wan Ling (Department of Nursing,Faculty of Medicine), Associate Prof. Dr. JacobJohn (Faculty of Dentistry), and Dr. Jim Chai(Faculty of Pharmacy) were key advisors inleading this event. Among the main academiccontributors were Dr. Jim Chai, who also servedas a facilitator; Dr. Sheron Goh (Faculty ofPharmacy); Dr. Kwa Schee Li (Department ofMedicine, Faculty of Medicine); Sr. KhairulNadiah binti Ismail (Department of Nursing,Faculty of Medicine); and Dr. AnandRamanathan (Faculty of Dentistry). Theseindividuals took on dual roles as panellists andfacilitators, each bringing valuable insights fromtheir respective disciplines.Malaysia’s population is ageing rapidly. By 2040,it is projected that 17% of Malaysians will be aged60 and above, with this number only expected torise in the decades beyond. Older adults typicallyexperience multiple chronic illnesses, cognitivedecline, mobility issues, and social vulnerabilitiesthat demand a comprehensive and coordinatedapproach to care.However, Malaysia’s healthcare system, like manyglobally, is often structured around disciplinarysilos. Doctors, pharmacists, nurses, and dentistsare trained separately and often practice withouttruly collaborative workflows. This separation canlead to fragmented care, duplication of services,delayed decision-making, and, ultimately, poorpatient outcomes, especially for vulnerable olderpatients.Geriatric care requires a shift in perspectiveamong healthcare professionals, prioritisesteamwork, shared ethical responsibility, andcommunication across disciplines. This guidingvision led to the Geriatrics Masterclass 3.0development.What makes this masterclass stand out is itsstudent-led leadership. The entire event wasconceptualised and executed by a team ofpassionate students from four different studentsocieties, representing the Medical Society(MedSoc), Pharmacy Society (PharmSoc), DentalSociety (DenSoc), and Nursing Society (NurSoc).These students were not just participants, theywere changemakers, fostering interdisciplinarycollaboration even before entering theprofessional world.The highlight of the morning was amultidisciplinary forum titled “ManagingGeriatric Cases: The Role of CollaborativeHealthcare,” where the panellists explored realworld challenges in working together acrossdisciplines. Moderated by Ms Nurul Syahida BtSupriadi (Nursing) and Ms Lee Joey(Pharmacy), the forum emphasised the realitiesof care transitions, overlapping roles, and theimportance of respect and open dialoguebetween healthcare professionals.Following this, participants were divided intomixed-discipline groups for interactive casebased learning sessions. Here, students tackledethically complex scenarios including refusal ofcare, suspected elder abuse, and patients withdiminished cognitive function, using the fourbiomedical principles of autonomy,beneficence, non-maleficence, and justice astheir ethical framework. Facilitators from eachfaculty guided discussions to help studentsreflect on how different professions approachsuch dilemmas, and how to communicaterespectfully when perspectives differ.Later, the atmosphere turned lively with ateam-based “GeriaQuiz” competition, whichtested participants on geriatrics knowledge,ethical concepts, and interprofessionalcommunication strategies. The event endedwith a group sharing session, closing remarks,and a photo session to commemorate theexperience.Geriatrics Masterclass 3.0A Nation Growing Older, A CallforIntegrationAn Immersive LearningExperienceThe event commenced with an openingceremony and welcoming remarks delivered bystudent leaders, followed by the official launchby Associate Professor Dr. Tengku AhmadShahrizal Tengku Dato' Omar, Deputy Dean ofthe Faculty of Medicine. His address set thetone for a day centred on collaboration,interdisciplinary synergy, and shared learning.Tearing Down the Silos: TheImportance ofInterprofessionalCommunicationOne of the core goals of the masterclass was toaddress a pressing challenge in healthcare: thelack of meaningful communication betweenprofessionals. While each discipline plays acritical role in patient care, misunderstandings,role confusion, and lack of dialogue oftenhinder outcomes. In geriatrics, these gaps canbe costly; for instance, when medication errorsoccur due to poor communication betweenprescribers and pharmacists, or whenbehavioural changes in a patient go unreportedbecause of fragmented documentation.THE PANACEA / VOLUME 4 2025 / 12Faculty of Pharmacy ResearchHighlights
Ethics at the ForefrontGeriatric care often involves ethically chargeddecisions: Should a confused patient be allowed torefuse treatment? Who decides when it’s time toinvolve social services? What do you do when afamily requests non-disclosure of a terminaldiagnosis?Using the four biomedical principles as a guide,students engaged with these tough questions andrecognised that ethical decision-making is rarelystraightforward. They also learned that ethicalclarity often emerges from team-baseddiscussions, where each professional contributes adifferent lens: medical, psychosocial,pharmaceutical, or dental.A Glimpse into a BetterHealthcare FutureJointly organised by four student societies andsupported by faculty and clinicians, GeriatricsMasterclass 3.0 was more than an academicexercise, it was a rehearsal for the future ofhealthcare. One where collaboration, ethics, andcommunication are not just ideals, but a standardapproach.By creating a space for honest dialogue andcooperative learning, the masterclass tookconcrete steps to break the culture of isolation thatoften pervades clinical environments. It planted theseeds for a generation of healthcare professionalswho will no longer view their roles in isolation, but incoordinated partnership with their peers.ConclusionIn a rapidly ageing society like Malaysia, the stakesare high. But events like the Geriatrics Masterclass3.0 offer hope that with the right education,guidance, and vision, the next generation ofhealthcare providers will rise to meet the challengenot alone, but together.As one participant aptly put it,“Today we didn’tjust learn about geriatrics, we learned how to bebetter teammates, better communicators, andoffers, propers education for our patients.”THE PANACEA / VOLUME 4 2025 / 13Throughout the masterclass, students engagedin meaningful, professional communicationacross disciplines whether raising concernsabout patient safety, offering alternativetreatment suggestions, or discussing ethicallysensitive issues. Role-play scenarios andfacilitated discussions enabled participants toexperiment with real-life communicationstrategies in a safe, supportive setting.Faculty of Pharmacy ResearchHighlights
GREEN PHARMACY PRACTICEIN ENHANCINGENVIRONMENTAL SUSTAINABILITY: AREWETHERE YET?With growing concerns over environmentalsustainability, the healthcare sector plays acrucial role in reducing its ecological footprint.Pharmaceutical products are increasinglyrecognized as environmental contaminants dueto their widespread presence in water and soil.This includes medicinal and personal care itemsused in both human and veterinary medicine.Pharmaceutical products are increasinglydetected in various environmentalcompartments, raising concerns about theirecological impacts (Gworek et al., 2020). Thesecompounds enter the environment throughhuman and animal excretion, manufacturingprocesses, and improper disposal (Bhatt et al.,2025; SanJuan-Reyes et al., 2017). Commonlyfound pharmaceuticals include antibiotics,NSAIDs, and antiretrovirals, with concentrationsranging from ng/L to μg/L in water systems(Gworek et al., 2020; Waleng & Nomngongo, 2021).Developing countries in Africa and Asia havereported high levels of these contaminants intheir water bodies (Waleng & Nomngongo, 2021).Conventional wastewater treatment plants areoften ineffective at removing pharmaceuticals,leading to their continuous release into theenvironment (SanJuan-Reyes et al., 2017). Thepersistence and accumulation of thesecompounds pose potential risks to ecosystemsand human health, including ecotoxicologicaleffects and the development of antimicrobialresistance (Sayadi et al., 2010). Further research isneeded to fully assess the environmental impactand develop appropriate risk managementstrategies.Green pharmacy practice is emerging as crucialstrategy within the pharmaceutical sector aimedat minimizing environmental impact andpromoting sustainability across all aspects ofpharmacy operations. These practices areincreasingly recognized as essential for thehealthcare industry to address its significantenvironmental footprint. This footprint includeswaste from drug development, production anddisposal processes (Srivastava et al., 2022). TheInternational Pharmaceutical Federation (FIP)highlights the importance of mitigation measures,including reduction of pharmaceutical pollution,using renewable energy, and implementing digitalprescriptions, alongside adaptation strategiesthat support the health of people andcommunities impacted by climate change andecological crises, such as optimizing medicineuse, avoiding unnecessary or more carbonintensive treatments or procedures, and ensuringequitable access to care (FIP, 2023).Yow Hui Yin1Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, UniversitiMalaya, 50603 Kuala Lumpur, Malaysia1*Corresponding author: Yow Hui Yin ([email protected])The FIP outlines several solutions for greenpharmacy practice to mitigate the environmentalimpact of pharmaceuticals. A summary of keystrategies is as follows (FIP, 2015):·Pharmaceutical waste management: Implementingproper disposal methods, including wastesegregation and collection of unused medicines, toprevent and minimize waste.·Sustainable manufacturing and distribution:Encouraging pharmaceutical companies to adopteco-friendly production methods and packagingmaterials, as well as processes for emissioncontrols, wastewater treatment, eco-adaptedtransport and fleet management initiatives.·Interprofessional collaboration: Providinginformation to other healthcare providers, in termsof environmentally adapted choices, such as unitdose or unit of use dispensing and small quantityprescribing when starting a medicine.·Eco-friendly pharmacy practices: Promoting\"greenoffice\"concepts and sustainable pharmacyoperations, including recycling paper waste,reducing paper use and utilizing virtual technology.·Consumers of medicines: Discussing with patientsand consumers the means for the appropriatedisposal of unused medicines.Education of futuregreen pharmacists: Incorporating environmentalconsiderations into pharmacy curricula and raisingawareness among future pharmacists.In Malaysia, the Ministry of Health has introducedseveral initiatives to promote safe medicationdisposal and environmental sustainability, includingthe “Return Your Medicine program”, MyMediSAFE,and “No Plastic Bag” campaign. The\"Return YourMedicines\"program in Malaysia aims to addressimproper disposal of unused medications, whichposes risks to public health and the environment.Subsequently, MyMediSAFE(https://www.mymedisafe.org.my/), which is one ofthe action plans of Thematic Working Groupformed for the National Environmental HealthAction Plan (NEHAP) in 2024. This initiativeencourages and educates the public to dispose oftheir unused or expired medicines in the correctand safe way. It aims to protect the environmentand prevent health risks from exposure topharmaceutical waste and antimicrobial resistance.On the other hand, the “No Plastic Bag” campaign isstarted in pharmacy departments in thegovernment hospitals since 2011, which aims toreduce plastic use by encouraging patients to bringbags their own bags to fill the medicine.Despite these efforts, public participation andawareness remain limited. Studies report thatonly 23.7-26.2% of respondents have used the“Return Your Medicine program” (Saharuddin etal., 2024; Yang et al., 2018; Ling et al., 2024).Common improper disposal methods includediscarding medicines in household trash orgiving them to others (Saharuddin et al., 2024;Wang et al., 2021), indicating poor disposalpractices. Factors associated with unusedmedicines include acute illness, paying formedication, and willingness to participate inreturn programs (Wang et al., 2021). Awarenessof environmental hazards from improperdisposal is relatively high (73-73.0%) (Yang etal., 2018; Ling et al., 2024). Another study inMalaysia found that the Safe D.U.M.Pintervention improved knowledge but did notsignificantly change attitudes or practices (Laiet al., 2021). This underscores the need foreffective education to improve publicperception and practices to reduce theenvironmental impact of pharmacy activities.In conclusion, the growing presence ofpharmaceuticals in the environment highlightsthe urgent need for sustainable practices in thehealthcare and pharmaceutical industries.Green pharmacy initiatives play a crucial role inminimizing pharmaceutical waste, promotingeco-friendly manufacturing, and raisingawareness about proper medication disposal.While efforts such as Malaysia’s\"Return YourMedicine\"program and MyMediSAFEdemonstrate progress, public participationremains low, emphasizing the need for strongereducation and engagement strategies. Movingforward, interprofessional collaboration andpolicy support will be essential in ensuring thatgreen pharmacy practice effectively mitigatesenvironmental contamination and contributesto a more sustainable future.THE PANACEA / VOLUME 4 2025 / 14Faculty of Pharmacy ResearchHighlights
References1. Bhatt, K., Vimal, A., & Mishra, V. (2025). PharmaIndustry Solid Waste Management Practices,Treatment, and Disposal. Solid Waste Management:A Roadmap for Sustainable Environmental Practicesand Circular Economy, 213-235.2.Gworek, B., Kijeńska, M., Zaborowska, M., Wrzosek,J., Tokarz, L., & Chmielewski, J. (2020). Occurrenceof pharmaceuticals in aquatic environment–areview. Desalination and Water Treatment, 184, 375-387.3.International Pharmaceutical Federation. (2015).Green pharmacy practice taking responsibility forenvironmental impact.https://www.fip.org/files/fip/publications/2015-12-Green-Pharmacy-Practice.pdf4.International Pharmaceutical Federation. (2023).FIP statement of policy on environmentalsustainability with pharmacy.https://www.fip.org/file/56185.Lai, P. S. M., Tan, K. M., Lee, H. G., Wong, Y. Y., Wasi,N. A. A., & Sim, S. M. (2021). Effectiveness of anintervention to increase the knowledge, attitude,and practice regarding the return and disposal ofunused medications. Malaysian Family Physician:The Official Journal of the Academy of FamilyPhysicians of Malaysia, 16(1), 56.6.Ling, J. Y., Ng, P. Y., Shamsuddin, A. S., Zulkifli, A., &Lee, K. E. (2024). Medication Disposal Patterns andPractices with Awareness of EnvironmentalContamination Caused by Pharmaceuticals amongthe General Public in Malaysia. Asian Pacific Journalof Cancer Prevention: APJCP, 25(8), 2723.7.Saharuddin, N. A., Md Hussin, N. S., & MohdNoordin, Z. (2024). Assessing public awareness andpractices in medicine disposal: a cross-sectionalstudy on the utilisation of the'return yourmedicines'program in Terengganu, Malaysia.International Journal of Pharmaceutical,Nutraceutical and Cosmetic Science (IJPNaCS),7(Suppl1), 34-47.8.SanJuan-Reyes, N., Gómez-Oliván, L. M., IslasFlores, H., Galar-Martínez, M., García-Medina, S.,Dublán-García, O., & Hernández-Navarro, M. D.(2019). Occurrence of Pharmaceuticals in theEnvironment. Ecopharmacovigilance:Multidisciplinary Approaches to EnvironmentalSafety of Medicines, 43-56.9.Sayadi, M. H., Trivedy, R. K., & Pathak, R. K. (2010).Pollution of pharmaceuticals in environment.Journal of Industrial Pollution Control, 26(1), 89-94.10.Srivastava, P., Wal, A., Chaturvedi, V., Wal, P.,Srivastava, A., & Sachan, A. Y. P. (2022).Sustainability in pharmaceuticals: an in-depth lookat the green pharmacy principles. Journal ofPopulation Therapeutics and Clinical Pharmacology,10.11.Waleng, N. J., & Nomngongo, P. N. (2022).Occurrence of pharmaceuticals in theenvironmental waters: African and Asianperspectives. Environmental Chemistry andEcotoxicology, 4, 50-66.12.Wang, L. S., Aziz, Z., & Chik, Z. (2021). Disposalpractice and factors associated with unusedmedicines in Malaysia: a cross-sectional study.BMC Public Health, 21, 1-10.13.Yang, S. L., Tan, S. L., Goh, Q. L., & Liau, S. Y. (2018).Utilization of ministry of health medication returnprogramme, knowledge and disposal practice ofunused medication in Malaysia. J Pharm PractCommunity Med, 4(1), 7-11.THE PANACEA / VOLUME 4 2025 / 15Faculty of Pharmacy ResearchHighlights
PHARMACY STUDENTS LEAD DIABETES FIGHTINUNDERSERVED COMMUNITIESKUALA LUMPUR (May 4, 2025) – Over 500residents from low-income communities inLembah Pantai received vital health servicesyesterday during the University of Malaya PublicHealth Campaign 2025 (UMPHC 2025). Organizedby final-year Pharmacy students, the initiativeaims to raise diabetes awareness under thetheme\"Kenali, Cegah, Rawat: Kencing Manis BukanHalangan\".Muhammad Luqman Nordin*University of Malaya’s health campaign empowers Pantai Dalam residents with freescreenings and educationCorresponding author: Muhammad Luqman Nordin([email protected])The initiative is part of Service-Learning Malaysia atSULAM University for Society, in conjunction withOIA3034 Emerging Topics in Pharmacy, addressingMalaysia’s growing diabetes crisis, which affects15.6% of the population. Strategic partnerships withthe Ministry of Health, CARING Pharmacy, UMMedical Centre, Pharmacy Society of UniversitiMalaya (PHARMSOC) and the Malaysian PharmacyStudents’ Association (MyPSA) amplified itsimpact.The key activities included:Free health screenings (blood pressure, glucose,lipids, body composition)Personalized pharmacist consultationsEducation booths on nutrition, medicationsafety, and exerciseA blood donation drive collected 41 units.Children’s activities, including a colouringcontest (55 participants)\"Events like UMPHC 2025 demonstrate how futurepharmacists can bridge healthcare gaps,\"saidProfessor Dr. Hasniza. \"Beyond screenings, we’reempowering communities with sustainableprevention knowledge.\"The Program Director Ahmad Nabil Mukhlis said,“The campaign aims to raise diabetes awarenessamong PPR residents by providing accessible andrelevant health information, free health screenings,and practical tools for early detection andprevention via tailored health counselling,interactive demonstrations, and lifestyle guidance. Ihope this kind of event can be continued in thefuture by our juniors”.The successful campaign sets a newbenchmark for university-community healthpartnerships, proving diabetes awareness canthrive even in underserved neighbourhoods.THE PANACEA / VOLUME 4 2025 / 16The event was held at IWK Eco Park from 9:30 AMto 5:00 PM, with a particular focus on thePeople’s Housing Program (PPR) communities inthe Lembah Pantai area, including Kg. Limau, SriPantai, and Seri Chempaka, where economicconstraints often limit access to healthcare andhealth education. Beyond its core goals, thecampaign also served to empower pharmacystudents by strengthening their role incommunity health engagement.Minister of Communications YB Datuk AhmadFahmi Mohamed Fadzil, who is Member ofParliament (MP) of Lembah Pantai, officiated theevent, accompanied by University of MalayaDeputy Vice-Chancellor Academic &International Professor Dr. Hasniza Zaman Huriand Deputy Vice-Chancellor Research &InnovationProfessor Ir. Dr. Kaharudin Dimyati isshown in the pictures below.Faculty of Pharmacy ResearchHighlights
REPOSITIONING DIABETESMANAGEMENTIN NIGERIA:THE ROLE OFCOMMUNITY PHARMACISTS TOWARDS PATIENT-CENTERED CAREDiabetes mellitus is a serious and increasingpublic health issue in Nigeria, where poor diseasecontrol is enabled by broken health infrastructureand limited specialist availability. studies havedocumented evidences of the advantage ofpatient-centered models of care. However, thecontribution of community pharmacists, thoughwidely available and drug-focused healthprofessionals, has not yet been fully leveraged.The chapter describes the state of diabetes carein Nigeria as it quotes structural, educational,policy, and cultural hurdles to optimal patientoutcomes. From national registries, as well asglobal case experience, we consider howcommunity pharmacists can bridge significantcare gaps through medication therapymanagement, lifestyle counseling, diseasescreening, and patient health education. We alsorecognize inert barriers such as restricteddiagnostic facilities, regulatory exclusion,inadequate training in chronic disease care, andreferral network exclusion. We also recognizeactionable opportunities such as task-shifting,public-private partnerships, and digitization ofpharmacy services that can empowerpharmacists to become frontline providers indecentralized diabetes care. Finally, we suggeststrategic policy reform, that focusses oncurriculum reform, continuous professionalengagement, legislative integration andremuneration for services to recalibratepharmacists engagements. Integration of thepharmacist within multidisciplinary teams is notjust feasible but necessary to achievesustainable, equitable, and patient-centereddiabetes care.Abubakar Sadiq Wada , Sagir Mustapha , Muhammad Luqman Nordin , AsifNawaz , Mustapha Mohammed , Lukman Mustapha , Khalid GarbaMohammed , Muazam Ibrahim , Rabi’u Nuhu Danraka , Ahmad KhusairiAzemi , Junaid Olawale Quazim , Siti Safiah Mokhtar1* 2* 33 4 5,6,78 9 910 11 12Department of Pharmacology and Therapeutics, Bayero University, Kano, Nigeria.1Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, 50603 Kuala Lumpur, Malaysia2Department of Pharmaceutical Technology, Faculty of Pharmacy, Universiti Malaya, 50603 Kuala Lumpur, Malaysia3Biomedical Research Center, QU Health, Qatar University, Doha, Qatar 4Department of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmaceutical Science, Kaduna State University, Nigeria. 5Infochemistry Scientific Center, ITMO University, Saint Petersburg, Russia. 6Department of Pharmaceutical Science, Faculty of Pharmacy, Universitas Airlangga, Indonesia. 78School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, United KingdomDepartment of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria. 9Institute of Climate Adaptation and Marine Biotechnology, Universiti Malaysia Terengganu, Kuala Terengganu, 21030, Terengganu, Malaysia.10Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia11Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia12*Corresponding Authors: Abubakar Sadiq Wada ([email protected])+2347037763700!Sagir Mustapha ([email protected])The Nigeria, with over 220 million people, is themost populous country in Africa, representingapproximately one-sixth of the continent'spopulation. It has half of its population living incities and is endowed with extensive culturaldiversity and numerous ethnic groups (Vitalis JaflaPontianus & Oruonye E.D., 2021). Despite itsnumerical strength, Nigeria's healthcare sectorremains greatly underdeveloped, marred byinadequate infrastructure, shortages of skilledhealthcare personnel, and unequal service delivery.The healthcare system is run by federal, state, andlocal governments collectively, with someinvolvement of the private sector (Nwankwo et al.,2022). However, quality care is constrained by cost,given that coverage under health insurance islimited and primarily available to civil servants,leaving the majority of people to pay out-ofpocket for services.The Nigerian burden of diabetes is also worsenedby sporadic and suboptimal control of the disease.Research shows that approximately 62% of Nigeriandiabetic patients have inadequately controlledblood glucose, associated with a significant rate ofcomplications (Ngwogu et al., 2012). The prevalenceof microvascular complications, such asretinopathy and nephropathy, is more commonthan macrovascular events. Such differences mayprimarily be due to delayed diagnosis, limitedaccess to necessary antidiabetic medication, nonadherence to therapy, and discontinuity of care(Adibe et al., 2018; Fasanmade & Dagogo-Jack,2015). Recently, diabetes management has shiftedfrom a physician-focused model to a moreuniversal, person-centered approach with a focuson partnership and long-term involvement. Inaddition to the traditional medical doctors andnurses care, other care team members such asdietitians, endocrinologists, and even pharmacistsare playing crucial roles, (Gatlin et al., 2024).Pharmacists now actively engage in direct patientcare through medication therapy management(MTM), providing counseling advices, monitoringadherence, and lifestyle modification to patients.They employ their knowledge of pharmacotherapyin diabetes management and community health.Collaborative models of care that involvepharmacists often lead to improved glycemiccontrol and reduced hospitalization, reflecting agreater understanding of the benefits of patientcentered care in the treatment of chronic diseases,particularly in resource-limited contexts such asNigeria (McConaha et al., 2015).THE PANACEA / VOLUME 4 2025 / 17Diabetes mellitus is a chronic metabolic disordercharacterized by the body's inability to producesufficient insulin or utilize it properly, resulting inhyperglycemia (Mustapha et al., 2022). Diabetesaffects millions of individuals globally and is asignificant public health concern. The InternationalDiabetes Federation (IDF) estimates that in 2019,nearly 463 million individuals lived with diabetes,and by 2045, it is predicted to rise to 700 million(Harding et al., 2024). Diabetes has resulted insignificant morbidity, mortality, and healthcarecosts. Both type 2 and type 1 diabetes have thepotential to lead to major complications such ascardiovascular disease, nephropathy, neuropathy,and retinopathy. High prevalence rates of type 2diabetes have primarily been linked with anunhealthy dieting, and age. Such findings call forefficient, equitable, and sustainable models of carein preventing complications and improving thequality of life in patients (Prodenxia et al.,2018).AbstractIntroductionDiabetes Management inNigeria: Current RealitiesThe management of diabetes involves bothpharmacological treatments and a nonpharmacological approach. While both are typicallyrecommended in the practice of medicine, thenon-pharmacological approach, most notablylifestyle changes, is often underemphasized inNigeria, with diet being the primary focus. Nutritionremains the backbone of glycemic control, butsingle diet does not suit all diabetic patients.Cultural belief patterns, religious preferences, andsocioeconomic status often determine food intake.It is also a common myth in Nigeria that the intakeof carbohydrates will lead to diabetes, confiningsome patients to monotonous diets, such asplantain and beans. These do not necessarilytranslate into improved glycemic control (AbioyeKuteyi et al., 2005; Ogbera & Ekpebegh, 2014).The management of diabetes is costly, and most ofthe patients pay out of their pocket to accessdiabetic care. Less than 10% of the Nigerianpopulation has health insurance coverage.Moreover, 20% of diabetic patients utilize selfmonitoring of blood glucose regularly. In addition,most patients lack basic knowledge regardingimportant diabetes indicators like HbA1c orcholesterol levels, and some do not even know whatmedication they are currently on (Ugwu et al., 2019).However, a substantial number of patients resort totraditional medicines with nearly half of diabeticpatients in Lagos using complementary treatmentslike Vernonia amygdalina (bitter leaf) for sugarcontrol (Ogbera & Ekpebegh, 2014).Pharmacological agents such as insulin and oralhypoglycemics like metformin and glimepiride forthe treatment of diabetes mellitus are available.Referral to specialists is typically reserved forcomplex treatments and the misuse of antidiabeticmedications, including the prescription of oralhypoglycemic agents (OHAs) for type 1 diabetes,which often occurs in general practice. TheDiabetes Association of Nigeria and the Endocrineand Metabolic Society are two national bodiesresponsible for developing guidelines andadvocating for the disease and its management.Guidelines are needed to harmonize care andensure consistent diabetes control in urban andrural settings.Faculty of Pharmacy ResearchHighlights
Role of CommunityPharmacists in Nigeria: Scope,Capacity, and ConstraintsNigerian community pharmacists are qualifiedhealthcare professionals who primarily practice inthe community and are often the first point ofcontact for patients seeking medical consultation.They dispense prescription and over-the-counterdrugs, provide drug counseling and professionaladvice to patients. They also educate patients onregimens and the benefits of medicationcompliance, and advise on lifestyle modifications,exercise, and diet to improve patients’ glycemiccontrol. Pharmacists also guide patients on selfmonitoring of blood glucose readings (Iqbal et al.,2024). Despite infrastructural and regulatorylimitations, an increasing number of pharmacistsare involved in ongoing health checks, such asblood glucose and blood pressure monitoring,particularly in disadvantaged or doctor-scarceareas. Pharmacists also send patients for follow-uptests or specialist care if needed.Community pharmacy practice is governed by thePharmacists Council of Nigeria (PCN) andconcurrently upheld by organizations such as thePharmaceutical Society of Nigeria (PSN) and theAssociation of Community Pharmacists of Nigeria(ACPN). Even with such an alliance, national chronicdisease programs fail to utilize the services ofpharmacists optimally, and their contributions todiabetes care are often minimized. All trainedpharmacists are required to hold a minimum of aBachelor of Pharmacy (BPharm) or Doctor ofPharmacy (PharmD) degree, complete aninternship, participate in the National Youth ServiceCorps (NYSC), and hold a PCN practicing licensure.The pharmacy programs, however, expose them tominimal training in chronic disease management,public health, and patient-centered care.Continuing education is provided throughMandatory Continuing Professional Development(MCPD), but it is often underutilized. Furthermore,certification or training in diabetes as it relates tocommunity pharmacists is not prevalent, therebylimiting their ability to provide holistic care topatients with complex care needs.THE PANACEA / VOLUME 4 2025 / 18Patient-Centered Care inDiabetes in Nigeria: Principlesand Why It MattersPatient-centered care in diabetes involvesdeveloping treatment and support plans tailored tothe patient's personal values, preferences, lifestyle,and needs. It aims to achieve both clinicaloutcomes and patient engagement by empoweringpatients to take an active role in their own care. It isguided by four principles:i.Shared decision-making: In which both patientand clinician work together to formulateappropriate therapies and take into considerationboth clinical guidelines and the socio-economicstatus of the patient.ii.Education empowerment: which teaches patientsto the level of required knowledge and skills forself-management, such as glucose testing andmonitoring, diet, exercise, and use of medications.iii.Effective communication: jargon-free,compassionate, and culturally sensitive to enablegreater understanding and concordance bypatients.iv.Continuity of care: enables follow-ups, and timelychanges to enhance long-term outcomes.Community pharmacists, due to their proximity topatients and pharmaceutical expertise, are bestpositioned to apply these principles. They aidpatients in maintaining drug treatment regimens,counsel them regarding diet and lifestyle, assist inmanaging side effects, and promote selfmonitoring of blood glucose, especially in areaswhere access to a physician is limited (Goode et al.,2019). Brazilian, Ethiopian, and Saudi Arabianevidence indicates that education and monitoringin a program-based style by pharmacists cansignificantly improve glycemic control and reducecomplications (Khan et al., 2020; Nigussie et al.,2021; Wells et al., 2025). In more advancedCanadian and British systems, pharmacists areformally recognized as members of diabetes careteams.In Nigeria, the role of pharmacists in diabetes careremains poorly defined in national policy. Despiteregulatory and advocacy efforts by PCN, PSN, andACPN, pharmacists remain not formally integratedinto the chronic care systems. Furthermore,pharmaceutical education does not offer adequatepreparation to manage the majority of noncommunicable diseases (NCDs). Even withoccasional MCPD sessions, their high cost andstructurally constraining nature contribute to itspoor attendance by members. This contrasts withSouth Africa and India, where there has beenproactive promotion of diabetes training evenamong pharmacists.In addition, pharmacy as a regulated profession,however, it is may not have definite law regardingpharmacists'contribution to the management ofNon-Communicable Diseases (NCDs), whichweakens its professional presence in chronic caresettings.The BPharm and PharmD curriculum offers minimaltraining in managing NCDs, contributing to trainingdeficiencies. This is complemented by sporadicMCPD, hindered mainly by logistical and financialconstraints. The traditional role of communitypharmacists, as perceived dispensers of medicinedue to the influence of unlicensed sellers, mayaffect their public image, which in turn constitutesanother barrier. The effort of the national NCDplans, which seldom include pharmacists in theirplanning and implementation, deprives them ofopportunities for decentralized, community-baseddiabetes care (Ikolaba et al., 2023).Barriers to EffectiveEngagement of CommunityPharmacists in Diabetes CareCommunity pharmacists have tremendous powerto make an impact in the management of diabetesin Nigeria, as shown in Figure 1; however, systemic,policy, and societal issues still prevent them fromproviding much intervention in chronic conditions.The exclusion of pharmacists from most nationalprograms for diabetes or chronic diseasemanagement teams, primarily due to the lack ofclear policies defining their clinical role, is evident inNigeria. This lapse is partly attributed to the failureof PCN, which oversees practice, policy reportsrelated to pharmacists, to always make loudpharmacists present in state-led programs, makingthem less visible in combined models of care.Additionally, insufficient financial incentives are asignificant concern as a barrier to effectiveengagement in care. Pharmacists in other highincome economies receive reimbursement forscreening and counseling rendered to thesepatients. However, Nigerian pharmacists do receivenothing to compensate for the increased services,such as education to improve lifestyle or bloodglucose monitoring techniques, thus renderingthese efforts unfeasible (Udoh et al., 2021).Shortages of infrastructure also limit theirtherapeutic potential. Most community pharmaciesdo not stock diagnostic tools, such as HbA1c testkits or cholesterol meters, and have limited accessto decision-support systems or patient healthrecords, which are necessary to achieve accuratediabetes screening and follow-up. In addition, thereferral pathways between community pharmacistsand physicians are often missing or incomplete,resulting in community pharmacists beingdisconnected from other members of thehealthcare team. This fragmentation defeatscontinuity of care, with a negative impact onpatients.Figure 1: Community Pharmacist in NigeriaEducating a Diabetic PatientThis image depicts a community pharmacist inNigeria engaging with a diabetic patient in apharmacy setting. The pharmacist, dressed intraditional attire with a cap, is seen explaining theproper use of diabetes medications to the patient.Key elements highlighted in the interaction include:1.Medication Counseling: The pharmacistdemonstrates how to use specific diabeticmedications, likely discussing dosageinstructions, timing, and administrationtechniques (e.g., oral medications or injectableslike insulin).2.Patient Education: The pharmacist emphasizesthe importance of adherence to the prescribedregimen, blood glucose monitoring, andrecognizing hypoglycemia/hyperglycemiasymptoms.3.Holistic Care: The interaction shows thepharmacist’s role in reinforcing lifestylemodifications (diet, exercise) alongsidepharmacotherapy for effective diabetesmanagement.4.Accessibility of Care: The setting reflects thecommunity pharmacist’s position as a frontlinehealthcare provider, offering accessible,patient-centered education to manage chronicconditions like diabetes.Faculty of Pharmacy ResearchHighlights
Opportunities forRepositioning NigerianCommunity Pharmacists inDiabetes ManagementThe continuous rise in diabetes prevalence inNigeria necessitates the need for a fir combinedmodel of care with the community pharmacistsplaying pivotal roles. Several significantopportunities exist to expand pharmacists'roles inthe national chronic disease management system.The practice of task-shifting and task-sharing(TSTS) aimed at diffusing the load on themainstream health system should be encouraged.This will allow pharmacists to perform tasks thatwere formerly done only by physicians or nurses,such as screening for diabetes, patient counseling,and follow-up (Yankam et al., 2023). The WHOguidelines, which were successfully applied in mostlow- and middle-income countries (LMICs), allowpharmacists to play a key part in public-privatepartnerships (PPP), such as the National HealthInsurance Authority (NHIA) or the National PrimaryHealth Care Development Agency (NPHCDA)(Gentilini et al., 2025) The partnerships may enablepharmacies to serve as screening centers or drugaccess points, particularly in rural areas.Integration of pharmacists into national controlmeasures for diabetes would legitimize theirpreventive, counseling, referral, and follow-up roleswithin the policy process, thereby enhancing theircontribution at both the practice and policy levels.These legislative changes should be actualized forthe patients' benefit. Pharmacy legislation andpractice regulation must be updated toaccommodate the professional contributions ofstriving pharmacists towards NCD management,particularly in chronic disease care, such asdiabetes. Closing the knowledge gaps in basicBPharm or PharmD training and the MCPD is crucial.Certification programs that focus on diabetes andenhance access to MCPD modules at lower costs,as well as online programs to strengthenpharmacists'competencies, should be rolled out.The application of digital health platforms, includingtelepharmacy and mobile interventions, providesscalable solutions for delivering diabetes servicesdirectly to patients, particularly in remote locationswithin the country.THE PANACEA / VOLUME 4 2025 / 19Recommendations and PolicyDirectionsRecognition and implementation of the communitypharmacists’ roles as essential stakeholders in thecontrol and management of diabetes in Nigeriarequire concerted efforts directed atinterprofessional collaboration among healthcareprofessionals, policy realignment, infrastructuraldevelopment, trainings and continuing professionaldevelopment, and public sensitization. Theseefforts should be complemented by transparentprocesses of monitoring and evaluation to assessprogress and key performance indicators acrossthe sectors.More pharmacists should be incorporated intostate and national task forces for NCDs and healthplanning bodies, leveraging communitypharmacists'access to a vast population forscreening, education, and treatment support.Practice guidelines and standard operatingprocedures (SOPs) for diabetes care bypharmacists should be established andimplemented with the inclusion of PCN and otherhealth policymaking stakeholders. The guidelinesand SOPs should outline key practices that clearlydefine their involvement in glucose monitoring,drug counseling, behavior modification support,and structured referral systems.Financing and facilitation of infrastructure remainbarriers. To address these, private consultingrooms, glucometers for blood glucose monitoring,and HbA1c test kits should be made available inpharmacies through subsidization. The governmentshould provide incentives through policies, such asapproving community pharmacies as NHIS centres,which can improve coverage of screening and caredelivery to the immediate community.Still re-emphasizing the need for education andtraining reforms, the country should implementnational certification schemes in diabetes carethrough MCPD, making them accessible throughonline platforms to improve the competence ofpharmacists. Empowering the communitypharmacists who are within the reach of the vastpopulation will help to strengthen sensitizationcampaigns to eliminate myths and promote earlydetection of the disease for prompt care (Khan etal., 2023).Abioye-Kuteyi, E. A., Ojofeitimi, E. O., Ijadunola, K. T.,& Fasanu, A. O. (2005). Assessment of dietaryknowledge, practices and control in type 2 diabetesin a Nigerian teaching hospital. Nigerian Journal ofMedicine: Journal of the National Association ofResident Doctors of Nigeria, 14(1), 58–64.https://doi.org/10.4314/NJM.V14I1.37137Adibe, M. O., Anosike, C., Nduka, S. O., & Isah, A.(2018). Evaluation of Health Status of Type 2Diabetes Outpatients Receiving Care in a TertiaryHospital in Nigeria. PharmacoEconomics - Open,2(3), 337–345. https://doi.org/10.1007/S41669-017-0056-X/TABLES/4Fasanmade, O. A., & Dagogo-Jack, S. (2015).Diabetes Care in Nigeria. Annals of Global Health,81(6), 821–829.https://doi.org/10.1016/J.AOGH.2015.12.012Gatlin, B., Miller, J., & Chang, S. (2024). OptimizingCollaborative Care of Patients with Chronic KidneyDisease Associated with Type 2 Diabetes: AnExample Practice Model at a Health Care Practicein Kentucky, United States. Diabetes Therapy, 15(1),1–11. https://doi.org/10.1007/S13300-023-01500-7/FIGURES/3Gentilini, A., Kasonde, L., & Babar, Z. U. D. (2025).Expanding access to NCD services via communityretail pharmacies in LMICs: a systematic review ofthe literature. Journal of Pharmaceutical Policy andPractice, 18(1).https://doi.org/10.1080/20523211.2025.2462450;JOURNAL:JOURNAL:JPPP19;PAGE:STRING:ARTICLE/CHAPTERGoode, J.-V., Owen, J., Page, A., & Gatewood, S.(2019). Community-Based Pharmacy PracticeInnovation and the Role of the Community-BasedPharmacist Practitioner in the United States.Pharmacy 2019, Vol. 7, Page 106, 7(3), 106.https://doi.org/10.3390/PHARMACY7030106Harding, J. L., Weber, M. B., & Shaw, J. E. (2024). TheGlobal Burden of Diabetes. Textbook of Diabetes,28–40. https://doi.org/10.1002/9781119697473.CH3Ikolaba, F. S. A., Schafheutle, E. I., & Steinke, D.(2023). Development, Feasibility, Impact andAcceptability of a Community Pharmacy-BasedDiabetes Care Plan in a Low–Middle-IncomeCountry. Pharmacy 2023, Vol. 11, Page 109, 11(4), 109.https://doi.org/10.3390/PHARMACY11040109Iqbal, M. Z., Alqahtani, S. S., Mubarak, N., Shahid, S.,Mohammed, R., Mustafa, A., Khan, A. H., & Iqbal, M. S.(2024). The influence of pharmacist-ledcollaborative care on clinical outcomes in type 2diabetes mellitus: a multicenter randomised controltrial. Frontiers in Public Health, 12, 1323102.https://doi.org/10.3389/FPUBH.2024.1323102/BIBTEXKhan, A., Abbas, S., Bibi, A., Mushtaq, S., Khan, G. M.,& Babar, Z.-U.-D. (2023). Interventions and PublicHealth Activities Performed by CommunityPharmacists. Encyclopedia of Evidence inPharmaceutical Public Health and Health ServicesResearch in Pharmacy, 900–906.https://doi.org/10.1007/978-3-030-64477-2_140Khan, Y., Imershein, S., Maryniuk, M., Armian, H.,Turkistani, S. A., Bayoumi, A. H., Al-Harbi, M. Y., & Hsu,W. C. (2020). A program utilizing communitypharmacists to improve diabetes education in theKingdom of Saudi Arabia. International Journal ofPharmacy Practice, 28(1), 49–55.https://doi.org/10.1111/IJPP.12572ConclusionThis chapter highlights the largely untappedpotential of community pharmacists in supportingdiabetes care in Nigeria. While they are presentlyinvolved in the provision of drug supply and basiccounseling, their role in screening, lifestylecounseling, and follow-up of long-term diseaseslike diabetes is underutilized due to policyloopholes, the lack of suitable diagnostic tools, andinsufficient training. Despite such hindrances,pharmacists can help bridge care gaps, particularlyin hard-to-reach communities, because they areaccessible and possess soundpharmacotherapeutic knowledge. Enabling theircontribution through regulatory support, capacitybuilding, and mainstreaming into national healthprograms can propel them to the same level as keystakeholders in diabetes prevention and control.Future diabetes care in Nigeria should be patientcentered, with teamwork among healthprofessionals being greatly valued. Integrating thecomplete contribution of pharmacists into such amodel will not only enhance the provision of carebut also speed up efforts towards achievingequitable and sustainable health coverage.ReferencesFaculty of Pharmacy ResearchHighlights
McConaha, J. L., Tedesco, G. W., Civitarese, L., &Hebda, M. F. (2015). A pharmacist’s contributionwithin a patient-centered medical home. Journal ofthe American Pharmacists Association, 55(3), 302–306. https://doi.org/10.1331/JAPHA.2015.14119Mustapha, S., Azemi, A. K., Wan Ahmad, W. A. N.,Rasool, A. H. G., Mustafa, M. R., & Mokhtar, S. S.(2022). Inhibition of Endoplasmic Reticulum StressImproves Diabetic Rats. Molecules, 2022, 1–18.N Ngwogu K gwogu K gwogu K gwogu KO, N. N., MMba I ba I ba I ba I E E E E K K K K, M. M., & N NgwoguA gwogu A gwogu A gwogu A C C C C, N. N. (2012).Glycaemic control amongst diabetic mellituspatients in Umuahia metropolis, Abia State, Nigeria.International Journal of Basic, Applied andInnovative Research, 1(3), 98–104.https://www.ajol.info/index.php/ijbair/article/view/108362Nigussie, S., Birhan, N., Amare, F., Mengistu, G., Adem,F., & Abegaz, T. M. (2021). Rate of glycemic controland associated factors among type two diabetesmellitus patients in Ethiopia: A cross sectionalstudy. PLOS ONE, 16(5), e0251506.https://doi.org/10.1371/JOURNAL.PONE.0251506Nwankwo, O. N. O., Ugwu, C. I., Nwankwo, G. I.,Akpoke, M. A., Anyigor, C., Obi-Nwankwo, U., Andrew,S., Nwogu, K., & Spicer, N. (2022). A qualitativeinquiry of rural-urban inequalities in the distributionand retention of healthcare workers in southernNigeria. PLOS ONE, 17(3), e0266159.https://doi.org/10.1371/JOURNAL.PONE.0266159Ogbera, A. O., & Ekpebegh, C. (2014). Diabetesmellitus in Nigeria: The past, present and future.World Journal of Diabetes, 5(6), 905.https://doi.org/10.4239/WJD.V5.I6.905Prudencio, J., Cutler, T., Roberts, S., Marin, S., &Wilson, M. (2018). The effect of clinical pharmacistled comprehensive medication management onchronic disease state goal attainment in a patientcentered medical home. Journal of Managed Careand Specialty Pharmacy, 24(5), 423–429.https://doi.org/10.18553/JMCP.2018.24.5.423/ASSET/IMAGES/FIG3.JPGUdoh, A., Akpan, M., Ibrahim, U. I., Lawal, B. K.,Labaran, K. S., Ndem, E., Amorha, K., Matuluko, A.,Tikare, O., Ohabunwa, U., & Kpokiri, E. (2021). Clinicalpharmacy services provided in public sectorhospitals in Nigeria: a national survey. InternationalJournal of Pharmacy Practice, 29(5), 471–479.https://doi.org/10.1093/IJPP/RIAB046Ugwu, E., Adeleye, O., Gezawa, I., Okpe, I., Enamino,M., & Ezeani, I. (2019). Burden of diabetic foot ulcerin Nigeria: Current evidence from the multicenterevaluation of diabetic foot ulcer in Nigeria. WorldJournal of Diabetes, 10(3), 200.https://doi.org/10.4239/WJD.V10.I3.200Vitalis Jafla Pontianus, & Oruonye E.D. (2021). TheNigerian population: A treasure for nationaldevelopment or an unsurmountable nationalchallenge. International Journal of Science andResearch Archive, 2(1), 136–142.https://doi.org/10.30574/IJSRA.2021.2.1.0026Wells, D. A., Sakaan, S., Shaver, J., Cutshall, B. T., &Twilla, J. (2025). Evaluation of pharmacist-initiatedglycemic control in adult medicine patients withdiabetes. Journal of the American College ofClinical Pharmacy, 8(2), 77–81.https://doi.org/10.1002/JAC5.2072THE PANACEA / VOLUME 4 2025 / 20Faculty of Pharmacy ResearchHighlights
ROBOTIC TECHNOLOGIES IN MODERN PHARMACYPRACTICE:TRENDS AND PROSPECTSRobotics has evolved from a novel concept intoan essential component of modern pharmacypractice. Over the past decades, pharmaceuticalsystems have advanced from basic automateddispensers to sophisticated platforms poweredby artificial intelligence (AI), addressing increasingdemands for medication safety, operationalefficiency, and cost control worldwide. Theintegration of robotics in pharmacy practicerepresents a transformative advancement thataims to enhance medication safety, operationalefficiency, and the quality of patient care. Thisarticle provides a comprehensive review ofrobotic technologies in pharmacy, encompassingthe current systems, emerging technologies, andtheir prospects. As healthcare continues itsdigital transformation, understanding robotictechnologies in pharmacy practice is essential forpharmacists, administrators, and policymakers,providing a reference point and roadmap forfuture adoption.Mustapha Mohammed¹*, Sagir Mustapha², Surajuddeen Muhammad³, KhadijaAbdullahi , Khadijat Muhammad , Abubakar Wada Sadiq , Abubakar Sha’aban3 4 5 6¹Biomedical Research Center, QU Health, Qatar University, Doha, Qatar²Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia³Faculty of Veterinary Medicine, Ahmadu Bello University, Kaduna, Nigeria⁴Department of Public Health, Iconic University, Sokoto, Nigeria⁵Department of Pharmacology and Therapeutics, Bayero University, Kano, Nigeria6Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United KingdomCorresponding author: [email protected] the promise, adoption of robotics inpharmacy varies widely across regions andinstitutions, influenced by financial, technical, andcultural factors. Understanding the status ofpharmacy robotics, its benefits, and limitations iscritical to guiding future implementations andensuring that these technologies effectivelysupport pharmacists in improving health outcomes.This article provides a comprehensive review ofrobotic technologies in pharmacy, encompassingcurrent robotic systems, emerging robotictechnologies, and their prospects.Robotic compounders operating in ISO Class 5environments with HEPA filtration reducemicrobial contamination by 85-90%, a criticalbenefit for immuno-compromised patients(Riestra et al., 2025). They achieve dosingaccuracy to 0.1 mL, enabling precise weightbased and complex multi-drug regimens,exemplified by the i.v. station system.Challenges include high capital costs ($1.5–$2.5million), a large physical footprint, andsignificant infrastructure requirements.However, the facilities report reducedmedication waste by 15-25%, achievedsignificant time savings (a 60-70% reduction instaff compounding time), and improvedregulatory compliance (McCall et al., 2022).THE PANACEA / VOLUME 4 2025 / 21AbstractIntroductionThe rapid evolution of healthcare technologieshas profoundly reshaped the landscape ofpharmacy practice. Pharmacists and otherhealthcare professionals face mounting pressureto ensure safe, timely, and effective patient care,particularly as patient complexity and medicationregimens continue to increase (Lott et al., 2021;Slazak et al., 2020). Medication errors remain aleading cause of preventable harm globally(Panagioti et al., 2024), prompting healthcaresystems to seek innovative solutions to minimizehuman error and enhance safety protocols.Robotics is defined as automated mechanicalsystems capable of performing repetitive andprecise tasks (Jahanshahi & Zhu, 2024). Theapplication of robotics has gained considerableattention in pharmacy practice (Alahmari et al.,2022; Batson et al., 2021; Stasevych & Zvarych,2023). Robotics technologies were initiallyemployed for dispensing tasks and haveprogressively expanded into areas such as sterilecompounding, inventory management, andclinical support services (M. Boyd & W. Chaffee,2019; Stasevych & Zvarych, 2023; Teja et al., 2014;Trenfield et al., 2022). These technologies offerthe potential to standardize processes, reducevariability, and allow pharmacists to dedicatemore time to patient-centered activities.Current RoboticTechnologies in PharmacyPracticeA) Automated DispensingSystemsAutomated dispensing systems (ADS) are the mostcommon pharmacy robotics used in bothcommunity and hospital settings. Modern ADS haveevolved beyond simple pill counting to incorporateadvanced computer vision and machine learningthat identify medications by size, shape, color, andimprint with high accuracy, significantly reducingdispensing errors (Hänninen et al., 2023).For example, the ScriptPro SP 200 employs opticalcharacter recognition and 3D imaging to verifymedications, virtually eliminating substitution errors(Shalina et al., 2025). Predictive analytics optimizeworkflow by forecasting demand and managinginventory, as seen in the Omnicell XT Series, whichautomatically triggers refills, reducing stockouts by40-60% in hospital pharmacies (Shoaib, 2024).Evidence demonstrates that AI-enhanceddispensing robots reduce errors by 78% and free30-40% of pharmacists’ time from routine tasks,enabling a shift toward patient-centered care,including medication therapy management andconsultations (Prezas et al., 2022).B)Robotic CompoundingSystemsRobotic compounding systems (RCS) represent anadditional level of automation in pharmacy,enhancing safety and precision in sterilecompounding, particularly for high-riskmedications such as chemotherapy and parenteralnutrition. The RCSs are usually equipped withgravimetric verification that is sensitive tovariations of 1-2 mg and barcode scanning, andperform multiple verification checks per dose. Forinstance, the APOTECAchemo averages 12 checkscompared to 3-4 checks performed manually(Geersing et al., 2020; Geersing et al., 2024).C)Autonomous MobileRobotsAutonomous Mobile Robots (AMRs) formedication distribution address the\"last mile\"delivery of medications within healthcarefacilities. The AMRs autonomously transportdrugs from pharmacies to the designated careunits. Using LiDAR and SLAM navigation,systems like Aethon’s TUG robot navigatecorridors, elevators, and doors without humanaid (Cognominal et al., 2021).Studies show AMRs reduce delivery times by40% and medication delivery errors by 30%,largely by minimizing manual handling andincorporating barcode verification. Securityfeatures include biometric access controls andcontinuous temperature monitoring; ARxIUM’sRIVA system adds blockchain tracking for animmutable custody record, critical forcontrolled substances (Nurgat et al., 2021).Implementation requires workflow integrationand facility adjustments, such as elevatoraccess and docking stations. Despite theseneeds, AMRs often achieve ROI within 2–3years through personnel cost savings andreduced medication losses.Faculty of Pharmacy ResearchHighlights
Self-Learning CompoundingRobotsD)AI-Powered ClinicalDecision Support RobotsAI-Powered Clinical Decision Support Robotsaugment pharmacists’ clinical decisions byanalyzing electronic health records with NLP andmachine learning to detect medication therapyproblems. Systems like PharmAssist AI rapidlyidentify potential drug interactions, dosingadjustments, and opportunities for therapyoptimization (Mohanty et al., 2021).Integrationemphasizes collaboration, with pharmacistsretaining final decision authority, as in Swisslog’sPillPick system, which provides real-time alertswhile allowing overrides (Bagattini et al., 2022).Future systems could aim to incorporatepredictive analytics for personalizedpharmacotherapy based on genetics andlifestyle, raising considerations of data privacyand algorithm transparency.Emerging Innovations inPharmacy RoboticsNanorobots are biocompatible devices capableof delivering drugs with cellular precision.Examples include MIT’s “pharmacy-on-a-chip,”which utilizes magnetic nanorobots for insulinrelease responsive to glucose levels, and goldnanoparticle robots that cross the blood-brainbarrier to deliver chemotherapy, resulting insignificantly improved tumor reduction in animalmodels (Rai et al., 2023; Sarella et al., 2024).Challenges remain in biocompatibility, immuneresponses, manufacturing scalability, and precisecontrol. Clinical use is anticipated in 5–10 years,initially for complex cases like brain tumors orpancreatic cancer.A)Nanorobotics for TargetedDrug DeliveryNext-generation robotic compounding systemsutilize machine learning to enhance performanceand adapt to new medications and protocolscontinually (Saharan, 2022). Unlike currentsystems that require explicit programming foreach task, these self-learning robots usereinforcement learning algorithms to optimizetheir movements and sequencing based on pastoutcomes. Advanced computer vision monitorseach compounding step, refining models of idealtechniques for different medication types. Forexample, the AutoCompounder AI systemdeveloped at UCSF Medical Center has reducedthe need for manual protocol updates byapproximately 80% compared to traditionalsystems (Hossain et al., 2024).Alahmari, A. R., Alrabghi, K. K., & Dighriri, I. M.(2022). An overview of the current state andperspectives of pharmacy roborts andmedication dispensing technology. Cureus, 14(8).Allam, A. R., Sridharlakshmi, N. R. B., Gade, P. K., &Venkata, S. S. M. G. N. (2024). Exploring SwarmRobotics for Enhanced Coordination andEfficiency in Logistics Operations. RoboticsXplore: USA Tech Digest, 1(1), 137-156.Bagattini, Â. M., Borges, J. L. A., Riera, R., & deCarvalho, D. C. M. F. (2022). Automation of atertiary hospital pharmacy drug dispensingsystem in a lower-middle-income country: Acase study and preliminary results. ExploratoryResearch in Clinical and Social Pharmacy, 6,100151.Batson, S., Herranz, A., Rohrbach, N., Canobbio, M.,Mitchell, S. A., & Bonnabry, P. (2021). Automationof in-hospital pharmacy dispensing: a systematicreview. European Journal of Hospital Pharmacy,28(2), 58-64.Cognominal, M., Patronymic, K., & Wańkowicz, A.(2021). Evolving field of autonomous mobilerobotics: Technological advances andapplications. Fusion of Multidisciplinary Research,An International Journal, 2(2), 189-200.Geersing, T., Klous, M., Franssen, E., van denHeuvel, J., & Crul, M. (2020). Roboticcompounding versus manual compounding ofchemotherapy: comparing dosing accuracy andprecision. European Journal of PharmaceuticalSciences, 155, 105536.Geersing, T. H., Pourahmad, D. M., Lodewijk, F.,Franssen, E. J., Knibbe, C. A., & Crul, M. (2024).Analysis of production time and capacity formanual and robotic compounding scenarios forparenteral hazardous drugs. European Journal ofHospital Pharmacy, 31(4), 352-357.Hänninen, K., Ahtiainen, H. K., Suvikas-Peltonen, E.M., & Tötterman, A. M. (2023). Automated unitdose dispensing systems producing individuallypackaged and labelled drugs for inpatients: asystematic review. European Journal of HospitalPharmacy, 30(3), 127-135.Hossain, M. F., Funk, M., Ratliff, A., & Oliver, D.(2024). Prospects and Challenges of Using anAutocompounder in a 503A Pharmacy for NonSterile Compounding: A Comparative Study.Journal of Pharmaceutical Compounding andTherapeutics| Open Access, 1(1).Jahanshahi, H., & Zhu, Z. H. (2024). Review ofmachine learning in robotic grasping control inspace application. Acta Astronautica.Jain, D., & Sharma, Y. (2017). Adoption of nextgeneration robotics: A case study on Amazon.Perspect. Case Res. J, 3, 9-23.Lott, B. E., Anderson, E. J., Zapata, L. V., Cooley, J.,Forbes, S., Taylor, A. M., Manygoats, T., & Warholak,T. (2021). Expanding pharmacists’ roles:Pharmacists’ perspectives on barriers andfacilitators to collaborative practice. Journal ofthe American Pharmacists Association, 61(2), 213-220. e211.M. Boyd, A., & W. Chaffee, B. (2019). Criticalevaluation of pharmacy automation and roboticsystems: a call to action. Hospital pharmacy,54(1), 4-11.THE PANACEA / VOLUME 4 2025 / 22B)Swarm Robotics forInventory ManagementNanorobots are biocompatible devices capableof delivering drugs with cellular precision.Examples include MIT’s “pharmacy-on-a-chip,”which utilizes magnetic nanorobots for insulinrelease responsive to glucose levels, and goldnanoparticle robots that cross the blood-brainbarrier to deliver chemotherapy, resulting insignificantly improved tumor reduction in animalmodels (Rai et al., 2023; Sarella et al., 2024).Challenges remain in biocompatibility, immuneresponses, manufacturing scalability, and precisecontrol. Clinical use is anticipated in 5–10 years,initially for complex cases like brain tumors orpancreatic cancer.ConclusionRobotics in pharmacy practice represents aprogressive advancement that enhancesaccuracy, efficiency, and safety in medicationmanagement by automating complexcompounding processes, dispensing, andinventory management. Such robotic systemsreduce human errors, free up pharmacist time,and improve overall patient outcomes. Theintegration of robotics with electronic healthrecords, combined with ongoing advancementsin artificial intelligence, is poised to furtherenhance the optimization of these technologies.Despite challenges such as high initial costs andinteroperability issues, the benefits of roboticsmake them an indispensable component ofmodern pharmacy practice. Continuedinnovation and adoption will be key to fullyrealizing their potential in delivering safer, morepersonalized pharmaceutical care.ReferencesFaculty of Pharmacy ResearchHighlights
McCall, J., Barnard, N., Gadient, K., Kasireddy, C.,Kurtz, A., Li, Y., Page, T., Putnam, T., & Brennan, Á.(2022). Environmental monitoring for closedrobotic workcells used in aseptic processing:data to support advanced environmentalmonitoring strategies. AAPS PharmSciTech, 23(6),215.Mohanty, K., Subiksha, S., Kirthikka, S., Sujal, B.,Sokkanarayanan, S., Bose, P., & Sathiyanarayanan,M. (2021). 6 AI-Powered Robotics. RoboticTechnologies in Biomedical and HealthcareEngineering, 117.Nurgat, Z. A., Alaboura, D., Aljaber, R., Mustafa, O.,Lawrence, M., Mominah, M., Al-Jazairi, A. S., & AlJedai, A. (2021). Real-world experience of astandalone robotic device for batchcompounding of small-volume parenteralpreparations. Hospital pharmacy, 56(1), 32-46.Panagioti, M., Hodkinson, A., Planner, C., Dhingra,N., & Gupta, N. (2024). Global burden ofpreventable medication-related harm in healthcare: a systematic review. World HealthOrganization.Prezas, L., Michalos, G., Arkouli, Z., Katsikarelis, A., &Makris, S. (2022). AI-enhanced vision system fordispensing process monitoring and qualitycontrol in manufacturing of large parts. ProcediaCIRP, 107, 1275-1280.Rai, A., Shah, K., & Dewangan, H. K. (2023). Reviewon the artificial intelligence-based nanoroboticstargeted drug delivery system for brain-specifictargeting. Current pharmaceutical design, 29(44),3519-3531.Riestra, A. C., Urretavizcaya, M., Uriguen, A. F.,Sarasola, O. O., Iglesias, A., Camba, Y., Bermejo, A.A., & Tames, M. J. (2025). Monitoring ofoccupational exposure to hazardous medicinalproducts in robotic compounding. EuropeanJournal of Hospital Pharmacy.Saharan, V. A. (2022). Robotic automation ofpharmaceutical and life science industries. InComputer Aided Pharmaceutics and DrugDelivery: An Application Guide for Students andResearchers of Pharmaceutical Sciences (pp.381-414). Springer.Sarella, P. N. K., Vipparthi, A. K., Valluri, S., Vegi, S., &Vendi, V. K. (2024). Nanorobotics: Pioneering drugdelivery and development in pharmaceuticals.Shalina, C., Karra, G., Rao, T. R., & Ishwarya, V.(2025). Robotic Prescription Dispensing Systems:A Comparative Analysis of Efficiency andAccuracy. In Advances in Sports Science andTechnology (pp. 226-230). CRC Press.Shoaib, M. (2024). Feasibility study and initialbusiness plan to introduce pharmacy vendingmachines in the Norwegian healthcare systemInland Norway University].Slazak, E., Cardinal, C., Will, S., Clark, C. M., Daly, C.J., & Jacobs, D. M. (2020). Pharmacist-ledtransitions-of-care services in primary caresettings: opportunities, experiences, andchallenges. Journal of the American PharmacistsAssociation, 60(3), 443-449.Stasevych, M., & Zvarych, V. (2023). Innovativerobotic technologies and artificial intelligence inpharmacy and medicine: paving the way for thefuture of health care—a review. Big data andcognitive computing, 7(3), 147.Teja, L. T., Keerthi, P., Datta, D., & Babu, N. M. (2014).Recent trends in the usage of robotics inpharmacy. Indian Journal of Research inPharmacy and Biotechnology, 2(1), 1038.Trenfield, S. J., Awad, A., McCoubrey, L. E.,Elbadawi, M., Goyanes, A., Gaisford, S., & Basit, A.W. (2022). Advancing pharmacy and healthcarewith virtual digital technologies. Advanced DrugDelivery Reviews, 182, 114098.THE PANACEA / VOLUME 4 2025 / 23Faculty of Pharmacy ResearchHighlights
THEIMPACT OF COMBINATION THERAPY ONWOUNDHEALINGThe skin protects the body's organs frommechanical, chemical, and thermal damage byacting as its first line of defense [1]. Among itsfeatures is a highly developed immune responsethat acts as a barrier against pathogens. Aneffective wound healing process requires theharmonious integration of multiple cellularactivities, including homeostasis, inflammation,proliferation, and remodeling [2]. In the event ofcutaneous damage, microorganisms can quicklyenter the tissues beneath the skin, resulting inchronic wounds and fatal infections [3]. Healthcare systems worldwide face a significantchallenge in wound management, which requiresa multidisciplinary approach. There is asubstantial economic burden associated withchronic wounds, requiring prolonged andexpensive interventions, multiple medical visits,and the possibility of complications such asinfection, amputation, or hospitalization. Due toaging populations and chronic diseases such asdiabetes, cardiovascular disease, and obesity,chronic wounds are becoming more common [4].Consequently, healthcare systems, third-partypayers, and individuals bear a heavier economicburden when treating wounds [5].To restore the integrity of the skin andsubcutaneous tissue, wound healing involves anintricate sequence of biochemical and cellularevents [6]. The presence of diverse activecomponents, ease of access, and limited sideeffects make several plant extracts andphytoconstituents promising wound healingagents [7]. Based on the variety of active andeffective components in medicinal plants, suchas flavonoids, essential oils, alkaloids, phenoliccompounds, terpenoids, fatty acids, etc., they canbe considered potent and promisingtherapeutics for improving wound healingprocesses. Compared to modern therapy, thesetraditional remedies have low costs, limited sideeffects, and high bioavailability [8].It has been shown that herbal-basednanostructures stimulate wound healing bysuppressing inflammatory cytokines andinflammation transduction cascades, reducingoxidative factors, enhancing anti-oxidativeenzymes, and promoting neovascularization andangiogenic pathways by increasing vascularendothelial growth factor, fibroblast growth factor,and platelet-derived growth factor expression [9].Muhammad Khursheed Alam Shah , Asif Nawaz , Sagir Mustapha1 2* 3*Gomal Center of Pharmaceutical Sciences, Faculty of Pharmacy, Gomal University, D.I.Khan, 29050, [email protected];1Department of Pharmaceutical Technology, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, [email protected];2Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia. [email protected] Authors: Asif Nawaz [email protected]; Sagir Mustapha [email protected] wound dressings incorporateessential oils, plant-derived compounds withdiverse properties [10]. The antibacterial, antiviral,antifungal, analgesic, anti-inflammatory, andantioxidant properties of these oils make themuseful in wound care [11]. Oils can also have uniqueproperties that make them more effective intreating wounds [10]. To improve antimicrobialdressing efficacy, oregano has been incorporatedinto cellulose acetate fibers, known for its antimutagenic properties. In several countries outsidethe U.S., tea tree oil is used in hydrogel dressings totreat burns. Lavender accelerates granulation tissueformation when applied topically to the skin, whileSt John's Wort promotes skin re-epithelization.Comparatively to traditional antibiotics, essentialoils have a low tendency to promote microbialresistance [12]. In wound infections, thischaracteristic makes them a valuable tool againstmultidrug-resistant bacteria, providing a possiblealternative to conventional antibiotics [13]. Inaddition, polyphenols have been shown to haveantimicrobial activity against a wide range ofbacteria and fungi [14]. In several studies,polyphenols, especially flavonoids, have beenshown to have antimicrobial activity by augmentingantibiotic activity as well as directly eliminating andattenuating microbes [15].The Aloe vera plant belongs to the Lilaceaefamily. Aloe comes from the Arabic word\"alloeh,\"which means\"bitter.\" The medicinaland functional properties of aloe Vera haveincreased its usage in food products [19]. Thealoe plant has been linked to a variety ofbiological functions, such as detoxification,constipation treatment, and waste removalfrom the body. Antibacterial, antimicrobial,antitumor, anti-inflammatory, anti-rheumatoid,and anti-arthritic properties are related to thealoe plant's bioactivity. There are three layers toaloe vera: the outer leaf, the green pulp, and thegel. There has been evidence of antioxidantactivity in aloe gel, aloe flowers, and aloe leafskin [20]. Traditionally, Aloe vera has been usedto heal wounds [21]. Pressure ulcers, burnwounds, surgical wounds, cracked nipples,genital herpes, and psoriasis can all be treatedwith aloe vera [22].THE PANACEA / VOLUME 4 2025 / 24Introduction 1.Plant-Derived NaturalCompounds2.1 Achilleamillefolium L.For quite some time, yarrow (Achillea) species havebeen used in ethnopharmacology. A. millefolium iscommonly used to treat wounds, bleeding,stomachaches, gastrointestinal disorders, colds, flu,and stomach issues. During the Trojan War, Achillesused this plant to monitor his blood flow and healhis wounds. The genus name may be derived fromhis name, while the species name\"millefolium\"refers to the delicately split leaves [1]. Manycultures have used Achillea species as traditionalherbal medicines since ancient times. A medicinalplant that grows naturally throughout Europe, Asia,North Africa, and North America is yarrow, Achilleamillefolium L. Traditionally, the flowery plant hasbeen used as an astringent, antiseptic, antiinflammatory, and antispasmodic agent to speedup the healing of burns, ulcers, cuts, and wounds[16]. Flavonoids in A millefolium are linked to itsantioxidant and anti-inflammatory properties [17].As an active ingredient in pharmaceuticals andcosmetics that protect skin from environmentalstress, Achillea extracts are intriguing candidatesfor use as tyrosinase inhibitors, antioxidants, andantibacterial [18].2.2 Aloe Vera2.Plant Species and TheirPotential TherapeuticInterests2.3 Curcuma LongaIn the Zingiberaceae family, Curcuma longa L(turmeric) plants contain curcumin, a brightyellow chemical. Curcumin was first discoveredby Harvard College laboratory scientists Vogeland Pelletier around 200 years ago [23].Turmeric has been used in traditional herbalmedicine for digestion, weight loss, andinflammation of the gastrointestinal and skin[24]. Turmeric contains curcumin,demethoxycurcumin, andbisdemethoxycurcumin, which are bioactivecurcuminoids with anti-inflammatory, anticancer, and anti-aging properties [25]. Priorstudies have demonstrated that topicalCurcumin treatment produced well-formedgranulation tissue that was primarily composedof collagen and epithelium regeneratingfollowing wound healing. Curcumin treatmentalso reduced matrix metallopeptidase-9 andtumor necrosis factor alpha and acceleratedwound healing in mice [1].Faculty of Pharmacy ResearchHighlights
2.4 Althaea officinalis 2.7 EucalyptusThe herb Althaea officinalis L (Malvaceae),commonly known as marshmallow, has beenused as a medicine for wounds andinflammations for thousands of years. Besidesretaining water, the root's polysaccharides boostthe body's immunity [26]. Furthermore, the Aofficinalis hydroethanolic extract containsphytochemicals that can kill gram positivebacteria and speed wound healing [27].2.5 Calendula officinalisEucalyptus globulus oil is used worldwide as anantiseptic and to treat colds, coughs, sorethroats, and other ailments [33]. For woundhealing investigation, collagen estimation, andhistological evaluation in rats, the optimizednanoemulsion of Eucalyptus essential oil (EEO)was selected over pure EEO and regulargentamycin. Rat wound healing was enhanced byoptimized EEO nanoemulsion [34]. For optimalwound healing results and to increase cellproliferation, Eucalyptus alba leaves should bedried at a temperature of no more than 30°C andextracted in ethanol [35].THE PANACEA / VOLUME 4 2025 / 252.6 Matricaria chamomillaChamomile (Matricaria chamomilla L.) belongs tothe Asteraceae family. Herbalists know Germanchamomile (M. chamomilla) for its therapeuticand fragrant properties. Chamomile (M.chamomilla) grows in south-eastern Europe andneighboring Asian nations. The flower heads andessential oils are used in traditional medicine[30]. M chamomilla contains a variety ofsecondary metabolites and active compounds,such as sesquiterpenes, polyacetylenes,coumarins, and flavonoids. Among the bioactivephenolic compounds in chamomile extracts areluteolin and luteolin-7-Oglucoside, quercetin andrutin, apigenin and apigenin-7-O-glucoside, andnaringenin. Chamomile has antibacterial, antiinflammatory, antiseptic, and antispasmodicproperties [31]. Due to its antibacterial,antioxidant, biocompatibility, and mechanicalproperties, chamomile loaded mats are suitablefor wound healing. Additionally, 15-20% ofchamomile loaded mats demonstrated excellentantibacterial efficacy, and inhibitory zonesincreased with chamomile content. Antibacterialefficacy of these nanofibers was greater thanthat of commercial silver-coated wounddressings [32].2.8 JojobaJojoba oil is a naturally occurring light yellow oilthat can be applied topically to heal wounds andrebuild skin barriers. There are polyphenols,flavonoids, alkaloids, and linear long-chain estersin jojoba oil. Jojoba oil dry nanoemulsion powders(JND) reduced bleeding and inflammatory cellinfiltrations in acute lung injury models (ALI),emphasizing its effectiveness as a natural oilbased anti-inflammatory and free radicalscavenger [36]. Unlike other oils, jojoba oilcontains over 98% pure waxes (mostly waxesters, with a small amount of free fatty acids,alcohols, and hydrocarbons), sterols, and vitamins[37]Chamomile (Matricaria chamomilla L.) belongs tothe Asteraceae family. Herbalists know Germanchamomile (M. chamomilla) for its therapeuticand fragrant properties. Chamomile (M.chamomilla) grows in south-eastern Europe andneighboring Asian nations. The flower heads andessential oils are used in traditional medicine[30]. M chamomilla contains a variety ofsecondary metabolites and active compounds,such as sesquiterpenes, polyacetylenes,coumarins, and flavonoids. Among the bioactivephenolic compounds in chamomile extracts areluteolin and luteolin-7-Oglucoside, quercetin andrutin, apigenin and apigenin-7-O-glucoside, andnaringenin. Chamomile has antibacterial, antiinflammatory, antiseptic, and antispasmodicproperties [31]. Due to its antibacterial,antioxidant, biocompatibility, and mechanicalproperties, chamomile loaded mats are suitablefor wound healing. Additionally, 15-20% ofchamomile loaded mats demonstrated excellentantibacterial efficacy, and inhibitory zonesincreased with chamomile content. Antibacterialefficacy of these nanofibers was greater thanthat of commercial silver-coated wounddressings [32].2.9 Plantago majorA wide range of illnesses and disorders, includingdigestive problems and respiratory issues, havebeen treated with the leaves and seeds of thisplant. Additionally, it is an anti-inflammatory,anti-microbial, and anti-tumor agent. In addition,plantains contain compounds that counterexternal and internal toxins [38]. Caffeic acidderivatives, polysaccharides, terpenoids, lipids,and flavonoids are present in Plantago major [39].In addition to healing wounds, P. major ointmentalso functions as an analgesic and antibacterialagent, making it a safe and effective herbalremedy for second-degree burn wounds [1].2.10 Alkanna tinctoriaAs Alkanna tinctoria (L) Tausch is commonlyknown, it is commonly called dyer's alkanet,alkanet, dyer's bugloss, orchanet, or Ratanjot (inPakistan). The species is native to Europe, theMediterranean region, Asia, and the Middle East,and belongs to the Boraginaceae family [40].Light and loose sandy soil is the ideal habitat forAlkanna species. They have exceptional droughtresistance and a high ability to absorb andtransfer water throughout the plant. The height ofan Alkanna plant is approximately 40 cm. Abushy, prostrate plant with long bristles, it has agrayish green stem and a soft, soft base. Dark redroots and striking blue flowers distinguish thisplant [41] (Figure 1). In various cultures andindustries over the centuries, this plant has beenprized for its vibrant red dye derived from itsroots [42]. Medicinal and cosmetic applicationsof Ratanjot roots'natural red pigments have beenfound in a variety of fields, including food,cosmetics, and textiles [43].Figure 1: Alkanna tinctoria & flowersMedicinal plants are abundant in componentscan accelerate the healing of burn wounds.These compounds include alkaloids, essentialoils, flavonoids, tannins, terpenoids, saponins,fatty acids, and phenolic compounds. Alkannatinctoria is a traditional medicinal plant whoseroots show excessive antibacterial activityagainst pathogenic bacteria like P. aeruginosa, S.aureus, and fungus that cause skin diseases(Candida) [44].Nearly all species of the Boraginaceae family’sroots contain enantiomerichydroxynaphthoquinone red pigments calledalkannin, shikonins (A/S), and their derivatives.Alkanna tinctoria is well known for possessingderivatives of naphthoquinone, such as alkannin,an alkyl derivative of 1,4-naphthaquinone. Theisomeric form of alkannin is shikonins. It becomesobvious that these substances are found in theouter layers of the roots. Alkannin/shikonins andits derivatives, among other importantcomponents, possess a wide variety of biologicalproperties such as antibacterial, antimicrobial,anti-inflammatory, and antioxidant properties.Alkannin esters also have a significant potentialfor healing wounds [45].Faculty of Pharmacy ResearchHighlights
2.10.1 Medical Importance ofAlkanna SpeciesAlkanna tinctoria root contains a mixture ofpigments soluble in lipids, notably shikonins,alkannins, -1,4naphthoquinone (naphthazarin)constituents [46].Several other derivatives of alkannin exist,including acetylalkannin, propionylalkannin,isobutylalkannin, angelylalkannin, andisovalerylalkannin, a-methyl-n-butylalkannin, βhydroxy-isovalerylalkannin, as well as β,βdimethylacrylalkannin [47]. The root tissues ofAlkanna plants also contain resins, alkaloids,tannins, and waxes [48].There are several diseases that can be cured andresisted by Alkanna root, which has proven to bean important part of medicinal plants. The multibiological properties of Alkanna plant areattracting scientists and pharmaceuticalindustries because of its health benefits.THE PANACEA / VOLUME 4 2025 / 26Figure 2: The chiral pair alkannin & shikonin thatpossess major biological activity [49]i) Anti-inflammatory andAnti-Pyretic Effectii)Anticancer ActivityThe Alkanna root can reduce the tight and slowblood circulation associated with migraines andheadaches. Headache can be relieved byimproving blood circulation. Aside from its antiinflammatory properties, alkanet root can also beused to cure inflammation of bones and muscles.Applying alkanet root essence oil to theinflammation area will reduce the pain andsymptoms. Because alkanet root induces sweat,it is useful in cooling down fevers andaccelerating healing processes [54].iv) Antifungal/Anti-Viral andSkin HealingAlkanna root has antifungal properties and canbe used to treat phlegm, ringworm, and eczemacaused by fungus on the skin [55].Antiviral and antibacterial properties of Alkannaroot prevent infection, especially in the skin.Alkanna root oil has anti-aging and anti-wrinkleproperties, which are beneficial to the skin'shealth and beauty (Figure 3) [42].The roots of Alkanna have anti-viral propertiesthat cure viral diseases like herpes. Herpes is animmune and skin disorder that causes skin scarsor bleeding. Alkanna root has antiviral propertiesthat can reduce herpes symptoms [42].Figure 3: Shikonin and derivatives'effects on woundhealing [56].Despite its advanced protective capabilities, skincan be damaged by foreign materials, resulting inwrinkles and aging. By preventing aging andwrinkles, alkanet root oil or alkanet root powdermay help preserve your skin's health and beauty.Alkanet root is highly effective in increasing hairstrength and preventing hair loss. Additionally,they reduce swelling and heal nail cracks [42].A primary active metabolite of this family isnaphthoquinones, which have anti-inflammatory,anti-bacterial, and antioxidant propertiescontributing to wound healing [50]. Alkannins andshikonins (A/S), Figure 2, as well ashydroxynaphthoquinones (HNQ) andisohexenylnaphthazarins (IHN), are potentpharmaceutical substances with a range ofwound healing, antibacterial, anti-inflammatory,anticancer, and antithrombotic properties. As awound healing agent, A/S may be effectivebecause of its potent scavenging activity forsuperoxide anion radicals, whereas as a cytotoxicagent, A/S semiquinone radicals may exhibitanticancer and antimicrobial effects through thegeneration of endogenous superoxide anionradicals. A unique property of arnebin-1 is that itis pro-angiogenic and synergistic with vascularendothelial growth factor (VEGF), which greatlyenhances wound healing [51]. Burn woundstreated with Alkanna tinctoria Tausch showedrapid epithelization and angiogenesis [52].A further advantage of this extract is that itincreases fibroblast production, which increasestissue regeneration, as well as providing betterperfusion to the wound area, leading to theformation of granulation tissue [53].Root bark extract of Alkanna tinctoria (L.)contains alkannin and angelylalkannincompounds that inhibit colon cancer cellproliferation by arresting the cancer cell cycle atG1, causing apoptosis to occur [42].iii) Scare recoveringScars can be recovered using Alkanna rootextract. In addition to its incredible healthbenefits, Alkanna root is capable of protectingthe skin from microbial infections and reducinginflammation. Alkanna root has been widely usedfor years to heal burn scars because it hasnatural anti-inflammatory and cooling propertiesto absorb heat. Its sun blocking and sunburnremoving properties also make it useful.V)Anti-aging Activity & Hair/Nail TreatmentVi)Rheumatic RecoveryIn treating rheumatic disease and reducing thediscomfort caused by it, Alkanna root has provento be extremely effective. Rheumatic pain can bereduced by regularly applying Alkanna oil alongthe painful area or by consuming the powder ona regular basis [48].vii) Supports and PromotesHigh PerformanceCardiovascular HealthThe Alkanna root plays an important role inmaintaining heart health. To drink the essence ofalkanet root, soak it in water and extract itsessence. Regular use of alkanet root can help torelease poisons from the body and improve theheart's ability to circulate blood. Besidescontrolling stress on cardiovascular system,Alkanna roots are also effective in reducing highblood pressure. A reduction in the risk of strokeand heart attack may also be achieved by thismethod. The free radicals are normally byproducts of metabolism, and they enter the bodyfrom external sources of harmful chemicals in theenvironment or from day-to-day activities.Antioxidants play an important role in scavengingthem. Antioxidant properties of Alkanna rootshelp to protect the body from free radicaldamage [57].Faculty of Pharmacy ResearchHighlights
Mupirocin, a naturally occurring crotonic aciddrug, is obtained from Pseudomonas fluorescensand exhibits a broad range of anti-Gram-positivebacterial activity. These actions, however, are notvery effective against gram-negative bacteria.With an 80% improvement in infected patientsand a 90% eradication rate in Staph isolates, thisdrug has an effective therapeutic impact fortreating superficial skin infections caused byStaphylococcus aureus [58].In terms of chemical composition, Mupirocinbelongs to the carboxylic acid class of drugs. Dueto its wide spectrum of activity and anti-biofilmcharacteristics, it is widely used to manage andtreat a variety of topical skin and soft tissueinfections [59]. Mupirocin is chemicallyC26H44O9. Early in the 1970s it was synthesizedby modular polyketide synthases and isolatedfrom soil bacteria Pseudomonas fluorescenceNCIMB 10586 (Figure 4) [60]. It was approved bythe U.S. Food and Drug Administration (FDA) in1997 [61]. It contains a short chain fatty acid anda monoic acid (pseudomonic acids (A-D) and 9-hydroxynonanoic acid). Mupirocin is an analogueof isoleucyl adenylate. Its molecular weight is500.6 g/mol and it is white to off-white in color[62]. Mupirocin is very slightly water soluble(0.0265 g/L), maximal at pH 3.5–4.5, and lipidsoluble, with a Log P of 2.45. The wavelength ofMupirocin is 221 nm [63]. Because of its shorthalf-life (<30 min) and the emergence ofresistance, it is not efficacious for treating certaindiseases. Because of its minimal systemicabsorption through intact skin, it is well toleratedas a topical antibiotic [64]. Although its clinicalapplication is limited by poor skin permeabilityand insufficient sustained delivery, its parenteraluse is limited by its high plasma protein bindingaffinity and metabolic inactivation. Consequently,its clinical application is limited to topical skininfections and nasal carriage for decolonizationwith Staphylococcus aureus [65].Topical antibiotics like Mupirocin are frequentlyused to treat skin infections like impetigo andfolliculitis. Instead of direct drug association,studies are currently concentrating on thephysical immobilization of Mupirocin in threedimensional nano-networks [69].THE PANACEA / VOLUME 4 2025 / 273.1 Mechanism of Action ofMupirocinAs topical antibiotic, it is used to treat skininfections by inhibiting bacterial proteinsynthesis via binding to isoleucyl-tRNAsynthetase (IleRS), it exerts its antibacterialactivity (Figure 5) [70]. There is a similaritybetween the moiety of Mupirocin (MUP) (C-14and C-11 of monic acid) and that of Ile, whichaccounts for its peculiar mechanism of action.Since it has a unique mechanism of action, it isnot cross-resistant to other antibiotics [71].4.Antibiotics in WoundDressingsWound dressings contain aminoglycosides, betalactams, glycopeptides, quinolones,sulfonamides, and tetracycline [72]. The antibioticclasses target bacteria differently: beta-lactamsand glycopeptides inhibit cell wall synthesis,aminoglycosides and tetracycline inhibit proteinsynthesis, sulfonamides inhibit nucleic acidsynthesis, and quinolones inhibit DNA replicationand transcription [73]. The antibiotic Mupirocin iseffective against Gram-positive bacteria likeMRSA, and metronidazole is effective againstanaerobic bacteria [74]. When broad-spectrumtopical antibiotic wound dressings are usedincorrectly or for an extended period of time,multidrug-resistant bacteria may develop [75].The majority of bacteria that cause woundinfections are resistant to at least one commonantibiotic, according to research [76]. There is agrowing prevalence of Mupirocin-resistantStaphylococcus aureus strains, reducingMupirocin effectiveness in preventing invasiveinfections, even though it is the only approvedantibiotic for decolonizing MRSA [77]. In order tochoose the right antibiotic for an infected wound,culture and sensitivity tests must be considered.Often, surface swab cultures are of limited usedue to the presence of transient bacteria onwounds and skin [78].As a promising alternative to traditional antibiotictherapy for treating multidrug-resistant bacterialwound infections, nanoparticles (NPs) havegained significant attention in regenerativemedicine. Physicochemically, biologically, andoptically, they are well suited for variousbiomedical applications, particularlyantimicrobial wound dressings [79]. There are twomain types of NPs: metallic and non-metallic.Non-metallic nanoparticles can be furthersubdivided into organic nanoparticles andcarbon nanoparticles. A few examples of metalnanoparticles are gold (Au), silver (Ag), platinum(Pt), copper oxide (CuO), iron oxide (Fe3O4), andzinc oxide (ZnO). Due to their large surface areas,unique particle shapes, and small sizes, metallicnanoparticles exhibit antimicrobial activity. Theyare also capable of producing reactive oxygenspecies, which contribute to their antimicrobialproperties. Non-metallic NPs include dendrimers,ferritins, micelles, liposomes, and polymer NPs,while carbon-based NPs include fullerenes,graphene, carbon black, carbon nanofibers,carbon nanotubes (CNTs), and occasionallyactivated carbon. A carbon-based nanoparticle'santimicrobial activity is closely correlated with itssize and surface area, with smaller sizes andlarger surfaces showing higher antimicrobialactivity. There are, however, potential side effectsand risks associated with excessive NP exposure.NPs can disperse and accumulate in variousorgans of the body, including the brain, lungs,kidneys, and skin, resulting in toxic reactions.Before using NPs in antimicrobial wounddressings, in vivo studies on their bio distributionand safe degradation profile are crucial toaddressing these risks. The in vivo behavior ofNPs can be thoroughly investigated to betterunderstand the potential risks and develop saferand more effective antimicrobial wounddressings [80].Figure 5: Mechanism of action of Mupirocin [66].3.Mupirocin 5.NanoparticlesFigure 4: Mupirocin chemical structure [66].As a topical antibiotic, Mupirocin is mostcommonly used for treating and preventing skininfections caused by Gram-positivestaphylococci,methicillin-resistantStaphylococcus aureus (MRSA), particularlyimpetigo and infections of the skin, skinappendages, and mucosa [67]. Some Gramnegative microorganisms, like Haemophilusinfluenza and Neisseria spp., have been reportedto be susceptible to Mupirocin (MUP) [68]. At lowconcentrations, Mupirocin is bacteriostatic, whileat high concentrations, it is bactericidal. It is pHdependent, with a higher concentration at acidicpH. Furthermore, its antibacterial properties arepH-dependent, meaning that at an acidic pH, theproduct displays a greater level of in vitroantibacterial activity, so a low pH environment isideal for effective treatment of acne [64].Faculty of Pharmacy ResearchHighlights
[1] G. Albahri, A. Badran, A. Hijazi, A. Daou, E.Baydoun, M. Nasser, et al.,\"The therapeuticwound healing bioactivities of various medicinalplants,\" Life, vol. 13, p. 317, 2023.[2] A. A. Mamun, C. Shao, P. Geng, S. Wang, andJ. Xiao,\"Recent advances in molecularmechanisms of skin wound healing and itstreatments,\" Frontiers in Immunology, vol. 15, p.1395479, 2024.[3] C. K. Sen,\"Human wound and its burden:updated 2022 compendium of estimates,\"vol. 12,ed: Mary Ann Liebert, Inc., publishers 140Huguenot Street, 3rd Floor New …, 2023, pp. 657-670.[4] C. K. Sen,\"Human wound and its burden:updated 2020 compendium of estimates,\"Advances in wound care, vol. 10, pp. 281-292,2021.[5] F. Yousefian, R. Hesari, T. Jensen, S. Obagi, A.Rgeai, G. Damiani, et al.,\"Antimicrobial wounddressings: a concise review for clinicians,\"Antibiotics, vol. 12, p. 1434, 2023.[6] P. J. Muire, M. A. Thompson, R. J. Christy,and S. Natesan,\"Advances in immunomodulationand immune engineering approaches to improvehealing of extremity wounds,\" InternationalJournal of Molecular Sciences, vol. 23, p. 4074,2022.[7] J. P. Yadav, A. Verma, P. Pathak, A. R. Dwivedi,A. K. Singh, P. Kumar, et al.,\"Phytoconstituents asmodulators of NF-κB signalling: Investigatingtherapeutic potential for diabetic wound healing,\"Biomedicine & Pharmacotherapy, vol. 177, p.117058, 2024.[8] H. Zandavar and M. A. Babazad,\"Secondarymetabolites: Alkaloids and flavonoids in medicinalplants,\" in Herbs and Spices-New Advances, ed:IntechOpen, 2023.[9] A. Ahmad and M. I. Nawaz,\"Molecularmechanism of VEGF and its role in pathologicalangiogenesis,\" Journal of cellular biochemistry,vol. 123, pp. 1938-1965, 2022.[10] C. Mouro and I. C. Gouveia,\"Electrospunwound dressings with antibacterial function: acritical review of plant extract and essential oilincorporation,\" Critical Reviews in Biotechnology,vol. 44, pp. 641-659, 2024.[11] K. Amra, M. Momin, N. Desai, and F. Khan,\"Therapeutic benefits of natural oils along withpermeation enhancing activity,\" InternationalJournal of Dermatology, vol. 61, pp. 484-507,2022.[12] R. Iseppi, M. Mariani, C. Condò, C. Sabia, andP. Messi,\"Essential oils: A natural weapon againstantibiotic-resistant bacteria responsible fornosocomial infections,\" Antibiotics, vol. 10, p. 417,2021.[13] M. E. Elshobary, N. K. Badawy, Y. Ashraf, A. A.Zatioun, H. H. Masriya, M. M. Ammar, et al.,\"Combating antibiotic resistance: Mechanisms,multidrug-resistant pathogens, and noveltherapeutic approaches: An updated review,\"Pharmaceuticals, vol. 18, p. 402, 2025.[14] T. Manso, M. Lores, and T. de Miguel,\"Antimicrobial activity of polyphenols and naturalpolyphenolic extracts on clinical isolates,\"Antibiotics, vol. 11, p. 46, 2021.[15] M. K. Mandal and A. J. Domb,\"Antimicrobialactivities of natural bioactive polyphenols,\"Pharmaceutics, vol. 16, p. 718, 2024.[16] A. Dalili, S. Ebrahimnia Milani, N. Kamali, S.Mohammadi, M. Pakbaz, S. Jamalnia, et al.,\"Beneficial effects of Achillea millefolium on skininjuries; a literature review,\" Journal of EssentialOil Research, vol. 34, pp. 479-489, 2022.[17] S. Hayat, G. Miana, M. Kanwal, Z. Ahsan, and M.J. Tariq,\"Determination of Total Flavonoid Contentand Phenolic Content, Antioxidant Assay, andAntiepileptic Activity of Achillea millefoliumExtract,\" Natural Product Communications, vol.20, p. 1934578X251319221, 2025.[18] M. Strzępek-Gomółka, K. Gaweł-Bęben, andW. Kukula-Koch,\"Achillea species as sources ofactive phytochemicals for dermatological andcosmetic applications,\" Oxidative medicine andcellular longevity, vol. 2021, p. 6643827, 2021.[19] O. I. Ogidi and U. E. Enenebeaku,\"Medicinalpotentials of Aloe Vera (Aloe barbadensis Miller):technologies for the production of therapeutics,\"in Sustainable utilization and conservation ofAfrica’s biological resources and environment, ed:Springer, 2023, pp. 295-321.[20] S. Razia, H. Park, E. Shin, K.-S. Shim, E. Cho, M.C. Kang, et al.,\"Synergistic effect of Aloe veraflower and Aloe gel on cutaneous wound healingtargeting MFAP4 and its associated signalingpathway: In-vitro study,\" Journal ofEthnopharmacology, vol. 290, p. 115096, 2022.[21] L. Zago, K. Prado, V. Benedito, and M. Pereira,\"The use of babosa (Aloe vera) in treating burns: aliterature review,\" Brazilian Journal of Biology, vol.83, p. e249209, 2021.[22] K. Pawłowicz, M. Paczkowska-Walendowska,T. Osmałek, and J. Cielecka-Piontek,\"Towards thePreparation of a Hydrogel from Lyophilisates ofthe Aloe arborescens Aqueous Extract,\"Pharmaceutics, vol. 14, p. 1489, 2022.[23] H. S. Wadkar and R. M. Pinjari,\"TheTherapeutic Wound Healing Activities of VariousMedicinal Plants,\" 2023.[24] B. M. Razavi, M. Ghasemzadeh Rahbardar,and H. Hosseinzadeh,\"A review of therapeuticpotentials of turmeric (Curcuma longa) and itsactive constituent, curcumin, on inflammatorydisorders, pain, and their related patents,\"Phytotherapy Research, vol. 35, pp. 6489-6513,2021.[25] E. A. Elhawary, A. Y. Moussa, and A. N. B.Singab,\"Genus Curcuma: chemical andethnopharmacological role in aging process,\"BMC complementary medicine and therapies,vol. 24, p. 31, 2024.[26] N. M. Duran,\"Biological Activities fromVegetal Products in Latin America,\" in FoodByproducts Management and Their Utilization, ed:Apple Academic Press, 2024, pp. 313-345.[27] S. Vitale, S. Colanero, M. Placidi, G. DiEmidio, C. Tatone, F. Amicarelli, et al.,\"Phytochemistry and biological activity ofmedicinal plants in wound healing: an overview ofcurrent research,\" Molecules, vol. 27, p. 3566,2022.[28] S. Sharma and K. Kumari,\"An overview onCalendula officinalis Linn.:(pot marigold),\" Journalof Advanced Scientific Research, vol. 12, pp. 13-18,2021.THE PANACEA / VOLUME 4 2025 / 28[29] C. De Angelis, A. Di Stadio, S. Vitale, G.Saccone, M. C. D. Angelis, B. Zizolfi, et al.,\"Use ofcalendula ointment after episiotomy: arandomized clinical trial,\" The Journal ofMaternal-Fetal & Neonatal Medicine, vol. 35, pp.1860-1864, 2022.[30] M. Aćimović and B. Lončar,\"EthnobotanicalReview of Wild Edible Plants in Serbia,\" inExploring Traditional Wild Edible Plants, ed: CRCPress, 2025, pp. 233-292.[31] B. W. Downs, S. P. Banik, M. Bagchi, B. S.Morrison, S. W. Kushner, M. Piacentino, et al.,\"Design of a Novel Bioflavonoid and PhytonutrientEnriched Formulation in Boosting ImmuneCompetence and Sports Performance: A productDevelopment Investigation,\" American Journal ofBiopharmacy and Pharmaceutical Sciences, vol. 1,2021.[32] B. F. Adamu, J. Gao, S. Tan, and E. K.Gebeyehu,\"Comparison of antibacterial propertyof herbal plant–based bio-active extract loadedpolymer electrospun nanofibrous mat wounddressings,\" Journal of Industrial Textiles, vol. 51, pp.1793S-1814S, 2022.[33] R. A. E. Shiekh, A. M. Atwa, A. M. Elgindy, A. M.Mustafa, M. M. Senna, M. A. Alkabbani, et al.,\"Therapeutic applications of eucalyptus essentialoils,\" Inflammopharmacology, pp. 1-20, 2024.[34] K. Cai, Y. Liu, Y. Yue, Y. Liu, and F. Guo,\"Essential oil nanoemulsion hydrogel with antibiofilm activity for the treatment of infectedwounds,\" Polymers, vol. 15, p. 1376, 2023.[35] R. Mumtaz, M. Zubair, M. A. Khan, S. Muzammil,and M. H. Siddique,\"Extracts of Eucalyptus albaPromote Diabetic Wound Healing by Inhibiting α‐Glucosidase and Stimulating Cell Proliferation,\"Evidence‐Based Complementary and AlternativeMedicine, vol. 2022, p. 4953105, 2022.36] S. Abdalla, M. K. Aroua, and L. T. Gew,\"AComprehensive Review of Plant-Based CosmeticOils (Virgin Coconut Oil, Olive Oil, Argan Oil, andJojoba Oil): Chemical and Biological Propertiesand Their Cosmeceutical Applications,\" ACSomega, vol. 9, pp. 44019-44032, 2024.[37] H. A. Gad, A. Roberts, S. H. Hamzi, H. A. Gad,I. Touiss, A. E. Altyar, et al.,\"Jojoba oil: an updatedcomprehensive review on chemistry,pharmaceutical uses, and toxicity,\" Polymers, vol.13, p. 1711, 2021.[38] B. Noureddine, M. Elachouri, R. W.Bussmann, and O. K. Khojimatov,\"Plantago afra L.,Plantago akkensis subsp. ounifensis (Batt.) Maire,Plantago albicans L., Plantago amplexicaulis Cav.,Plantago ciliata Desf., Plantago coronopus L.,Plantago lanceolata L., Plantago major L., Plantagoovata Forssk. Plantaginaceae,\" in Ethnobotany ofNorthern Africa and Levant, ed: Springer, 2024,pp. 1-24.[39] N. T. Munawer,\"Plantago major as aBeneficial Medicinal Plant,\" European Journal ofMedical and Health Research, vol. 2, pp. 89-97,2024.[40] H. A. Alshamar and R. W. Dapson,\"Usingextract from alkanet (Alkanna tinctoria) as asource of both a red lipid stain and a bluecounterstain for histology,\" Biotechnic &Histochemistry, vol. 98, pp. 554-560, 2023.ReferencesFaculty of Pharmacy ResearchHighlights
[41] N. A. Jaradat, A. N. Zaid, F. Hussen, L. Issa, M.Altamimi, B. Fuqaha, et al.,\"Phytoconstituents,antioxidant, sun protection and skin anti-wrinkleeffects using four solvents fractions of the rootbark of the traditional plant Alkanna tinctoria (L.),\"European Journal of Integrative Medicine, vol. 21,pp. 88-93, 2018.[42] N. Kusculu and F. Eser,\"Applicability ofalkanet (Alkanna tinctoria) extract for thehistological staining of liver tissue,\" Journal of theIndian Chemical Society, vol. 99, p. 100409, 2022.[43] S. Adeel, S. Abrar, M. Ozomay, M. Hussaan,and F. Batool,\"Evolving role of plant pigments inthe cosmetic industry,\" in Renewable Dyes andPigments, ed: Elsevier, 2024, pp. 307-319.[44] M. S. Alwahibi and K. Perveen,\"Chemicalanalysis by GC-MS and in vitro antibacterialactivity of Alkanna tinctoria extracts against skininfection causing bacteria,\" Biomed. Res, vol. 28,pp. 7946-7949, 2017.[45] S. Yadav, A. Sharma, G. A. Nayik, R. Cooper, G.Bhardwaj, H. S. Sohal, et al.,\"Review of shikoninand derivatives: isolation, chemistry, biosynthesis,pharmacology and toxicology,\" Frontiers inpharmacology, vol. 13, p. 905755, 2022.[46] S. Das, A. Bhattacharya, and S. R. Maulik,\"Isolation and characterization of natural dyesand pigments,\" in Renewable Dyes and Pigments,ed: Elsevier, 2024, pp. 37-48.[47] A. Assimopoulou, M. Ganzera, H. Stuppner,and V. Papageorgiou,\"Simultaneousdetermination of monomeric and oligomericalkannins and shikonins by high‐performanceliquid chromatography–diode array detection–mass spectrometry,\" BiomedicalChromatography, vol. 22, pp. 173-190, 2008.[48] O. E. Abdel-Gelil, N. A. Atwa, A. R. A. Moustafa,and S. R. Mansour,\"Alkanna species: a promisingherbal medicine and its uses,\" Journal of FoodScience and Nutrition Research, vol. 2, pp. 309-315, 2019.[49] A. Assimopoulou, I. Karapanagiotis, A.Vasiliou, S. Kokkini, and V. Papageorgiou,\"Analysisof alkannin derivatives from Alkanna species byhigh‐performance liquidchromatography/photodiode array/massspectrometry,\" Biomedical Chromatography, vol.20, pp. 1359-1374, 2006.[50] D. Y. Lee, S.-I. Choi, S. H. Han, Y.-J. Lee, J.-G.Choi, Y.-S. Lee, et al.,\"Potential of PseudoshikoninI isolated from Lithospermi Radix as inhibitors ofMMPs in IL-1β-induced SW1353 cells,\"International Journal of Molecular Sciences, vol.17, p. 1350, 2016.[51] F. Safavi, M. Farimani, M. Golalipour, P.-C.Leung, K.-M. Lau, H.-F. Kwok, et al.,\"Investigationson the wound healing properties of Onosmadichroantha Boiss root extracts,\" South AfricanJournal of Botany, vol. 125, pp. 344-352, 2019.[52] K. Gümüş and Z. K. Özlü,\"The effect of abeeswax, olive oil and Alkanna tinctoria (L.)Tausch mixture on burn injuries: an experimentalstudy with a control group,\" Complementarytherapies in medicine, vol. 34, pp. 66-73, 2017.[53] A. Yazdinezhad, H. Monsef-Esfahani, and M. H.Ghahremani,\"Effect of Alkanna frigida extracts on3T3 fibroblast cell proliferation,\" Int. J. Pharm. Biol.Sci, vol. 3, pp. 212-215, 2013.54] F. SEYYEDI, K.SHAHSAVARINIA, B. DAVAMI, H. NAZEMIYEH, A.KHEIRI, H. VALIZADEH, et al.,\"Clinical assessmentof an ointment obtained from Alkanna orientalisroot extract in the management of burn wounds:a pilot cross-sectional clinical trial,\" Journal ofResearch in Pharmacy, vol. 28, 2024.[55] J. R. Bame, T. N. Graf, H. A. Junio, R. O.Bussey III, S. A. Jarmusch, T. El-Elimat, et al.,\"Sarothrin from Alkanna orientalis is anantimicrobial agent and efflux pump inhibitor,\"Planta medica, vol. 79, pp. 327-329, 2013.[56] K. Kaur, R. Sharma, A. Singh, S. Attri, S. Arora,S. Kaur, et al.,\"Pharmacological and analyticalaspects of alkannin/shikonin and their derivatives:An update from 2008 to 2022,\" Chinese HerbalMedicines, vol. 14, pp. 511-527, 2022.[57] I. Salimikia, A. R. Yazdinezhad, F.Golfakhrabadi, and H. R. M. Esfahani,\"In vitroantioxidant and free radical scavenging activityof four Alkanna species growing in Iran,\"Pharmacognosy Research, vol. 7, p. 100, 2015.[58] P. Nandhini, P. Kumar, S. Mickymaray, A. S.Alothaim, J. Somasundaram, and M. Rajan,\"Recentdevelopments in methicillin-resistantStaphylococcus aureus (MRSA) treatment: areview,\" Antibiotics, vol. 11, p. 606, 2022.[59] A. Kaur and S. Dang,\"Synergisticcombination of phytotherapeutics for infectiousdiseases,\" in Nanocarriers for the Delivery ofCombination Drugs, ed: Elsevier, 2021, pp. 337-392.[60] J. A. Connolly, A. Wilson, M. Macioszek, Z.Song, L. Wang, H. H. Mohammad, et al.,\"Definingthe genes for the final steps in biosynthesis ofthe complex polyketide antibiotic mupirocin byPseudomonas fluorescens NCIMB10586,\"Scientific reports, vol. 9, p. 1542, 2019.[61] A. Cern, Y. Bavli, A. Hod, D. Zilbersheid, S.Mushtaq, A. Michael-Gayego, et al.,\"Therapeuticpotential of injectable Nano-mupirocinliposomes for infections involving multidrugresistant bacteria,\" Pharmaceutics, vol. 13, p. 2186,2021.[62] K. Rupali, P. Shete, D. Doifode, and S.Chitlange,\"Analytical method development andvalidation for simultaneous determination ofsimvastatin and mupirocin using reverse-phasehigh-pressure liquid chromatographic method,\"Turkish Journal of Pharmaceutical Sciences, vol.18, p. 438, 2021.[63] S. Priya, R. B. Roselin, A. Karuppiah, and V.Sankar,\"Formulation of mupirocin adsorbed silvernanoparticle with antibiofilm agents forenhancing antibacterial activity,\" Indian J PharmEduc Res, vol. 56, p. 50e7, 2022.[64] A. Tucaliuc, A. C. Blaga, A. I. Galaction, and D.Cascaval,\"Mupirocin: applications andproduction,\" Biotechnology letters, vol. 41, pp.495-502, 2019.[65] B. Alhasso, M. U. Ghori, and B. R. Conway,\"Development of nanoemulsions for topicalapplication of mupirocin,\" Pharmaceutics, vol. 15,p. 378, 2023.[66] A. Gangwar, P. Kumar, R. Singh, and P. Kush,\"Recent advances in mupirocin deliverystrategies for the treatment of bacterial skin andsoft tissue infection,\" Future Pharmacology, vol. 1,pp. 80-103, 2021.[67] V. Shivanna and V. Dasegowda,\"Comparisonof disk diffusion and agar dilution method for thedetection of mupirocin resistance instaphylococcal isolates from skin and soft tissueinfections,\" Journal of laboratory physicians, vol.15, pp. 372-376, 2023.THE PANACEA / VOLUME 4 2025 / 29[68] M.-C. Roghmann, A. D. Lydecker, M. Shardell,R. T. DeBoy, J. K. Johnson, L. Zhao, et al.,\"Effect ofmupirocin for Staphylococcus aureusdecolonization on the microbiome of the noseand throat in community and nursing homedwelling adults,\" PloS one, vol. 16, p. e0252004,2021.[69] T. Ramasamy, S. Jayaseelan, G. Moorthy,and M. Muruganantham,\"The skin battle:Exploring the depths of pyoderma diagnosis,treatment, and management strategies,\"International Journal of Pharmaceutical Sciences,vol. 1, pp. 1-1, 2023.[70] D. Twilley, O. Reva, D. Meyer, and N. Lall,\"Mupirocin promotes wound healing bystimulating growth factor production andproliferation of human keratinocytes,\" Frontiers inPharmacology, vol. 13, p. 862112, 2022.[71] D. A. Williamson, G. P. Carter, and B. P.Howden,\"Current and emerging topicalantibacterials and antiseptics: agents, action, andresistance patterns,\" Clinical microbiologyreviews, vol. 30, pp. 827-860, 2017.[72] Y. Liang, Y. Liang, H. Zhang, and B. Guo,\"Antibacterial biomaterials for skin wounddressing,\" Asian Journal of PharmaceuticalSciences, vol. 17, pp. 353-384, 2022.[73] M. F. Haddad, B. A. Abdullah, H. AlObeidi, A.M. Saadi, and M. F. Haddad,\"Antibioticclassification, mechanisms, and indications: Areview,\" International Journal of Medical and AllBody Health Research, vol. 5, pp. 39-46, 2024.[74] M. Dallo, K. Patel, and A. A. Hebert,\"Topicalantibiotic treatment in dermatology,\" Antibiotics,vol. 12, p. 188, 2023.[75] S. A. Sousa, J. R. Feliciano, T. Pita, C. F.Soeiro, B. L. Mendes, L. G. Alves, et al.,\"Bacterialnosocomial infections: multidrug resistance as atrigger for the development of novelantimicrobials,\" Antibiotics, vol. 10, p. 942, 2021.[76] L. Chelkeba, T. Melaku, and T. A. Mega,\"Gram-negative bacteria isolates and theirantibiotic-resistance patterns in patients withwound infection in Ethiopia: a systematic reviewand meta-analysis,\" Infection and DrugResistance, pp. 277-302, 2021.[77] H. S. Arora, H. Khan, H. Ailumerab, G.Natarajan, K. Meert, H. Salimnia, et al.,\"A tale oftwo intensive care units (ICUs): baselineStaphylococcus aureus colonization andmupirocin susceptibility in neonatal and pediatricpatients requiring intensive care,\" InfectionControl & Hospital Epidemiology, vol. 44, pp. 447-452, 2023.[78] S. Li, P. Renick, J. Senkowsky, A. Nair, and L.Tang,\"Diagnostics for wound infections,\"Advances in wound care, vol. 10, pp. 317-327, 2021.[79] Z. Asvar, N. Pirbonyeh, A. Emami, S.-S.Hashemi, M. Fadaie, A. Ebrahiminezhad, et al.,\"Enhancing antibacterial activity against multidrug resistant wound bacteria: Incorporatingmultiple nanoparticles into chitosan-basednanofibrous dressings for effective woundregeneration,\" Journal of Drug Delivery Scienceand Technology, vol. 95, p. 105542, 2024.[80] S. Singh, S. Shankar, and Shikha,\"MicrobialSynthesis of Nanoparticles for WastewaterRemediation,\" in Nano-biotechnology for WasteWater Treatment: Theory and Practices, ed:Springer, 2022, pp. 115-150Faculty of Pharmacy ResearchHighlights
THE PREPAREDNESS PARADOX: PHARMACY PERSPECTIVEOFTHE NEXT GLOBAL HEALTH EMERGENCYThe COVID-19 pandemic exposed a harsh reality:despite years of emergency planning, pharmacysystems worldwide were unprepared.Governments had stockpiles, emergencyprotocols, and supply chain agreements onpaper, yet frontline pharmaceutical responsesfailed during real-time crises. This “preparednessparadox,” having plans without action, became adefining feature of the pandemic’s early months.The COVID-19 pandemic conveyed anexceptional global crisis, emphasizing the urgentneed for resilient healthcare systems andthorough pandemic preparedness measures. Inresponse to these emerging challenges, theconcept of healthcare 5.0 has gainedprominence, advocating for a technologicallyintegrated and adaptive health system that iseco-friendly (Wazid et al., 2022). This implies thatthe process involves the use of a new generationof information technologies like Big Data analytics(BDA), artificial intelligence (AI), cloud computing,blockchain, and Internet of Things (IoT).Healthcare 5.0 goes beyond basic technologicalupgrades, incorporating multiple integrated layersof innovation and service delivery (Wazid et al.,2021). The medical model has shifted fromdisease-centered care to a more patientcentered approach.The pandemic incident highlighted the criticalrole of the healthcare system's strength whenchallenged with large-scale public healthemergencies. According to the World HealthOrganization, resilience refers to “the ability of asystem, group, or person to absorb disturbance,reorganize while changing, and preserve the samefunction, structure, identity, and feedback”(Navarro, 2001). This capability is essential, as itguarantees uninterrupted access to criticalhealthcare services, especially during times ofcrisis (Kruk et al., 2015) This capability is essential,as it guarantees uninterrupted access to criticalhealthcare services, especially during times ofcrisis (Thomas et al., 2013).Sagir Mustapha , Kayatri Govindaraju , Hasniza Zaman Huri , Mustapha Mohammed , Muhammad Luqman Nordin , Asif Nawaz , AbubakarSadiq Wada , Lukman Mustapha , Khalid Garba Mohammed , Ibrahim Mu’azzamu Aliyu , Rabi’u Nuhu Danraka , Ahmad Khusairi Azemi , SitiSafiah Mokhtar , Junaid Olawale Quazim1 Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, 50603 Kuala Lumpur, Malaysia2 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, 50603 Kuala Lumpur, Malaysia3 Biomedical Research Center, QU Health, Qatar University, Doha, Qatar4 Department of Pharmaceutical Technology, Faculty of Pharmacy, Universiti Malaya, 50603 Kuala Lumpur, Malaysia5 Department of Pharmacology and Therapeutics, Bayero University, Kano, Nigeria. 6 Department of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmaceutical Science, Kaduna State University, Nigeria. 7 Infochemistry Scientific Center, ITMO University, Saint Petersburg, Russia. 8 Department of Pharmaceutical Science, Faculty of Pharmacy, Universitas Airlangga, Indonesia. 9 School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, United Kingdom10 Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria.11 Institute of Climate Adaptation and Marine Biotechnology, Universiti Malaysia Terengganu, Kuala Terengganu, 21030, Terengganu, Malaysia.12 Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia13 Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia*Corresponding authors: Sagir Mustapha [email protected] Mohammed [email protected] global response to COVID-19 was hampered bymany universal challenges. These includedinadequate emergency preparedness amonghealthcare workers and critical shortages ofessential supplies such as personal protectiveequipment (PPE), diagnostic kits, masks, ventilators,hospital beds, hand sanitizers, and approvedtherapeutic agents. At the onset, a specific vaccinefor COVID-19 was also unavailable. Theseweaknesses substantially impacted pharmacistsand pharmacy experts, who have always functionedon the frontlines of patient care (Cohen et al.,2020). Throughout the pandemic, pharmacyprofessionals proved outstanding adaptability anddedication. Both community and hospitalpharmacies remained operational, extendingservice hours to guarantee the supply of essentialmedicines, support to patients, and clinical teams.Furthermore, pharmaceutical scientists have beeninstrumental in advancing vaccine and treatmentresearch efforts. Pharmacists have also playedcrucial roles in public health preparedness.Numerous pharmacists serve in local or stateemergency agencies to contribute toward logistics,continuity-of-care initiatives, and medicationdistribution. Others volunteered in underservedareas, helping to maintain community access tohealthcare resources. Their responsivenessreinforced the indispensable role of pharmacyprofessionals in safeguarding public health duringlarge-scale emergencies (Aruru et al., 2021).It is evident that numerous national andinternational pharmacy organizations have madecommendable efforts to equip pharmacists withpandemic-specific guidance. Recognizing thecritical role of pharmacists during healthemergencies, the International PharmaceuticalFederation (FIP) issued comprehensive Guidelinesfor Pharmacists and the Pharmacy Workforce inresponse to COVID-19 (FIP, 2020). These guidelineshighlighted key pharmacist responsibilities,including the management of pharmaceuticalsupply chains, patient counseling, clinical triage,and active participation in public health initiativessuch as vaccination programs. Remarkably, suchpreparedness efforts were not novel. The CanadianPharmacists Association, for instance, released itsPharmacists' Guide to Pandemic Preparedness asearly as 2009, focusing on practical strategies forcommunity pharmacy. These included selfprotection protocols, supply chain managementduring surges in demand, and implementation ofinfection control measures within retail pharmacysettings (Pharmacists Association, 2009). RoyalPharmaceutical Society (UK) developed guidanceduring the COVID-19 crisis addressing the ethicaland professional challenges faced by pharmacists,particularly regarding service prioritization,resource rationing, and decision-making underpolicy ambiguity (RPS, 2020).Similarly, the American Society of HealthSystem Pharmacists (ASHP), in alliance with theAmerican Pharmacists Association (APhA) andthe National Association of Chain Drug Stores(NACDS), had earlier fashioned out apharmacist’s guide to pandemic preparednessin 2007. These frameworks are in opposite tothose of their British and Canadiancounterparts, highlighting pharmacy continuityand professional resilience (APhA, 2020).During the initial phase of the COVID-19outbreak, APhA played a vital role indisseminating daily updates to frontlinepharmacists, clarifying controversies such asthe use of hydroxychloroquine and publicmisinformation surrounding disinfectantingestion (APhA, 2020). However, despite morethan a decade of accumulated guidance andscenario planning, the speed and scale ofCOVID-19 challenged the practical utility ofthese documents. The unprecedented societallockdowns, healthcare disturbances, andmisinformation crises called into question thereal-world effectiveness of existingpreparedness protocols. Nonetheless, thepandemic offers an unparalleled opportunity tostudy, in real-time, how community pharmacieshave adapted to such extreme conditions,highlighting both their resilience and areas inneed of systemic reform.THE PANACEA / VOLUME 4 2025 / 30IntroductionPharmacists'contributionsto public healthPharmacists play an integral role in publichealth through activities such as point-of-caretesting, disaster response, disease selfmanagement training, health promotion,immunizations, patient and medicationcounseling, health education, and emergencypreparedness and response (EP&R). Bothinternational and national pharmacyorganizations have supported pharmacists'roles in public health, including EP&R initiatives.FIP has released a guidance document forpharmacy professionals in association withCOVID-19 for the pharmacy workforce (FIP,2020). It is imperative to say that the FIPguidance document is essential for use duringCOVID-19 for EP & R, supported by Cadogan &Hughes and Ung (Cadogan & Hughes, 2021; Ung,2020).1* 1 2* 3* 4 45* 6,7,8* 9 10 1112 1310Faculty of Pharmacy ResearchHighlights
Emergency Preparednessand Response (EP&R)inPublic HealthOver the past two decades, the reciprocal valuebetween pharmacy and public health has gainedsignificant recognition. Leading pharmacyorganizations in the U.S. have increasinglyacknowledged the critical role that public healthplays in shaping the profession. At the same time,key public health institutions have begun toformally recognize the contributions ofpharmacists to advancement in public health.Notably, the American Association of Colleges ofPharmacy (AACP) established its Public HealthSpecial Interest Group (SIG) in the mid-2000s tochampion the integration of public healthprinciples into pharmacy education, research,practice, and service, many of which haveincorporated emergency preparedness andresponse (EP&R) themes (Aruru et al., 2021).Recognizing the need for formal representationwithin the broader public health community,members of the AACP Public Health SIG initiatedefforts to gain recognition for pharmacy withinthe American Public Health Association (APHA), abody representing over 25,000 public healthprofessionals. Although the APHA hadacknowledged the role of pharmacists in a 2006policy statement (Strand, 2025), it had not yetestablished a dedicated forum or section forpharmacy professionals. In response to theabove, Dr. Stuart Feldman, a respected pioneer inpublic health pharmacy, mobilized a committedgroup of academic leaders to petition the APHAfor the formation of a special primary interestgroup (SPIG) for pharmacy. This effort culminatedin APHA’s approval of the Pharmacy SPIG inNovember 2014. Further, in 2016, revisions toAPHA’s policy were proposed to reflect theevolving and expanding responsibilities ofpharmacists in public health (Ann & Mager,2020). This momentum led to a significantmilestone in 2018, when the APHA officiallyelevated the Pharmacy SPIG to full Sectionstatus, marking the first creation of a new Sectionin the organization in several years. The APHAPharmacy members cut across different areas ofpharmacy, like public health professionals,researchers, academics, students, and otherswho have an interest in public health pharmacy(Aruru et al., 2021). In the United States, there areabout ten agencies that are responsible fordelivering ten essential services to protect thepublic, and pharmacists are involved in all ofthese agencies now (Strand, 2025). There areseveral key opportunities for pharmacists in thefuture, including:Building and sustaining a strong organizationalbase for public health.Innovating and improving public healthfunctions through continuous evaluation,quality improvement, and research.Supporting a diverse and skilled public healthworkforce.Creating, championing, and implementingpublic health policies, plans, and laws.Investigating, diagnosing, and addressinghealth problems and hazards affecting thepopulation.Emergency responses worldwide are oftenreactive rather than proactive, partly due tolimited funding allocated before, during, and aftercrises, as witnessed during the COVID-19pandemic. In the United States, funding andresources for public health emergencypreparedness and response (EP&R) increasedfollowing the September 11, 2001 attacks andHurricane Katrina in 2005. These events led to astrengthened EP&R infrastructure at local, state,national, and even global levels. The PharmacyEmergency Preparedness and Response (PEPR)Framework has broadened the defined roles andresponsibilities of pharmacy professionals inemergencies. It outlines the existing structures,processes, expected outcomes, andcontributions of pharmacy professionals duringemergencies.Considering the COVID-19 pandemic, ten majorpharmacy organizations collaboratively issued apolicy statement to clearly define thepharmacist's role in emergency response efforts.Their recommendations built upon existingframeworks, such as Medical Reserve Corps(MRCs), collaborations with state and local healthdepartments, and the emergency preparednessand response (EP&R) task forces of the Boards ofPharmacy ( AACP,2020). Among the keyproposals was the call to eliminate obstacles thatcould hinder the management of medicalproduct shortages, ensuring continuity of patientcare. Additionally, they advocated for reducingoperational barriers to support pharmacists inmanaging workforce and workflow challengesduring public health emergencies. The AACPadvocates for pharmacy professionals to engagein the following:1. Authorize Pharmacists to Test, Treat, andImmunize: Empower pharmacists to orderdiagnostic tests, collect and interpret specimens,and initiate treatment for infectious diseasessuch as COVID-19, influenza, and streptococcalinfections, while also counseling patients onavailable options. Expand pharmacists'immunization authority to include theadministration of all FDA-approved vaccines,including upcoming vaccines for COVID-19,across all eligible populations.2. Alleviate Operational Challenges Related toWorkforce and Workflow: Permit licensedpharmacists and pharmacy technicians topractice across state lines, including throughtelehealth platforms. Allow pharmacy staff toperform routine tasks remotely, such asprescription data entry and verification, even iflicensed in another state, to maintain workflowefficiency during emergencies.3. Address Product Shortages and EnsureContinuity of Care: Extend pharmacists’ authorityto engage in therapeutic interchange andsubstitution during drug shortages, withappropriate physician notification. The FDAshould actively identify medications at risk ofshortage, collaborate with manufacturers toextend expiration dates, and require moredetailed reporting on shortage causes anddurations, making such information publiclyaccessible.4. Expand Reimbursement and Eliminate AccessBarriers: Ensure that pharmacists are reimbursedfor services within their scope of practice ifsimilar services are covered when provided byother healthcare professionals. Eliminate the\"day's supply\" limitations on co-pay waivers forcritical, life-sustaining medications duringshortages or rationing. Remove restrictions onhome and mail delivery services, and guaranteeaccess to testing, treatment, and pharmacist-ledservices for underserved patients.THE PANACEA / VOLUME 4 2025 / 31Healthcare Delivery andCommunity HealthStrategiesPublic health funding is often reactive, causingpatient-centered care and population-basedinterventions to be overlooked until an epidemicor pandemic becomes imminent. This sectionoutlines the micro-level aspects of public health,focusing on individual patient care, as well as themacro-level aspects, encompassing populationwide initiatives and policy-driven public healthactions during emergencies (Aruru et al., 2021).The PEPR framework identifies processes andstructures linked to pharmacists’ expected rolesin improving patient care and community healthduring emergencies. These settings may includelong-term care facilities, community pharmacies,drug information centers, outpatient clinics, andhospitals. Pharmacists can support screeningand triage for essential medications and patientneeds, while telepharmacy and call centers canhelp implement modified care protocols. Theseefforts are supported by actions such asprocuring essential medications and supplies,assisting with ongoing screening, testing, andimmunization, and providing medication pick-upand delivery services. Another key priority isproviding high-quality patient education andensuring access to evidence-based healthinformation. It is also essential to countermisinformation during emergencies throughaccurate education and effective communicationstrategies (Carico et al., 2021). Community healthinvolvement is also identified in the structures,especially in the local and state departments.These interventions required the integration ofpharmacists in practice, to share information andresources such as updated software systems andintegrated workflows, and protocols (Aruru et al.,2021).Faculty of Pharmacy ResearchHighlights
ReferencesEducation plays a crucial role in supporting theintegration, recognition, and long-terminvolvement of pharmacy professionals inemergency preparedness and responseactivities. Pharmacy training pathways rangefrom traditional bachelor’s programs inPharmaceutical Sciences to modern PharmDcurricula, postgraduate residencies,interprofessional education (IPE), and continuingprofessional education (CPE). Public healtheducation for pharmacists should fullyincorporate emergency preparedness andresponse, with a focus on expanding IPEopportunities between pharmacies and publichealth professionals. However, public healthpreparedness continues to be an inconsistentpriority within the broader public health agenda(Aruru et al., 2021).A Pharmacist’s Guide to Pandemic Preparedness.Retrieved April 22, 2025, from www.ashp.Ann, N., & Mager, D. (2020). preconception andinterconception health and routine health serviceuse among women in a rural midwesterncommunity.APhA Issues Preparedness and PreventionGuidance During Coronavirus Pandemic. (n.d.).Retrieved April 22, 2025, fromhttps://www.prnewswire.com/newsreleases/apha-issues-preparedness-andprevention-guidance-during-coronaviruspandemic-301019134.htmlAruru, M., Truong, H. A., & Clark, S. (2021).Pharmacy Emergency Preparedness andResponse (PEPR): a proposed framework forexpanding pharmacy professionals’ roles andcontributions to emergency preparedness andresponse during the COVID-19 pandemic andbeyond. Research in Social and AdministrativePharmacy, 17(1), 1967–1977.https://doi.org/10.1016/J.SAPHARM.2020.04.002Cadogan, C. A., & Hughes, C. M. (2021). On thefrontline against COVID-19: Communitypharmacists’ contribution during a public healthcrisis. Research in Social and AdministrativePharmacy, 17(1), 2032–2035.https://doi.org/10.1016/J.SAPHARM.2020.03.015Carico, R. R., Sheppard, J., & Thomas, C. B. (2021).Community pharmacists and communication inthe time of COVID-19: Applying the health beliefmodel. Research in Social and AdministrativePharmacy, 17(1), 1984–1987.https://doi.org/10.1016/J.SAPHARM.2020.03.017Cohen, S. P., Baber, Z. B., Buvanendran, A., McLean,B. C., Chen, Y., Michael Hooten, W., Laker, S. R.,Wasan, A. D., Kennedy, D. J., Sandbrink, F., King, S.A., Fowler, I. M., Stojanovic, M. P., Hayek, S. M., &Phillips, C. R. (2020). Pain Management BestPractices from Multispecialty OrganizationsDuring the COVID-19 Pandemic and Public HealthCrises. Pain Medicine, 21(7), 1331–1346.https://doi.org/10.1093/PM/PNAA127Guidance on ethical, professional decisionmaking in the COVID-19 pandemic. (n.d.).Retrieved April 22, 2025, fromhttps://www.rpharms.com/aboutus/news/details/guidance-on-ethicalprofessional-decision-making-in-the-covid-19-pandemicInternational Pharmaceutical Federation (FIP)COVID-19 information hub - Good practice anduseful resources - Patient Safety Learning - thehub. (n.d.). Retrieved April 22, 2025, fromhttps://www.pslhub.org/learn/coronaviruscovid19/tips/international-pharmaceuticalfederation-fip-covid-19-information-hub-r2397/Kruk, M. E., Myers, M., Varpilah, S. T., & Dahn, B. T.(2015). What is a resilient health system? Lessonsfrom Ebola. The Lancet, 385(9980), 1910–1912.https://doi.org/10.1016/S0140-6736(15)60755-3Navarro, V. (2001). The New ConventionalWisdom: An Evaluation of the Who Report HealthSystems: Improving Performance. InternationalJournal of Health Services, 31(1), 23–33.https://doi.org/10.2190/3LM8-A37Q-FKJ4-TE0RPharmacist Advocacy Groups Call for New Actionto Enhance COVID-19 Patient Care | AACP. (n.d.).Retrieved April 27, 2025, fromhttps://www.aacp.org/article/pharmacistadvocacy-groups-call-new-action-enhancecovid-19-patient-carePharmacists Association, C. (2009). PandemicInfluenza: A pharmacist’s guide to pandemicpreparedness. www.pharmacists.ca/pandemicPress releases - FIP - InternationalPharmaceutical Federation Press releases. (n.d.).Retrieved April 22, 2025, fromhttps://www.fip.org/press-releases?press=item&press-item=64Strand, M. A. (2025). The role of pharmacy inpromoting public health: Pharmacy and publichealth in 2050. Journal of the AmericanPharmacists Association, 65(1), 102272.https://doi.org/10.1016/J.JAPH.2024.102272Thomas, S., Keegan, C., Barry, S., Layte, R., Jowett,M., & Normand, C. (2013). A framework forassessing health system resilience in aneconomic crisis: Ireland as a test case. BMCHealth Services Research, 13(1), 1–8.https://doi.org/10.1186/1472-6963-13-450/FIGURES/1Ung, C. O. L. (2020). Community pharmacist inpublic health emergencies: Quick to actionagainst the coronavirus 2019-nCoV outbreak.Research in Social and Administrative Pharmacy,16(4), 583–586.https://doi.org/10.1016/J.SAPHARM.2020.02.003Wazid, M., Bera, B., Das, A. K., & Singh, D. P. (2021).IoT and blockchain technology-based healthcaremonitoring. Blockchain in Digital Healthcare, 69–91. https://doi.org/10.1201/9781003133179-7/iotblockchain-technology-based-healthcaremonitoring-mohammad-wazid-basudeb-beraashok-kumar-das-devesh-pratap-singhWazid, M., Das, A. K., Mohd, N., & Park, Y. (2022).Healthcare 5.0 Security Framework: Applications,Issues and Future Research Directions. IEEEAccess, 10, 129429–129442.https://doi.org/10.1109/ACCESS.2022.3228505THE PANACEA / VOLUME 4 2025 / 32Public Health Training forPharmacists and ContinuingEducationConclusionImproving global public health requires thecommitment of all healthcare providers to ensuresafe and healthy communities for all populations.During the COVID-19 pandemic, pharmacyprofessionals responded promptly by deliveringessential services and collaborating withhealthcare teams worldwide. A public healthperspective on pharmacy practice emphasizesdisease prevention and universal service delivery,rather than focusing solely on individualized carefor those with access. Evidence across diversesettings shows that prioritizing population healthneeds leads to improved overall healthoutcomes. This expanded approach may alsoopen new employment opportunities, diversifyrevenue sources, and improve job satisfaction forpharmacists. Building on decades of progress inpharmacy, pharmacists are well-positioned toaddress future public health challenges andcontribute meaningfully to population health,particularly in preparation for future pandemics.Enhancing their role in public health will furthersolidify pharmacists as essential public healthprofessionals and improve health outcomesnationwide.Faculty of Pharmacy ResearchHighlights
CURCUHEAL: SCIENCE, INNOVATIONAND A SHOT ATTHE BIG STAGECurcuHeal, our innovative wound-healingcurcumin-based hydrogel, was brought to life bya passionate team from the Faculty of Pharmacy,University of Malaya, comprising of Dr. WanSafwani Wan Kamarul Zaman (Project Head), Dr.Zarif Bin Mohamad Sofian (Co-Project Head), andSushmitha Rajeev Kumar (Postgraduate Student).When we submitted CurcuHeal to INNOVATHONSeason 3, a national innovation competitionorganised by the Ministry of Science, Technology,and Innovation (MOSTI), the Ministry of Economyand Astro, we knew it was the perfect platform toshare our vision of merging tissue engineering,sustainability, and accessibility in wound care,specifically for chronic wounds. The competitionattracted brilliant minds from across Malaysia,each presenting groundbreaking solutions toreal-world challenges.We were thrilled to successfully pass all threeaudition rounds that were held at the Universityof Malaya for the Wilayah Persekutuan KualaLumpur category. We are now eagerly awaitingthe call that will determine if CurcuHeal makes itto the Top 56 innovations to be featured on thenationally televised reality series and theopportunity to win RM 1 million in terms of a grantfor further research.A defining moment in our INNOVATHON auditionjourney was the privilege of being auditioned byYB Tuan Chang Lih Kang, Minister of Science,Technology & Innovation (MOSTI). We wereextremely proud that our product wasshowcased up close to the Minister and werethrilled to share our innovation with him. Thismoment validated the hard work and passioninvested in our research. We were also fortunateto have the fabrication process of CurcuHealfilmed in our laboratory at the Faculty ofPharmacy by ASTRO, which will bring nationalexposure to the science and effort behind ourwork and the value of research done in theUniversity of Malaya.We are deeply grateful to the organiser, theUniversity of Malaya Centre of Innovation &Enterprise (UMCIE), and the Faculty of Pharmacyfor giving us the opportunity and drive to shareour innovation through this reality show. Thisexperience has already been an unforgettablechapter in our research journey. Regardless of theoutcome, this journey has been both inspiringand humbling, strengthening our commitment todelivering impactful solutions for society.THE PANACEA / VOLUME 4 2025 / 33IntroductionSushmitha Rajeev Kumar, Wan Safwani Wan Kamarul ZamanDepartment of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, 50603, Kuala Lumpur,MalaysiaCorresponding author: Associate Professor Dr Wan Safwani Wan Kamarul Zaman [email protected] of Pharmacy ResearchHighlights
DOUBLETROUBLE:THE RISING TREND OF DUAL CIGARETTEAND E-CIGARETTE USEThe trend-setting growth in traditional cigarettesalongside electronic cigarettes carries importantconsequences for public health, pharmacypractice, and smoking-cessation efforts. Thisreview explores emerging trends in dual use,particularly among younger populations, andevaluates the compounded risks, includingheightened nicotine dependence and aggravatedrespiratory and cardiovascular diseases.Evidence indicates that dual users often perceivee-cigarettes as a safer alternative, resulting inreduced motivation to quit smoking altogether.Beyond public health implications, dual usepresents clinical and pharmacy-relatedchallenges. Pharmacists, as accessible healthcareproviders, play a critical role in identifying highrisk individuals, providing evidence-basedcessation counseling, and managing nicotinereplacement therapies (NRTs) or pharmacologicalinterventions such as varenicline and bupropion.Additionally, pharmacists can help preventinappropriate or overlapping use of cessationaids, reduce adverse drug interactions, and lowerhealthcare costs through optimised interventions.This review also highlights socioeconomic andbehavioural factors that influence dual use,underscoring the need for integrated cessationprograms that combine public health policy withclinical and pharmacy practice perspectives. Byincorporating pharmacists into multidisciplinarytobacco control strategies, healthcare systemscan more effectively address the dual usephenomenon and mitigate its individual, clinical,and societal impacts.THE PANACEA / VOLUME 4 2025 / 34AbstractIntroductionSmoking is a leading preventable cause of deathglobally, responsible for over 8 million deathsannually, including 1.3 million from second-handsmoke exposure (CHEN et al., 2020). In Malaysia,smoking claims 27,000 lives each year, with analarming 12.7% of smokers starting between 15and 24 years old, increasing the future burden ofdisease (Qi, 2024). Despite its health andfinancial impacts, averaging RM177.70 spentmonthly on cigarettes, many smokers remainuninterested in quitting (Seraj, 2024).E-cigarettes (commonly known as vapes),frequently promoted as'harm reduction'alternatives, have surged in popularity,particularly among Malaysian youth, with 8.6% ofthose aged 15–24 now using these devices (Seraj,2024). Despite their perceived safety, growingevidence ties e-cigarette use to significant healthrisks, including cardiovascular impairment andpulmonary damage (Chulasai et al., 2021). TheMalaysian market for these products hasexpanded rapidly, growing 53% from RM2.27billion in 2019 to RM3.48 billion in 2023 (MVCC,2023). This boom has driven an alarming trend:69% of Malaysian smokers now engage in dualuse (simultaneous traditional cigarette and ecigarette consumption), which intensifies nicotinedependence, undermines quit attempts, andjeopardizes tobacco control achievements. Thisstudy investigates the drivers of dual use,including social, behavioural, and commercialfactors, evaluates its compounded healthimpacts, and identifies evidence-basedcessation strategies. In addition, we explore theclinical and pharmacy practice implications ofdual use, particularly its influence on medicationsafety, nicotine dependence management, andthe role of pharmacists in cessation interventions.By elucidating these dynamics, we aim to equippolicymakers, healthcare providers, andpharmacists with actionable insights tostrengthen tobacco control measures andsafeguard public health.MethodologyIn recent years, there has been a growing trendof individuals using both e-cigarettes andtraditional cigarettes, known as dual use. Thisapproach has given rise to considerablediscussion and investigation into its potentialconsequences and public health implications. It isimportant to examine this trend's historicalbackground, significant personalities, influence,diverse viewpoints, and possible futuredevelopments to fully comprehend it.The historical context of the dual use of ecigarettes and cigarettes can be traced back tothe introduction of e-cigarettes in the early2000s as a potential harm reduction tool forsmokers. According to Czoli et al. (2019),\"dualuse\" is the simultaneous use of e-cigarettes(vaping) and tobacco cigarettes (smoking).Electronic cigarettes (e-cigarettes) are devicesdesigned to produce a nicotine-containingaerosol, often referred to as vapor, by heating aliquid solution typically composed of propyleneglycol or glycerol (glycerin), nicotine, and flavoringagents. The modern version of e-cigarettes wasdeveloped in the early 2000s by Chinesepharmacist Hon Lik (Grana et al., 1972). Thesimultaneous use of e-cigarettes and traditionaltobacco cigarettes, referred to as\"dual use,\"represents the most prevalent pattern of ecigarette consumption (Czoli et al., 2019).According to research, dual use (use of an ecigarette alongside smoking) may result in anongoing problem for some people when they quitsmoking entirely (Jackson et al., 2024). Dual usersoften perceive e-cigarettes as safer and usethem for smoking reduction or cessationattempts (Maglia et al., 2018). E-cigarettes weremarketed as a safer alternative to traditionalcigarettes, containing fewer harmful chemicalsand carcinogens. However, as their popularitygrew, some individuals began using both ecigarettes and traditional cigarettes concurrently,leading to concerns about the impact on health.According to studies, dual usage is prevalentamong younger people, those attempting toreduce their smoking, and those experimentingwith harm reduction techniques. Studies haveshown that a substantial portion of e-cigaretteusers are also regular smokers.By following the protocols outlined for literaturereview methodologies by Palmatier et al. (2017), acomprehensive literature search was conductedfrom November 2024 to December 2024 usingmultiple online resources, including NIH, GoogleScholar, and other scientific electronic libraries.This independent search spanned variousdatabases, encompassing original peer-reviewedjournal articles, patents, books, dissertations, andreports focusing on tobacco use and itsassociated health effects. Specifically, studiespublished between 2011 and 2024 wereconsidered, provided they contained relevantinformation on the dual-use trend of traditionalcigarettes and e-cigarettes. To enhance searchaccuracy, broad terms such as “tobacco control,”“respiratory,” “nicotine,” “smoking,” “vaping,”“traditional cigarettes,” “E-cigarettes,” “dual-usetrend,” “health impact,” and “smoking cessation”were utilized. Relevant search results meeting thepredefined criteria were gathered fromdatabases such as ScienceDirect, OxfordAcademic, and Google Scholar.Results & DiscussionA) Trend of Dual Cigaretteand E-Cigarette UseJia Rong Tee , Nur Syafiza Rakhidin , Muhammad Fitri Azizan , Akif Moula , Ren Xin Esther Yong , Nur Alani Binti Zainal , Kuhaneetha BaiKalaicelvan and Maw Shin SimFaculty of Built Environment, Universiti Malaya, MalaysiaFaculty of Medicine, Universiti Malaya, MalaysiaFaculty of Built Environment, Universiti Malaya, MalaysiaFaculty of Arts and Social Sciences, Universiti Malaya, MalaysiaFaculty of Pharmacy, Universiti Malaya, Malaysia* Corresponding author: Maw Shin Sim ([email protected])1 2 34 5*2 3 312345*Faculty of Pharmacy ResearchHighlights
For example, a survey conducted by the USTobacco Use Supplement to the CurrentPopulation between 2018 and 2019 revealed that39% of current e-cigarette users were also dualusers (Coleman et al., 2022). Demographic trendsplay a significant role in the prevalence of dualuse. For instance, a study by the National Centrefor Health Statistics (NCHS) shows that youngeradults, especially those in the 18-24 age group,are more likely to engage in dual use comparedto older individuals (Kramarow and NazikElgaddal, 2021). Socioeconomic status andpersonal smoking history also contribute to dualuse patterns. For instance, individuals from lowersocioeconomic backgrounds may be moreinclined to dual use due to limited access toresources and support for quitting smoking(Jackson et al., 2024). Additionally, those with alonger history of smoking may be more likely tocontinue using both traditional cigarettes and ecigarettes.A distinction could also be seen between heavydual users and predominant vapers in thisparticular regard, as research has shown thatheavy dual users witnessed a significant drop incigarette dependence and consumption (Buu etal., 2023), further solidifying the notion that dualusers engage in both vaping and conventionalsmoking to quit or reduce combustible cigaretteusage. Research conducted among Korean menalso showcased a higher number of quit attemptsand quit intentions amongst dual users incomparison with cigarette-only smokers (Kim etal., 2020).Another common cause of dual use in thedifferent articles reviewed is the appeals of eachtype of cigarette. While there is some mention ofthe combustible cigarette, articles mostly reflecton the appeal of e-cigarettes. Chulasai et al.(2021) and Puteh et al. (2018) reported that thevariety of flavours available for vapers is asignificant pull factor for dual users, encouragingsmokers to transition towards e-cigarette usagecompared to combustible cigarettes. Besides theappeal of differing flavours, the same study notedthat other features of the vapes, such as theabsence of cigarette smoke odour, and thegreater affordability of the products, significantlycontribute to dual use, with more than 70% ofundergraduate smokers claiming that thesefactors encourage them to use e-cigarettes.Interestingly, all papers discussing this particularfactor reported a consistent demographic: youngdual users, who are primarily adolescents,students, and young adults (Kim et al., 2020;Coleman et al., 2022; Chulasai et al., 2021; Lim etal., 2022).While not as widely documented and discussed,Coleman et al. (2022) reflect that the e-cigaretteusers continue using combustible cigarettes dueto the authenticity of this tobacco product, orrather a lack of authenticity that theyexperienced when solely using e-cigarettes tosatisfy their cravings. Hence, this is why there is acontinued use of combustible cigarettes evenwhen e-cigarettes are used by individuals tosubstitute or help smokers quit and cut downtheir smoking frequency.THE PANACEA / VOLUME 4 2025 / 35B) Cause of Dual Cigaretteand E-Cigarette UseWhile it may be difficult to pinpoint any singledefining cause for dual usage of e-cigarettes andcombustible cigarettes amongst the generalpopulation, there are several overlapping factorsthat have been reported by different articlesstudying the drivers of dual smoking, which willbe explored further in this section. While themain products of the studies do focus oncombustible cigarettes and e-cigarettes in theform of vape, it must also be noted that somestudies also factor in other tobacco productssuch as shisha (Lim et al., 2022), which provides amore nuanced argumentation of the causes ofdual usage amongst different population groups.B) Cause of Dual Cigaretteand E-Cigarette UseOne of the recurring and prominent causes ofdual usage reported from smokers is theutilization of e-cigarettes as a means to quit orcut down on smoking combustible cigarettes.Coleman et al. (2022) and Puteh et al. (2018)reported that more than half of dual users use ecigarettes for this particular purpose. Theyreported that the utilisation of e-cigarettes aidssmokers in coping with nicotine cravings andwithdrawal symptoms that become prominentwhen dual users attempt to quit smokingcombustible cigarettes. This trend, however, ismore pronounced in older dual users (aged 40years old and above) as compared to a youngerdemographic (18 years old - 24 years old)(Coleman et al., 2022), and this is furthervalidated when a report on factors of dualsmoking amongst northern Thai undergraduatestudents identified that 93.9% of dual users hadno attempts to quit smoking cigarettes, and95.8% of this demographic also had no intentionto quit (Chulasai et al., 2021).Harm reduction perceptionamongst dual usersMany studies also indicate that dual users havespecific beliefs about e-cigarettes andcombustible cigarettes that cause them toengage in the utilisation of both types of tobaccoproducts. According to Coleman et al. (2022), themedia has influenced the perception of relativeharm amongst the smoker population, withcoverage of tobacco products often portrayinge-cigarettes as less harmful in relation to usingcombustible cigarettes. However, in the samestudy, this perception has become lessreinforced over the years, as comparative studiesof surveyed data in the US have witnessed a dropof more than 20%, in which adults have found ecigarettes less harmful than cigarettes. Despitethis, low perceptions of the adverse healtheffects of vaping are still one of the prevailingcauses of dual use (Chulasai et al., 2021; Lim et al.,2022).The study conducted by Lim et al. (2022)presents a particularly interesting theory that isrelated to this cause - the Cognitive Dissonancetheory - which contributes to the tendency ofdual grew, some individuals began using both ecigarettes and traditional cigarettes concurrently,leading to concerns about the impact on health.According to studies, dual usage is prevalentamong younger people, those attempting toreduce their smoking, and those experimentingwith harm reduction techniques. Studies haveshown that a substantial portion of e-cigaretteusers are also regular smokers. For example, asurvey conducted by the US Tobacco UseSupplement to the Current Population between2018 and 2019 revealed that 39% of current ecigarette users were also dual users (Coleman etal., 2022). Demographic trends play a significantrole in the prevalence of dual use. For instance, astudy by the National Centre for Health Statistics(NCHS) shows that younger adults, especiallythose in the 18-24 age group, are more likely toengage in dual use compared to older individuals(Kramarow and Nazik Elgaddal, 2021).Socioeconomic status and personal smokinghistory also contribute to dual use patterns. Forinstance, individuals from lower socioeconomicbackgrounds may be more inclined to dual usedue to limited access to resources and supportfor quitting smoking (Jackson et al., 2024).Additionally, those with a longer history ofsmoking may be more likely to continue usingboth traditional cigarettes and e-cigarettes.Appeal of each type ofcigaretteOtherfactorsWhile not as commonly reported and studied,there are several other causes of dual useamongst smokers. One of the stated reasons isenjoyment. This particular factor depends on thedemographics and habits of the dual user, inwhich younger dual smokers and non-daily dualsmokers use cigarettes and e-cigarettes forenjoyment. (Coleman et al., 2022; Chulasai et al.,2021). Other internal factors also include selfcuriosity, predominantly claimed by youngersmokers (Chulasai et al., 2021). External pressuresthat drive dual use include the evasion of smokefree policies, in which environments thatdiscourage the use of combustible cigarettescause cigarette users to switch to e-cigarettes inthese environments (Coleman et al., 2022).In summary, while there are a variety of causesthat drive the trend of dual use of cigarettes ande-cigarettes among smokers, there are threecommon factors namely the intention andattempts of smokers to quit or cut downcombustible cigarette usage, their personalperceptions of the harms and effects of smoking,and the appeal of each type of cigarette.However, it is worth noting that there are otherunderlying causes, and the findings from thereviews identify these causes in relation to thedemographics of dual smokers.Faculty of Pharmacy ResearchHighlights
Dual use of cigarettes and e-cigarettes isincreasingly linked to serious health problems,especially affecting the respiratory andcardiovascular systems. Dual users face highercardiopulmonary risks compared to those whouse only one product. Studies by Wang et al.(2018) show dual users have higher rates ofbreathing difficulties, asthma, and COPD.Vardavas et al. (2011) found that even short-terme-cigarette use leads to acute pulmonary effectssuch as increased airway resistance andoxidative stress. Furthermore, Kim et al. (2020)identified a higher prevalence of metabolicsyndrome in dual users, including elevatedtriglycerides and reduced HDL cholesterol,contributing to greater cardiovascular risks. Ecigarette aerosols contain over 80 harmfulcompounds, such as formaldehyde,acetaldehyde, and acrolein, as well as metalnanoparticles like nickel and chromium. Theseirritate the airways, cause oxidative stress, andpromote inflammation, which can impair lungfunction (Thirión-Romero et al., 2019). Thus, dualuse exacerbates physical health problems,underlining the need for targeted healthinterventions.Pharmacists are well-positioned to addressthese misconceptions, provide evidence-basedcounseling on the additive risks of dual use, andguide patients through structured cessationprograms. By actively engaging in theseinterventions, pharmacists can help reduce thehealth burden of dual use while improving overallmedication safety and therapeutic outcomes.THE PANACEA / VOLUME 4 2025 / 36B)Impact of Dual Use onNicotine Dependence andSmoking CessationDual use of e-cigarettes and traditionalcigarettes substantially exacerbates nicotinedependence through compounded exposure.Kim et al. (2020) demonstrated that dual usersexhibit 27% higher urinary cotinine levels thanexclusive smokers, a biomarker confirminggreater systemic nicotine absorption. This effectis further amplified by younger age, prolongedsmoking history, and frequent vaping (Martínez etal., 2019), with dual use driving a 53% surge intotal nicotine consumption compared tocigarette-only use. Paradoxically, while dual usersattempt smoking cessation more frequently thantraditional smokers (Kim et al., 2020), theirsuccess rates remain markedly lower, as manyrelapse into exclusive smoking or persistent dualuse (Piper et al., 2019). Emerging evidence hintsat a potential cessation benefit, some studiesreport that sustained e-cigarette adoption mayeventually facilitate smoking abstinence (Zhuanget al., 2016; Etter & Bullen, 2013). Nevertheless,the predominant reality is clear: dual useentrenches nicotine addiction and erectsformidable barriers to long-term quittingsuccess.Smoking cessation is essential to safeguard thehealth of users and to protect the well-being ofthose around them exposed to secondhand orthirdhand smoke. While the users know thehealth risks that they may be facing in the longterm, many dual users struggle to quit smokingand vaping due to a lack of adequate supportand structured cessation plans. Addressing thisissue requires a comprehensive approach thatcombines behavioural intervention,pharmacological tools and personalized plans tohelp dual users achieve their goals of becomingtobacco- and nicotine-free.The first step involves assessing the user’sbehaviour, including their frequency of use,nicotine dependency levels and cause of dualuse, such as harm reduction tools or socialfactors. This assessment helps determine theirreadiness to quit and informs the development oftailored strategies to support their efforts. A cleargoal should be established, with the primaryobjective being the complete cessation of bothsmoking and vaping. Depending on the individual'readiness, this might involve graduallydecreasing cigarette use while reducingdependency on e-cigarettes or setting a quitdate for one or both products.One way of achieving a successful cessation ofdual cigarette and e-cigarette use is througheffective behavioural intervention (Le et al.,2023). Counseling, whether through quitlines,support groups, or individual therapy, helps usersnavigate the challenges of quitting. Tailoredbehavioural therapy can address triggers andequip users with coping mechanisms, while socialsupport from family and friends providesencouragement and accountability. This therapyshould offer guidance on treating withdrawalsymptoms through techniques such as deepbreathing for physical relaxation, mood, and aphysical activity to distract users from reachingfor cigarettes or e-cigarettes. Pharmacologicaltools are also effective for managing high nicotinedependency and withdrawal symptoms. Nicotinereplacement therapy (NRT), including nicotinepatches, gums, and lozenges, helps alleviatecravings in dual users. At the same time,medications like varenicline (Chantix) andbupropion (Zyban) are effective in reducingnicotine dependency and managing withdrawalsymptoms. Some studies show that combiningnicotine replacement therapy (NRT) andbehavioural support helps users stay quit andencourages additional quit attempts (Stead et al.,2016).Impact of Dual Cigarette andE-Cigarette UseA)Health Impacts of DualCigarette and E-cigaretteUseC)Environmental andSocietal Impacts of DualCigarette and E-cigaretteUseDual use also negatively impacts the environmentand society. Cigarette butts, the most prevalentform of litter globally, are non-biodegradable andrelease harmful substances such as nicotine,arsenic, and heavy metals into the environment(Novotny et al., 2015). E-cigarette waste, includingelectronic and plastic components, also posesenvironmental risks by releasing harmfulsubstances like heavy metals (Ngambo et al.,2023). In addition, emissions from bothcigarettes and e-cigarettes contribute to airpollution, containing harmful aldehydes, volatileorganic compounds (VOCs), and particulatematter.On a societal level, dual use exposes nonsmokers to secondhand smoke and e-cigaretteaerosols, leading to health risks such asrespiratory problems and cardiovasculardiseases. Thirdhand smoke, residues from smokeand aerosols on surfaces, presents long-termrisks to children and pets (NIDA, 2021).Furthermore, normalising smoking and vapingbehaviours reduces public awareness of theirrisks, increasing nicotine addiction rates amongyouth. This trend challenges public health effortsto reduce tobacco use, especially in at-riskpopulations.D)Pharmacy PracticeImplicationsFrom a pharmacy practice perspective, dual useof cigarettes and e-cigarettes presentssignificant challenges for patient care. Cigarettesmoke is a potent inducer of the hepatic enzymeCYP1A2, primarily due to the polycyclic aromatichydrocarbons (PAHs) produced during tobaccocombustion, which accelerate the metabolism ofcertain medications such as clozapine,theophylline, olanzapine, and warfarin (Zevin &Benowitz, 1999; Faber & Fuhr, 2004). When adual user reduces or stops cigarette smokingbut continues vaping, which does not induceCYP1A2, drug metabolism slows, potentiallyleading to elevated plasma drug concentrationsand toxicity (Polosa et al., 2019). Therefore,Pharmacists need to routinely assess patients’smoking status and adjust medication dosagesaccordingly.In addition, dual users often exhibit higher levelsof nicotine dependence compared to singleproduct users, which can complicate cessationefforts (Saddleson et al., 2016). Pharmacists canplay a pivotal role in developing personalized quitplans, optimizing nicotine replacement therapy(NRT) dosages, and considering pharmacologicaloptions such as varenicline or bupropion, whileclosely monitoring for side effects (Fiore et al.,2008). Patient education is equally critical, asmany dual users mistakenly believe thatalternating between cigarettes and e-cigarettesreduces harm, despite evidence suggesting thatdual use may sustain nicotine addiction andprolong smoking-related health risks (Glasser etal., 2017).Recommendation of SmokingCessation StrategiesFaculty of Pharmacy ResearchHighlights
Long-term smoking and vaping cessation can beeffectively supported through sustainedengagement with counseling services, evidencebased digital tools, and tailored relapseprevention strategies (Nguyen et al., 2024).Mobile health applications, particularly thoseincorporating milestone tracking and rewardsystems, have demonstrated significant potentialto enhance user motivation and commitment toquitting. Given the near-universal ownership ofsmartphones across age groups, from teenagersto older adults, these digital platforms offer aunique opportunity to deliver scalable healtheducation and real-time support. By leveragingsocial media integration and push notifications,such apps can raise awareness about the oftenoverlooked dangers of both combustiblecigarettes and e-cigarettes, including theirshared harmful constituents (e.g., nicotine, heavymetals, and volatile organic compounds). Thisdual approach, combining interactive selfmonitoring with public health messaging, mayprove critical in addressing the growing challengeof dual use and nicotine dependence.Grana, R., Benowitz, N., & Glantz, S. A. (2014). Ecigarettes: a scientific review. Circulation, 129(19),1972–1986.https://doi.org/10.1161/CIRCULATIONAHA.114.007667Health Problems Caused by Secondhand Smoke.(2024). Smoking and Tobacco Use.https://www.cdc.gov/tobacco/secondhandsmoke/health.htmlJackson, S. E., Cox, S., Shahab, L., & Brown, J.(2025). Trends and patterns of dual use ofcombustible tobacco and e-cigarettes amongadults in England: A population study, 2016-2024.Addiction (Abingdon, England), 120(4), 608–619.https://doi.org/10.1111/add.16734Kim, CY., Paek, YJ., Seo, H.G. et al. (2020). Dual useof electronic and conventional cigarettes isassociated with higher cardiovascular risk factorsin Korean men. Sci Rep 10, 5612https://doi.org/10.1038/s41598-020-62545-3Kramarow, E. A., & Elgaddal, N. (2023). CurrentElectronic Cigarette Use Among Adults Aged 18and Over: United States, 2021. NCHS data brief,(475), 1–8.Le, D., Ciceron, A. C., Romm, K. F., Clausen, M. E.,Abroms, L. C., Evans, W. D., Graham, A. L., & Berg,C. J. (2023). E-cigarette cessation interest andquit attempts among young adults reportingexclusive e-cigarette use or dual use with othertobacco products: How can we reach them?.Tobacco prevention & cessation, 9, 33.https://doi.org/10.18332/tpc/172416Lim, K. H., Cheong, Y. L., Lim, H. L., Ghazali, S. M.,Kee, C. C., Cheah, Y. K., Heng, P. P., Hashim, M. H. M.,Tan, C. V., & Lim, J. H. (2022). Correlates ofdual/poly tobacco use among school-goingadolescents in Malaysia: Findings from anationwide school-based study. TobaccoInduced Diseases, 20(June), 1–10.https://doi.org/10.18332/tid/148247Maglia, M., Caponnetto, P., Di Piazza, J., La Torre, D.,& Polosa, R. (2017). Dual use of electroniccigarettes and classic cigarettes: a systematicreview. Addiction Research & Theory, 26(4), 330–338.https://doi.org/10.1080/16066359.2017.1388372Martínez, Ú., Martínez-Loredo, V., Simmons, V. N.,Meltzer, L. R., Drobes, D. J., Brandon, K. O., Palmer,A. M., Eissenberg, T., Bullen, C. R., Harrell, P. T., &Brandon, T. H. (2019). How Does Smoking andNicotine Dependence Change After Onset ofVaping? A Retrospective Analysis of Dual Users.Nicotine & Tobacco Research, 22(5), 764–770.https://doi.org/10.1093/ntr/ntz043Ngambo, G., Hanna, E. G., Gannon, J., Marcus, H.,Lomazzi, M., & Azari, R. (2023). A scoping reviewon e-cigarette environmental impacts. TobaccoPrevention & Cessation, 9(October), 1–8.https://doi.org/10.18332/tpc/172079Nguyen, N., Koester, K. A., Tran, C., & Ling, P. M.(2024). Desires and Needs for Quitting Both eCigarettes and Cigarettes Among Young Adults:Formative Qualitative Study Informing theDevelopment of a Smartphone Intervention forDual Tobacco Cessation. JMIR FormativeResearch, 8, e63156. https://doi.org/10.2196/63156THE PANACEA / VOLUME 4 2025 / 37ConclusionThe escalating prevalence of dual cigarette ande-cigarette use represents a pressing publichealth crisis, with disproportionate impacts onyouth and vulnerable populations. Byperpetuating nicotine addiction through multipledelivery mechanisms, dual use creates a uniquebarrier to cessation. It synergistically exacerbateshealth risks, doubling the burden ofcardiovascular disease, respiratory impairment,and other smoking-related pathologies.Compounding this issue, pervasivemisperceptions of e-cigarettes as'safer'alternatives undermine quit attempts, despiterobust evidence of their harmful chemicalconstituents and health consequences.Socioeconomic disparities further entrench thischallenge: marginalised communities facesystemic barriers to cessation resources, whiletargeted marketing of flavoured productscapitalizes on youth susceptibility. To reverse thistrajectory, a coordinated, evidence-basedresponse must integrate: (1) tailored cessationprogrammes addressing dual users'specificneeds. (2) Public education campaignsdismantling myths about e-cigarette safety. (3)Policy reforms restricting flavoured products andpromoting equitable access to treatment. (4) Theintegration of pharmacy practice into cessationstrategies. As highly accessible healthcareproviders, pharmacists can identify dual users,deliver personalised cessation counselling,optimise pharmacotherapy (e.g., nicotinereplacement therapy, varenicline, bupropion),monitor for inappropriate or overlapping use ofcessation aids, and reduce relapse risk throughongoing support.Ultimately, mitigating the dual-use epidemicdemands collaboration across sectors,healthcare providers, pharmacists, policymakers,educators, and community leaders to implementproactive, multilevel interventions. Without urgentaction, we risk normalizing a new era of polytobacco addiction that threatens to erodedecades of progress in tobacco control andcompromise the health of future generations.AcknowledgementsThe work was supported by theFRGS/1/2020/SKK05/UM/02/1.ReferencesConflict of InterestThe authors declare that they have no knowncompeting financial interests or personalrelationships that could have appeared toinfluence the work reported in this paper.Buu, A., Tong, Z., Cai, Z., Li, R., Yang, J. J., Jorenby, D.E., & Piper, M. E. (2022). Subtypes of dual users ofcombustible and electronic cigarettes:longitudinal changes in product use anddependence symptomatology. Nicotine &Tobacco Research, 25(3), 438–443.https://doi.org/10.1093/ntr/ntac151CHEN Zi-yue, TAN Yin-liang, SHI Fang-hui, ZHUJing-fen, & HE Ya-ping. (2020). Prevalence andinfluencing factors of e-cigarette and cigaretteuse among college students in Shanghai. Journalof Environmental and Occupational Medicine,37(8), 777–781.https://doi.org/10.13213/j.cnki.jeom.2020.20034Chulasai, P., Vientong, P., Chinwong, S., Hall, J. J., &Chinwong, D. (2021). Factors Associated with theDual Use of Electronic Cigarettes and Cigarettesamong Thai Undergraduate Students WhoSmoked Cigarettes. Children, 8(12), 1197.https://doi.org/10.3390/children8121197Coleman, S. R. M., Piper, M. E., Byron, M. J., & Bold,K. W. (2022). Dual Use of Combustible Cigarettesand E-cigarettes: a Narrative Review of CurrentEvidence. Current addiction reports, 9(4), 353–362. https://doi.org/10.1007/s40429-022-00448-1Czoli, C. D., Fong, G. T., Goniewicz, M. L., &Hammond, D. (2019). Biomarkers of ExposureAmong\"Dual Users\"of Tobacco Cigarettes andElectronic Cigarettes in Canada. Nicotine &tobacco research : official journal of the Societyfor Research on Nicotine and Tobacco, 21(9),1259–1266. https://doi.org/10.1093/ntr/nty174Etter, J., & Bullen, C. (2013). A longitudinal study ofelectronic cigarette users. Addictive Behaviors,39(2), 491–494.https://doi.org/10.1016/j.addbeh.2013.10.028Faber, M. S., & Fuhr, U. (2004). Time response ofcytochrome P450 1A2 activity on cessation ofheavy smoking. Clinical pharmacology andtherapeutics, 76(2), 178–184.https://doi.org/10.1016/j.clpt.2004.04.003Fiore, M., Jaén, C., Baker, T., Bailey, W., Benowitz, N.,& Curry, S. (2008). Treating tobacco use anddependence: 2008 update U.S. Public HealthService Clinical Practice Guidelineexecutive summary. PubMed, 53(9), 1217–1222.https://pubmed.ncbi.nlm.nih.gov/18807274Glasser, A. M., Collins, L., Pearson, J. L., Abudayyeh,H., Niaura, R. S., Abrams, D. B., & Villanti, A. C.(2017). Overview of Electronic Nicotine DeliverySystems: A Systematic Review. American journalof preventive medicine, 52(2), e33–e66.https://doi.org/10.1016/j.amepre.2016.10.036Faculty of Pharmacy ResearchHighlights
Novotny, T. E., Bialous, S. A., Burt, L., Curtis, C., DaCosta, V. L., Iqtidar, S. U., Liu, Y., Pujari, S., &D’Espaignet, E. T. (2015). The environmental andhealth impacts of tobacco agriculture, cigarettemanufacture and consumption. Bulletin of theWorld Health Organization, 93(12), 877–880.https://doi.org/10.2471/blt.15.152744Owusu, D., Huang, J., Weaver, S. R., Pechacek, T. F.,Ashley, D. L., Nayak, P., & Eriksen, M. P. (2019).Patterns and trends of dual use of e-cigarettesand cigarettes among U.S. adults, 2015–2018.Preventive Medicine Reports, 16, 101009.https://doi.org/10.1016/j.pmedr.2019.101009Palmatier, R. W., Houston, M. B., & Hulland, J.(2017). Review articles: purpose, process, andstructure. Journal of the Academy of MarketingScience, 46(1), 1–5. https://doi.org/10.1007/s11747-017-0563-4Piper, M. E., Baker, T. B., Benowitz, N. L., & Jorenby,D. E. (2019). Changes in Use Patterns Over 1 YearAmong Smokers and Dual Users of Combustibleand Electronic Cigarettes. Nicotine & TobaccoResearch, 22(5), 672–680.https://doi.org/10.1093/ntr/ntz065Polosa, R., O'Leary, R., Tashkin, D., Emma, R., &Caruso, M. (2019). The effect of e-cigaretteaerosol emissions on respiratory health: anarrative review. Expert review of respiratorymedicine, 13(9), 899–915.https://doi.org/10.1080/17476348.2019.1649146Puteh, S. E. W., Manap, R. A., Maharani, H., Ahmad, I.S., Idris, I. B., Sham, F. M., Lin, A. B. Y., Chun, I. S.,Mohamad, M. R. P., Mokhtar, A. I., Zakaria, H., Lee, J.,Nordin, A. S. A., Ariaratnam, S., & Yusoff, M. Z. M.(2018). The use of e-cigarettes among universitystudents in Malaysia. Tobacco Induced Diseases,16(December). https://doi.org/10.18332/tid/99539Qi, Z. M. (2024). Malaysia Loses 27,000 LivesAnnually Due to Tobacco Use. Retrieved fromOriental Daily News Malaysia:https://www.orientaldaily.com.my/news/nation/2024/05/16/652346Saddleson, M. L., Kozlowski, L. T., Giovino, G. A.,Hawk, L. W., Murphy, J. M., MacLean, M. G.,Goniewicz, M. L., Homish, G. G., Wrotniak, B. H., &Mahoney, M. C. (2015). Risky behaviors, ecigarette use and susceptibility of use amongcollege students. Drug and alcohol dependence,149, 25–30.https://doi.org/10.1016/j.drugalcdep.2015.01.001Seraj, Z. (2024). Malaysia Loses 27,000 LivesAnnually Due to Tobacco Use, Says HealthMinister. Retrieved from Malay Mail :https://www.malaymail.com/news/malaysia/2024/05/16/malaysia-loses-27000-lives-annuallydue-to-tobacco-use-says-healthminister/134715Stead, L. F., Koilpillai, P., Fanshawe, T. R., &Lancaster, T. (2016). Combined pharmacotherapyand behavioural interventions for smokingcessation. The Cochrane database of systematicreviews, 3(3), CD008286.https://doi.org/10.1002/14651858.CD008286.pub3Tabacco. (2023). Retrieved from World HealthOrganization : https://www.who.int/newsroom/factsheets/detail/tobacco#:~:text=The%20tobacco%20epidemic%20is%20one,%2Dhand%20smoke%20(4).THE PANACEA / VOLUME 4 2025 / 38The Malaysian Vape Industry Study 2023.(2023). Retrieved from Malaysian VapeChamber of Commerce (MVCC): The workwas supported by theFRGS/1/2020/SKK05/UM/02/1.Thirión-Romero, I., Pérez-Padilla, R., Zabert, G.,& Barrientos-Gutiérrez, I. (2019). RESPIRATORYIMPACT OF ELECTRONIC CIGARETTES AND\"LOW-RISK\" TOBACCO. Revista deinvestigacion clinica; organo del Hospital deEnfermedades de la Nutricion, 71(1), 17–27. Thework was supported by theFRGS/1/2020/SKK05/UM/02/1.Vardavas, C. I., Anagnostopoulos, N., Kougias,M., Evangelopoulou, V., Connolly, G. N., &Behrakis, P. K. (2011). Short-term PulmonaryEffects of Using an Electronic Cigarette.CHEST Journal, 141(6), 1400–1406. The workwas supported by theFRGS/1/2020/SKK05/UM/02/1.Wang, J. B., Olgin, J. E., Nah, G., Vittinghoff, E.,Cataldo, J. K., Pletcher, M. J., & Marcus, G. M.(2018). Cigarette and e-cigarette dual use andrisk of cardiopulmonary symptoms in theHealth eHeart Study. PLoS ONE, 13(7),e0198681. The work was supported by theFRGS/1/2020/SKK05/UM/02/1.What are the effects of secondhand andthirdhand tobacco smoke? | National Instituteon Drug Abuse. (2021). National Institute onDrug Abuse. The work was supported by theFRGS/1/2020/SKK05/UM/02/1.Zevin, S., & Benowitz, N. L. (1999). Druginteractions with tobacco smoking. An update.Clinical pharmacokinetics, 36(6), 425–438.The work was supported by theFRGS/1/2020/SKK05/UM/02/1.Zhuang, Y., Cummins, S. E., Sun, J. Y., & Zhu, S.(2016). Long-term e-cigarette use andsmoking cessation: a longitudinal study withUS population. Tobacco Control, 25(Suppl 1),i90–i95. The work was supported by theFRGS/1/2020/SKK05/UM/02/1.Faculty of Pharmacy ResearchHighlights
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