Introduction: Tuberculosis is an infectious disease with high rates of infection and mortality throughout the world, but its spread is greater in developing countries, and its control is difficult. It is known that the most common side reaction of drug treatment for tuberculosis is hepatotoxicity resulting from the drugs, which negatively affects adherence to treatment as a result of patients not continuing to use it. Objective:This study aimed to determine the extent of hepatotoxicity as a result of drug treatment for tuberculosis. Methods: The study is a cross-sectional study conducted on TB patients undergoing TB treatment in a general hospital in Islamabad, Pakistan. A data collection form was used to obtain demographic and treatment data. The hepatotoxicity of TB drug therapy was evaluated by performing liver function tests (LFTs).Study duration was of 4 months. Results: The study showed that out of 100 tuberculosis patients, 55 patients were hepatotoxic. Hepatotoxic population includes 26% males and 29% females including almost 10% children either male or female. The maximun hepatotoxicity was observed in the patients undergoing combination therapy. Around 3-5 % patients showed that the Serum-GlutamicPyruvic-Transaminase (SGPT) values more than 2 times of their normal values. While other 50% showed hepatotoxicity 1-2 times of their normal values. Most of the patients found were in the age group ranging from 35-60 years. The main drugs used in tuberculosis treatment were: Isoniazid, Rifampicin, Pyrazinamide, Ethambutal. Conclusion:The rate of hepatotoxicity in TB patients on anti-TB treatment was high. The current study concluded that the more we move towards a greater number of drugs in combination, the greater the extent and chance of hepatotoxicity. The combination of three anti-tuberculosis drugs (isoniazid, rifampicin, and pyrazinamide) resulted in maximum hepatotoxicity. Peer Review History: Received: 21 August 2023; Revised: 18 September; Accepted: 19 October, Available online: 15 November 2023 Academic Editor: Dr. Marwa A. A. Fayed, University of Sadat City, Egypt, maafayed@gmail.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Owanaro Peter, Nigeria, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria. owonaropeter@gmail.com Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. Sheikh Abdul Khaliq, Department of Pharmacy Practice, Faculty of Pharmacy, Hamdard University, Karachi, Pakistan, drwadhsheikh1974@gmail.com

Objective: Conventional dosage forms may not be suitable for all patients, especially those facing difficulty with swallowing, which results in reduced adherence to medication, impacting treatment outcomes. This study aimed to formulate and characterize metoclopramide lozenges using the quality-by-design approach to provide a patient-friendly alternative. Materials and Method: Formulations were optimized using response surface methodology and a Design Expert, focusing on Metoclopramide, Citric Acid, and Carboxymethyl Cellulose, with hardness and dissolution as primary response variables. The experimental design involved 20 runs, six replications of the central point, and a quadratic model for improved model fitting, with adjustments made through transformation and numerical hill-climbing algorithms. Results and Discussion: Formulations of metoclopramide lozenges were obtained through a systematic quality-by-design approach. Using numerical optimization, the formulation with the highest desirability score of 1.00 was selected, yielding a hardness of 14.55 kg and a dissolution time of 1.25 minutes. The optimal coded values were 1.53223 grams for Metoclopramide (A), 4.84302 grams for Citric acid (B), and 18.5048 grams for Carboxymethyl cellulose (C). The optimized formulation was subjected to in vitro testing to validate its performance, yielding a hardness ranging from 13.98 to 15.00 kg/cm2 and a dissolution time ranging from 1.11 to 2.23 minutes. The effectiveness of the QbD approach was confirmed as outcomes closely aligned with the targeted responses. Conclusions: The Quality by Design approach was found effective in optimizing the formulation of metoclopramide lozenges. Using the Design of Expert and Response Surface Methodology, an optimized formulation was obtained with the desired hardness and dissolution rate. Peer Review History: Received 26 April 2024; Revised 4 May 2024; Accepted 28 June; Available online 15 July 2024 Academic Editor: Dr. DANIYAN Oluwatoyin Michael, Obafemi Awolowo University, ILE-IFE, Nigeria, toyinpharm@gmail.com Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. Hatem Sameir Abbas, Al-Azhar University, Egypt, hsam8406@yahoo.com

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

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

Background: Cardiovascular disease remains a leading cause of global morbidity and premature mortality, with increasing involvement of younger adults in Pakistan. Despite this trend, limited evidence exists regarding the level of cardiovascular awareness among non-medical university students, a group representing a large proportion of the young adult population. This study assessed their understanding of cardiovascular disease, associated risk factors, and recognition of early warning symptoms. Methods: A descriptive cross sectional survey was conducted among two hundred non-medical university students in Lahore. Data were collected using a structured questionnaire designed to assess knowledge of cardiovascular disease types, major risk factors, and symptoms of myocardial infarction and stroke. Results: Knowledge levels varied across different domains. Nearly half of the participants were unable to identify a single cardiovascular condition, although commonly known heart attack symptoms such as chest pain were frequently recognized. Awareness of atypical myocardial infarction symptoms and stroke warning signs was comparatively low. Students demonstrated better understanding of lifestyle related risk factors including smoking, unhealthy diet, stress, and high cholesterol, whereas physical inactivity and diabetes were less frequently identified. Conclusions: The study highlights important gaps in cardiovascular knowledge among non medical university students, particularly in symptom recognition. Strengthening structured cardiovascular education within universities and expanding community based preventive services may help improve awareness and support earlier response to cardiovascular risk among young adults. Peer Review History: Received 2 October 2025; Reviewed 11 November 2025; Accepted 13 December; Available online 15 January 2026 Academic Editor: Dr. Amany Mohamed Alboghdadly, Ibn Sina National College for Medical Studies in Jeddah, Saudi Arabia, amanyalboghdadly@gmail.com Reviewers: Dr. Sheikh Abdul Khaliq, Department of Pharmacy Practice, Faculty of Pharmacy, Hamdard University, Karachi, Pakistan, drwadhsheikh1974@gmail.com Dr. Taiwo O Elufioye, University of Ibadan, Nigeria, toonitaiwo@yahoo.com

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