Kidney-transplant recipients have complex medication regimens due to chronic comorbidities, in addition to immunosuppressive medications leading to serious medication-related problems (MRPs). 1 Pharmacists play crucial role in identifying and assessing MRPs, providing education, monitoring and suggesting alternative medications. Studies reported that clinical-pharmacists joining renal-transplant clinics have potential impact on patients’ outcomes. 2,3 There is a paucity of data on prevalence of MRPs in kidney-transplant patients at King-Abdulaziz medical city, Jeddah. Therefore, the study aims to determine the prevalence and types of MRPs in kidney-transplant recipients at the outpatient clinics. Secondary objectives include identifying the pharmacological classes of medications contributed to the MRPs, the categories of MRPs and the predictors of MRPs. Methods: Retrospective cross-sectional, electronic health records review. Data were collected from June 2016 until June 2017. Inclusion criteria: patients above 18 years, receiving maintenance immunosuppressants and at least 3 months post-transplant. MRPs include: Drug-drug interactions, ADR, improper dosing, medications without clear indication, indication with no medication and Duplication. A sample of 80 patients was estimated to detect prevalence of 31%of one MRP at least per patient with 95%confidence interval, 5%precision, an alpha of 0.05. Results and conclusion: Screened patients were129. The mean age was 50±15.75, 66.3% were males. Most common comorbidities were hypertension(62%) and diabetes(42.5%). The prevalence of MRPs was 28.97% in 1393 medication orders reviewed. The most frequent MRP types were drug-drug interactions(46.1%) and duplications(16.7%), Most common medications involved were Immunosuppressive and cardiac-medications. Most significant predictors for developing >3MRPs were: number of medications and duration post kidney-transplant.

The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this study. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conduct.

Cancer is responsible for one in eight deaths worldwide more than AIDS, tuberculosis, and malaria together. Natural product still continue to be important as source of novel drugs because these dugs does not need sophisticated instrument, cheep resources, less toxic, no resistance to them by bacteria compared with  the synthetic drugs. However the natural product will continue to be important in addition in three areas of discovery, they are a target for production by biotechnology, as source  of new lead compounds of novel chemical structure  and as the active ingredients of useful treatments divided from traditional systems of folkloric medicine(1) . The herb Loranthus Europaeus leaves and fruits was used in Iraq traditional medicine for treatment of inflammation, tumor and antimicrobial infection (2). For these reasons we tried to use the phytochemical and pharmacological studies to approache to their bioactive products as a new source for medicine. The extraction of active constituent of loranthus Europaeus (flavonoids terpenoids and alkaloids) by using chromatography method using a thimble of suxlet with different organic solvents. The ethylacetate extract contain flavonoid which contain qurcitin and quercitrin.                                 The active ingredient mixture of LE leaves extract have used as mouth wash  for 10 ladies different age have breast cancer and under treatment with chemotherapy. We found that the bioactive martial extracted from LE used as mouth wash cause cure of the inflammation of the mouth of those ladies.                                                                  In addition that 10 humans of different sexes complaining of cyst attached to one of their tooth treated with different types of antibiotic there was no response but when have given an antibiotic with bioactive agents of this LE there was complete cure of the cyst and there was no need for operation which give the possibility of presence of one or more of these (qurcitin and quercitrin) active agents act as positive nano carrier of the antibiotic to the cyst directly and cure it. In the following medicinal plant as Haloxylon, Loranthus European, Salvia, Artemesia, Ocimum sanctum microemulsion, polymeric nano  particles act as drug delivery barrier for alkaloids so which act directly on cancer cell without side effect So we can have cheap cancer drugs therapy which available from  Cheap resources and safe effective cancer therapy.

AMR spread is huge with millions of death due to ineffectiveness of antibiotics. This is happened due to creation of hundreds of mdr genes like beta-lactamases (blaTEM, blaCTX-M, blaOXA and blaNDM1), drug acetyltransferases (aacC1, aacA1, cat) and phosphotransferases (aph4) in MDR conjugative plasmids and chromosome. In other mechanisms, drug efflux proteins like tetA/C, acrAB and mexAB kickout drugs from bacterial cytoplasm increasing drug MIC and thus tetracycline, streptomycin, azithromycin, ciprofloxacin became ineffective to destroy pathogenic bacteria. We have investigated here the reason of such widespread creation of mdr genes in bacteria which are resident of intestine synthesizing 20 vitamins and complex biomolecules for our body. We have hypothesized that such 2x1012 diverse species are killed due to high dose of antibiotic intake since 1940s creating acute health hazard in human which is now balanced by probiotic bifidobacteria and vitamin-B complex capsules supplement. The hypothesis suggested that molecular signalling from intestinal luminal cells (TGFβ, IL-10, IL-22) as well as from bacteria (LPS, vitamins, butyrate) orchestrated to preserve symbiosis relation between human and bacteria. Vitamins are converted into provitamins (FADH2, NADH+, THFA, Biotin, B12, TPP etc.) needed for every steps of >30000 enzymatic reactions in human cells. Thus MDR bacteria will be the resident of intestine favouring vitamin biosynthesis and immune-modulation needed for normal human metabolosome. Indeed mdr genes are abundantly created in plasmids and chromosomes with further mutations of target genes (rRNA, ponA, porB, gyrAB, parC) and likely all are to protect gut microbiota to save human from extinct. Thus with time all bacteria will be drug resistant and infections should be controlled by heterogenous phyto-antibiotics, gene medicines, phage therapy and DNA nanocarriers for toxic drug delivery.