Research Article
Volume 3 Issue 6 - 2016
National Survey of Total Parenteral Nutrition Practice in Saudi Arabia: Prescribing and Transcribing at MOH Hospitals
Yousef Ahmed Alomi1* and Sumaiah Mohammed Aljudaibi2
1Department of National Clinical pharmacy and pharmacy practice Head, Saudi Arabia
2Department of General Administration of Pharmaceutical Care, Saudi Arabia
*Corresponding Author: Department of Pharmaceutical Care, National Clinical pharmacy and pharmacy practice Head, Saudi Arabia.
Received: March 18, 2016; Published: April 23, 2016.
Citation: Yousef Ahmed Alomi and Sumaiah Mohammed Aljudaibi. National Survey of Total Parenteral Nutrition Practice in Saudi Arabia: Dispensing and Administration at MOH Hospitals”. EC Nutrition 3.6 (2016): 748-756.
Abstract
The National Survey of Total Parenteral Nutrition practices with emphasis on TPN preparation and administration at MOH hospital conducted in Saudi Arabia. To explore the TPN current practice with focusing on TPN preparation and administration Twenty-four hospitals received the survey with twenty hospitals responded 80.33% response rate. Of those TPN medications completely available at 25% of the hospital, the 20% of TPN devices and 30% TPN filter available before preparation. The IV Admixture-TPN-Oncology Preparation system did not exist in 45% of the hospitals. The 95% of hospitals had full detail label, and alerting system founded in 75% of the hospitals, More than 80% of the hospitals administer TPN through the central line and three-quarters used an infusion pump. Application of TPN Quality Management found in 50% of hospitals, and in range, 60-65 had policy and procedures of TPN. The majority of TPN distributive pharmacists 95% had not had board certification of nutrition support pharmacy and 45% had not had any TPN training. The TPN references not completely available 45% of hospitals. While 25% of hospitals had pharmacists, do not attend the national or international TPN conference. Also, TPN education lectures to health care providers physicians, pharmacists, and nurses not existed in about 45% of hospitals. The survey explored the real TPN practice of preparation and administration Targeting of implementing international standard TPN practice in preparation and administration lead to preventing TPN misadventures, TPN-related complications, improve TPN services with excellent patient outcome, and avoid unnecessary cost of health care system.
Keywords: Parenteral Nutrition; Pharmaceutical Care; Ministry of Health; Saudi Arabia
Abbreviations: TPNS: Total parenteral nutrition services; KFSH & RC: King Faisal Specialist Hospital and Research Center; KKUH: King Khalid University Hospital; GAPC: General Administration of Pharmaceutical care; MOH: Ministry of Health; ASHP: American Society of heath system pharmacist
Introduction
The international organizations; Joint Commission on Hospital Accreditation [1], American specify of health Pharmacist (ASHP) [2], and national institutions Saudi Central Board for Accreditation of Healthcare Institutions [3] required the minimum standards for hospital pharmacies. One of the vital essential required is Intravenous Administration department. This unit is necessary to prepare all parenteral medications including Total Parenteral Nutrition. The preparation should follow aseptic techniques and safe practice to prevent TPN-related infection and TPN complications [4]. In 2013, General Administration of Pharmaceutical Care established strategic planning of pharmaceutical care for more 270 hospital pharmacies. Intravenous administration and TPN services are of them [5-6]. Assessment of TPN services is required to determine the gap analysis, key performance indicators, and fore casting of the future. A national survey of TPN services of three sections including prescribing and transcribing, preparation and administration, then TPN monitoring and patient education. It is based on previous studies from ASHP and Saudi Pharmaceutical Society (SPS) [7-12].
ASHP did a survey in the USA with emphasis on hospital pharmacy practice and as same as stages mentioned above. In the preparation and administration phase, they found 65% of hospitals had a clean room for IV preparations; commercially prepared TPN decreased from 36 to 43% of hospitals in years 2011-2014, most of the small and medium hospitals used them. TPN made by automated compounding devices dropped from 20.4% to 11.8% of hospitals at same years [7]. Another study showed the adherence of TPN guidelines reach to more 70% of the hospital with 33.4% in TPN order from, 78.8% pharmacist revised TPN formulation, and 86.9% used inline filter 2 in 1 TPN [13]. Also, Saudi Pharmaceutical Society with the collaboration of ASHP did like this study in Saudi Arabia; they found 60.7% of hospitals had an IV admixture with 65.5% of hospitals stated quality management program for IV services. Besides, 46.3% of hospitals had TPN services while 36% used automated compounding. There were several barriers prevents changing pharmacy practice including but not limited; lacking qualified technician, and lacking pharmacy resources and training [11].
This survey the First did in Saudi Arabia and Gulf countries, the author is not familiar with any literature discussed the national survey of TPN practice before the objective of this study to explore TPN practice preparation and administration stage in Saudi Arabia.
Methods
This survey is the second segment of the national survey of Total Parenteral Nutrition at MOH hospitals only; prescribing and transcribing. Others hospitals Non-MOH governmental hospitals (Royal, Military, National Guard, Security Forces, Universities) and private hospitals excluded from the study. It contains part of 50 questions designed by the authors. It based on American Parenteral and Enteral Nutrition standard and guidelines, and American Society of Health-System Pharmacists. It included the following; TPN Practice Management, Managing the TPN-Use Process, Total Parenteral Nutrition Patient Care, TPN Material Procurement and Inventory Management, Total Parenteral Nutrition (TPN) Delivery, Evaluating the Effectiveness the TPN-use System, Total Parenteral Nutrition (TPN) Research.
The survey distributed to twenty-four Total parenteral nutrition services (TPNS) of MOH hospital in different regions. In 2014; The study conducted. The survey circulated to hospitals by email to TPNS supervisor. The authors followed up by telephone and emails after two weeks. After four weeks the surveys final collected. The survey information entered into Microsoft Excel version 10 for analysis. In this study, the second segment is prescribing and transcribing explored and analyzed.
Results
The survey distributed to twenty-four hospitals, of those twenty hospitals responded, the response rate was 20 (80%). Of that 15 % medical cities, 20% medium size hospitals, and 65% large hospitals as showed in Table 1. The TPN medications available at 25% of the hospital completely, 20 % of TPN devices and 30% TPN filter available before preparation as showed in Table 2. In TPN preparation, the authors found that is IV Admixture-TPN-Oncology Preparation Program not existed in 45% of the hospitals, 95% of hospitals used TPN automated compounding with 95% had full detail label, and alerting system founded in 75% of the hospitals as showed in Table 3. In the TPN administration, more than 80% of the hospitals administer TPN through the central line and 75% used infusion pump during administration as showed in Table 4. In the TPN Quality Management, 50% of hospitals used quality management tools in TPNS, and in range 60-65 had policy and procedures of TPN as showed in Table 5. The majority of TPN distributive pharmacists 95% had not had board certification of nutrition support pharmacy and 45% had not had any TPN training as showed in Table 6. In the TPN Education and Training, the author found TPN references not completely available at TPN units lost 45% while 25% of pharmacist does not attend any TPN national or international conference. Also TPN education lectures to health care providers physicians, pharmacists and nurses not existed in about 45% of hospitals as showed in Table 7.
Region Number of hospitals Percentages %
Hospital size (Number of staffed beds)
   
Small
   
< 50
0 0%
50-99
0 0%
Medium
   
100-199
0 0%
200-299
4 20%
Large
   
300-399
4 20%
400-599
9 45%
More that or equal 600
0 0%
Very Large
   
Medical Cities
3 15%
Missing No-Response
4 20 %
Ownership
   
MOH-Hospitals
20 100%
Non-MOH Hospitals
0 0%
Privates
0 0%
Accreditation
   
CIBAHI
20 100%
JCI
5 25%
Canada
0 0%

Table 1: Size Ownership and Accreditation of Respondents.

Region Small
< 100
n (%)
Medium
100-299
n (%)
Large
300-399
n (%)
Large
400- > or =
600 n (%)
Medical
Cities
n (%)
Total
n (%)
Size Meter Sequre of TPN units (hospitals n = 19)
> 30
0 (0) 1 (5.26) 0 (0) 1 (5.26) 0 (0) 2 (10.52)
21-30
0 (0) 0 (0) 0 (0) 3 (15.78) 1 (5.26) 4 (21)
11-20
0 (0) 3 (15.78) 3 (15.78) 4 (21) 1 (5.26) 11 (57.9)
1-10
0 (0) 0 (0) 1 (5.26) 1 (5.26) 0 (0) 2 (10.52)
No of Laminart Air Flow Hood (LAFH) (hospitals n = 20)
> 6
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
5-6
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
3-4
0 (0) 1 (5) 0 (0) 2 (10) 0 (0) 1 (5)
1-2
0 (0) 3 (15) 4 (20) 6 (30) 0 (0) 13 (65)
0
0 (0) 0 (0) 0 (0) 0 (0) 1 (5) 1 (55)
No of Automated compounding equipments (hospitals n = 20)
> 6
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
5-6
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
3-4
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
1-2
0 (0) 3 (15) 2 (10) 6 (30) 3 (15) 14 (70)
0
0 (0) 1 (5) 2 (10) 3 (15) 0 (0) 6 (30)

Table 2: TPN units size and equipments.

Region Small
100
n (%)
Medium
100-299
n (%)
Large
300-399
n (%)
Large
400- > or = 600
n (%)
Medical
Cities
n (%)
Total
n (%)
IV Adnixture-TPN-Oncolgy Preprartion Program avaliable (hospitals n = 20)
100 % applications
0 (0) 1 (5) 1 (5) 3 (15) 2 (10) 7 (35)
75 % applications
0 (0) 0 (0) 0 (0) 1 (5) 1 (5) 2 (10)
50 % applications
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
25 % applications
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
0 % applications
0 (0) 3 (15) 3 (15) 3 (15) 0 (0) 9 (45)
TPN Peparations
100 % of TPN orders prepare by pharmacists or pharmacy technicians
0 (0) 4 (20) 4 (20) 8 (40) 3 (15) 19 (95)
75 % of TPN orders prepare by pharmacists or pharmacy technicians
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
50 % of TPN orders prepare by pharmacists or pharmacy technicians
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
25 % of TPN orders prepare by pharmacists or pharmacy technicians
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
0 % of TPN orders prepare by pharmacists or pharmacy technicians
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
TPN Automated Preparations (hospitals n = 20)
100 % of TPN Preparations by Automtic Compounding
0 (0) 4 (30) 4 (20) 9 (45) 2 (10) 19 (95)
75 % of TPN Preparations by Automtic Compounding
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
50 % of TPN Preparations by Automtic Compounding
0 (0) 0 (0) 0 (0) 1 (0) 0 (0) 1 (5)
25 % of TPN Preparations by Automtic Compounding
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
Not Cover hospital wards
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
TPN preparation label contains all active ingredient (hospitals n = 20)
100% applications
0 (0) 4 (20) 4 (20) 8 (40) 3 (15) 19 (95)
75% applications
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
50% applications
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
2 % applications
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
0% applications
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
Use ca ph compatibility chart to prevent TPN precipitation (hospitals n = 20)
100% Prescriptions
0 (0) 2 (10) 3 (15) 7 (35) 3 (15) 15 (75)
75% Prescriptions
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
50% Prescriptions
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
25% Prescriptions
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
0% Prescriptions
0 (0) 2 (10) 1 (5) 2 (10) 0 (0) 5 (25)

Table 3: TPN prepration.

Region Small
< 100
n (%)
Medium
100-299
n (%)
Large
300-399
n (%)
Large
400- > or = 600
n (%)
Medical
Cities
n (%)
Total
n (%)
TPN Central line administration (hospitals n = 20)
100% applications
0 (0) 3 (15) 2 (15) 5 (25) 2 (10) 12 (65)
75% applications
0 (0) 1 (5) 1 (5) 2 (10) 1 (5) 5 (25)
50 % applications
0 (0) 0 (0) 1 (5) 0 (0) 0 (0) 1 (5)
25 % applications
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 0 (5)
0 % applications
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 0 (5)
TPN Prescriptions (hospitals n = 20)
100% applications
0 (0) 4 (20) 3 (15) 5 (15) 3 (15) 15 (75)
75% applications
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
50 % applications
0 (0) 0 (0) 0 (0) 2 (10) 0 (0) 2 (10)
25% applications
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
0% applications
0 (0) 0 (0) 1 (5) 1 (5) 0 (0) 2 (10)

Table 4: TPN administration.

Region Small
< 100
n (%)
Medium
100-299
n (%)
Large
300-399
n (%)
Large
400- > or = 600
n (%)
Medical
Cities
n (%)
Total
n (%)
TPN – TQM Applications (hospitals n = 20)
100% Prescriptions
0 (0) 2 (10) 1 (5) 4 (20) 2 (10) 9 (45)
75 % Prescriptions
0 (0) 2 (10) 0 (0) 0 (0) 0 (0) 2 (10)
50% Prescriptions
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
25% Prescriptions
0 (0) 0 (0) 1 (5) 2 (10) 0 (0) 3 (15)
0 % Prescriptions
0 (0) 0 (0) 2 (10) 2 (10) 1 (5) 5 (25)
TPN Policy and Procedures and Job descriptions (hospitals n = 20, may contain more than one answers)
Adults
0 (0) 1 (5) 3 (15) 6 (30) 3 (15) 13 (65)
Pediatrics
0 (0) 3 (15) 2 (10) 7 (35) 1 (5) 3 (65)
Neonates
0 (0) 4 (20) 1 (5) 7 (35) 0 (0) 12 (60)

Table 5: TPN Quality Management.

Region Small
< 100 n (%)
Medium 100–299
n (%)
Large
300–399 n (%)
Large
400- > or = 600 n (%)
Medical Cities
n (%)
Total
n (%)
Pharmacists has BCNSP Avaliable (hospitals n = 20)
100% Pharmacists
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
75% Pharmacists
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
50% Pharmacists
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
25% Pharmacists
0 (0) 1 (5) 0 (0) 0 (0) 0 (0) 1 (5)
0% Pharmacists
0 (0) 3 (0) 4 (20) 9 (45) 3 (15) 19 (45)
Pharmacist had accredited TPN Training Certificate (hospitals n = 20)
100% Pharmacists
0 (0) 1 (5) 0 (0) 3 (15) 0 (0) 4 (20)
75% Pharmacists
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
50% Pharmacists
0 (0) 0 (0) 0 (0) 0 (0) 1 (5) 1 (5)
25% Pharmacists
0 (0) 1 (5) 1 (5) 3 (15) 1 (5) 6 (30)
0% Pharmacists
0 (0) 2 (10) 3 (15) 3 (15) 1 (5) 9 (45)

Table 6: TPN staff qulification.

Region Small
< 100
n (%)
Medium
100-299
n (%)
Large
300-399
n (%)
Large
400- > or = 600
n (%)
Medical
Cities
n (%)
Total
n (%)
TPN References (hospitals n = 20)
100% of them avaliable
0 (0) 0 (0) 1 (5) 1 (5) 1 (5) 3 (15)
75% of them avaliable
0 (0) 0 (0) 1 (5) 1 (5) 2 (10) 4 (20)
50% of them avaliable
0 (0) 3 (15) 1 (5) 5 (25) 0 (0) 9 (45)
25% of them avaliable
0 (0) 1 (5) 1 (5) 1 (5) 0 (0) 1 (5)
0% of them avaliable
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
Pharmacist attend national and international TPN Conference (hospitals n = 20)
100% Pharmacists
0 (0) 1 (5) 0 (0) 2 (10) 2 (10) 5 (25)
75% Pharmacists
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
50% Pharmacists
0 (0) 1 (5) 1 (5) 4 (20) 1 (5) 7 (35)
25% Pharmacists
0 (0) 1 (5) 1 (5) 1 (5) 0 (0) 3 (15)
0% Pharmacists
0 (0) 1 (5) 2 (10) 2 (10) 0 (0) 5 (25)
TPN Lectures given to Physicians and Nurses (hospitals n = 20)
100% attened of Physicians and Nurses
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
75% attened of Physicians and Nurses
0 (0) 0 (0) 0 (0) 1 (5) 1 (5) 2 (10)
50% attened of Physicians and Nurses
0 (0) 1 (5) 1 (5) 3 (15) 1 (5) 6 (30)
25% attened of Physicians and Nurses
0 (0) 0 (0) 0 (0) 1 (5) 0 (0) 1 (5)
0 % attened of Physicians and Nurses
0 (0) 3 (15) 3 (15) 3 (15) 1 (5) 10 (50)
TPN Lectures given to Pharmacists and Pharmacy Tecnicians (hospitals n = 20)
100 % attened of Pharmacist and Pharmacy Tecnicians
0 (0) 0 (0) 0 (0) 3 (15) 1 (5) 4 (20)
75 % attened of Pharmacist and Pharmacy Tecnicians
0 (0) 0 (0) 0 (0) 0 (0) 1 (5) 1 (5)
50 % attened of Pharmacist and Pharmacy Tecnicians
0 (0) 0 (0) 1 (5) 4 (20) 1 (5) 6 (30)
25 % attened of Pharmacist and Pharmacy Tecnicians
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
0 % attened of Pharmacist and Pharmacy Tecnicians
0 (0) 4 (20) 3 (15) 2 (10) 0 (0) 9 (45)

Table 7:TPN Education and Training.

Discussions
In the first study in Saudi Arabia about TPN services at MOH hospitals, the second phase was dispensing, and administration explored below. TPN services found in thirteen regions overall King of Saudi Arabia, seven regions do not have TPN services at all. It is available 8.88% of all total hospitals. Most of the medium bed size hospitals, large, and medical cities had TPN services as showed in Table 9. In the hospital pharmacy that run IV admixture and TPN services, all medications and required material for preparation should be available in the ideal standard system. In the study, the author found some TPN components was not available for varieties percentages, in addition to there was demanding of TPN devices for preparation, material, and even TPN filter used during administration phase. The author did not find study mentioned that is to compare with it. It is hard to identify the reasons behind that are in this study. We need to validate the deficiency with another survey in the future. The shortages of TPN components may lead to nutritional errors and potentially death. For that, some reports mentioned the shortages of some nutritional elements, and strategies in how to deal with them [14].
In IV admixture is sitting, the authors found the percentage of hospitals had IV admixture program at MOH hospitals less than what found in Alsultan., et al. [11], and Pedersen CA [7]. In this study, the authors included all MOH hospitals while Alsutan study did not include them. Also none- MOH governmental hospitals are more developed than MOH hospitals. They started pharmacy application services since the 1980s and 1990s.
All TPN preparations done by the pharmacy, there is no nurse or physician prepares TPN at all. Also, the majority of the hospital had excellent preparations with standard labels, automated alarming system during the preparation of TPN to prevent any preparation errors. The study had a better result than what found in Hassig TB., et al. [14], this study ancient and TPN automated compounding was available most of the hospitals. Majority of the hospital used central administration of TPN this need for guidelines for infection control to prevent central line infection, and utilization of infusion pump for TPN lead to reduction of TPN administration errors.
In TPN quality, application TPN Quality management and TPN policy and procedures at MOH hospitals are the same results founded in Alsultan., et al. [11] and better than Hassig TB., et al. [14]. This system needs to improve more to prevent drug-related problems during preparation and administration of TPN and apply IV admixture outcome indicators, the authors highly recommended to use quality management for automated compounding according to ASHP guidelines [15]. In TPN education and treating section, the authors found the same percentages of Alsultan., et al. study [11]. It was one of the barriers to change pharmacy practice, the pharmacist need training; it was general without emphasis on TPN services. In TPN staff qualification, the author found the number of hospitals as the same as the percentage of Alsutan., et al. study [11], the lack pharmacist staff resources and lack of qualified pharmacy technician as one of the barriers to change pharmacy practice. In TPN resources, the authors found our percentages almost the same results of Alsutan., et al. [11] study with availability a regular pharmacy electronic resource. However, the resources should be more specialized in TPN with increases number of resources.
Limitations
Despite the investigation is the unique in Saudi Arabia and Gulf countries and it maybe around the world, as a national survey of TPN practice with emphasis on Preparation and administration, it contained several useful practical information, and the best available resources currently. However, it had some limitations including but not limited to the following, the study with a small number of hospitals; it did not include non-MOH hospitals or privates sectors. In addition to there is no full or complete information TPN administration as one of stage of TPN distribution process.
Conclusion
This survey explored the gap analysis between the real practice and our strategic goals and objectives in IV admixture sitting, adherence to international guidelines (ASPEN, ASHP) for preparations, pharmacy staff qualifications, pharmacy education and training TPN practices. Approaching to correct the previous discrepancies with regular follow-up survey every year or every other year; it increase the TPN services adherence to Internal and National Guidelines, leads to prevent TPN-related problems, with avoiding the extra cost of TPN related problems in the pharmaceutical care system.
Bibliography
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  3. Saudi Central Board for Accreditation of Healthcare Institutions. “National Hospital Standards”. 2015 Third Edition. CBAHI publications (2015).
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Copyright: © 2016 Yousef Ahmed Alomi and Sumaiah Mohammed Aljudaibi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


February Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the February issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before February 17, 2023.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.