Military Suicides Free Essay Example, 1500 words

Most military soldiers find it difficult to cope up with their tough duties and, therefore, some become stressed and desperate. To reduce their levels of stress, some opt to use drugs to suppress their stressful life conditions and many get addicted. Mental health can be affected by some factors like addiction to marijuana, alcohol or drug abuse, which in most times affects the rightful human senses of a normal person (Bond et al. , 2010). The same applies to military soldiers, who out of external factors like stress or alcohol and drug addiction, become mentally distorted into thinking that committing suicide is the quick relief from their many problems. The risk of military suicide attempts is increased by such factors and the best solution when noticed in any military soldier by the military leadership in charge, is to handle such a soldier individually by guiding him or her to visit a psychiatrist. The earlier the soldier visits a psychiatrist, the better to avoid attempts like suicide (Joiner, 2010). The military management team has even had the assumption that the fewer recruitments done in a year, the higher the number of military suicides in active duty. We will write a custom essay sample on Military Suicides or any topic specifically for you Only $17.96 $11.86/pageorder now The military leaders are failing to curb the increasing suicide cases properly by making irrational assumptions. Recruitments in no way related to the causes of military suicides. Mental health disorder is the main cause of military suicide is even suffered by non-military people who aspire to join the military forces. Therefore, most of the military recruits suffer from mental disorder before they get into active duty. Most of them suffered the mental health condition a long time ago in their past life before joining the military life due to some addictions like alcohol or drug abuse of marijuana. However, in such instances the burden of proof of qualifications of military recruit shifts to the military management and the United States Unified Combatant Command body. The responsibility of these bodies is to ensure the soldiers been recruited in the military force are in proper mental conditions to reduce the risks of military suicides (Joiner, 2010 ).

Escherichia Coli An Causative Agent Of Infections Essay

Uropathogenic Escherichia coli is a strain of bacteria that is defined as primary the causative agent of infections in the urinary tract. Many strains of this bacteria are specifically adapted to overcome host defenses. The signs of a potential urinary tract infection include inflammation and shedding of the epithelial cells that line the urinary bladder. Importance Study into this field is crucial for human and animal populations around the world. The importance of studying this organism includes, but is not limited to: developing a technique of how to combat active infections, understanding how the organism penetrates a host’s defenses, and to develop practices that will prevent repetitive infections. Introduction Uropathogenic species of microorganisms are extremely resistant to medical treatments. More recent studies have shown that even with the implementation of antibiotics reservoirs of bacteria can survive. A reservoir refers to any place or substance that can harbor infectious agents under normal circumstances. The term is typically used in microbiology to reference the source of infections agents that can infect individuals. Urinary Tract Infections have a large net effect on a variety of populations around the world. The disease is highly frequent and associated medical costs are also high. It is estimated that approximately one third of the female population in America will be plagued with at least one Urinary Tract Infection (UTI) before they reach the ageShow MoreRelatedEscherichia Coli Related Cystitis Prevalence and Pathogenicity1066 Words   |  5 Pagesvirulence factors of Escherichia coli to the prevalence and symptoms of cystitis. This will be accomplished by defining the disease, its etiology and the causative agent. The mode of transmission and risk factors will be discussed as well, the pathogenesis, signs and symptoms will be explained. 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The reasons range from knowing the causative agent of a disease in a patient, so as to know how it can be treated, to knowing the correct microorganism to be used for making certain foods or antibiotics. This study was done by applying all of the methods that I have been learned so far in the microbiology laboratory class for the identificationRead Moreantimicrobial agents933 Words   |  4 PagesAntimicrobial Agents Lisette Vazquez October 27, 2013 Antimicrobial Agents Antimicrobial agents are utilized to kill microorganisms that cause infections. In order to be able to kill these microorganisms we must have an understanding of the factor associated with the infection. The purpose of this paper is to explore the different types of antimicrobial agents and the differences between viral and bacterial infections. 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It is a form of a urinary tract infection (UTI) one instance may lead to substantial renal damage, kidney failure, abscess formation, sepsis, septic shock, and the failure of multiple organs. The infection typically begins in the urethra or bladder and travels up into the kidneys, where it could potentially harm the organs and even the life of the infected individualRead MoreThe Impact Of Reporting On Foodborne Diseases2297 Words   |  10 Pagescases are often not detected through routine surveillance.12 Medical professionals, health departments, and laboratories play key roles in identifying foodborne diseases and their sources and reporting them through surveillance systems. Also, some agents transmitted commonly through food (e.g., norovirus) are not monitored by certain surveillance systems because clinical laboratories do not routinely test for them. Most foodborne diseases can be prevented, and progress has been made in decreasingRead MoreAntibacterial Studies Of Some Bisindolizine Compounds2365 Words   |  10 PagesR=p-C6H5Br, h.R= p-C6H5 F R1=- COOCH3 Scheme1 Synthesis of bisindolizine derivatives The antibacterial activity of the compounds were studied against Bacillus cereus (NCIM 2155), Bacillus pumilus (NCIM 2189), Escherichia coli (NCIM 2343), Klebsiella pneumonia (NCIM 2707), Proteus vulgaris (NCIM 2027), Clostridium perfringens (NCIM 2677), Bacillus macerans (NCIM 2131), Pseudomonas aeruginosa (NCIM 2863), Salmonella typhimurium (NCIM 2501) and Staphylococcus aureusRead MoreAnti-Bacterial Property of Duhat (Syzgium Cumini) Bark Extract2168 Words   |  9 PagesM. Vicera January, 2012 Ms. Santiago Abstract Humans especially for those who live in dirty community are prone to get disease such as cholera, diarrhea, fever and many more because there is an unseen specimen called bacteria. Bacteria such as e-coli and staphylococcus are the most common bacteria that can cause illness to mankind. According to the World Health Organization (WHO) 3 out of 10 people are infected by bacteria that cause various diseases. This study was conducted to determine the anti-bacterial

Indo-Pakistan Relations Free Essays

Since independence, relations between Pakistan and India have been characterized by rivalry and suspicion. Although many issues divide the two countries, the most sensitive one since independence has been the status of Kashmir. Born out from the furnace of animosity, India and Pakistan, the twin brothers have a history of unique relations. We will write a custom essay sample on Indo-Pakistan Relations or any similar topic only for you Order Now There is much in common between Republic of India and Islamic Republic of Pakistan. The diplomatic relations developed soon after independence but these relations did not ensure good friendship. Roots of Conflict Here are some of the highs and lows in relations between the two counties 1947 – Britain divides its Indian empire into secular (but mainly Hindu) India and Muslim Pakistan on August 15 and 14 respectively. The partition causes one of the largest human migrations ever seen, and sparks riots and violence across the region. 1947/48 -,The blaming process started soon after the inception of Pakistan when during the world’s biggest mass migration both states were unable to provide security to minorities. At that time there were 680 princely states and their future was to be decided according to their own will. Junagadh and Kashmir are two of these states which are still a bone of contention between India and Pakistan. Junagadh was composed of 88% Hindu Majority with a Muslim ruler named Nawab Mahabat Khan. The ruler voted for Pakistan but India did not accept it on the plea of heavy Hindu majority. One the other hand, the ruler of Kashmir, Hair Singh, wanted to join India but the majority of Muslim population was in the favour of Pakistan. Maharaja Hair Singh made a â€Å"stand still agreement† with the Government of Pakistan. However, the rumors spread in Pakistan that Mahraja Hari Singh was going to accede with India. The forces of Pakistan invaded in Kashmir in 1947 and Hari Singh asked India for help. Indian Armed forces violating the provision of their constitution entered into the jurisdiction of Kashmir. 1954 – The accession of Jammu and Kashmir to India is ratified by the state’s constituent assembly. 1957 – The Jammu and Kashmir constituent assembly approves a constitution. India, from the point of the 1954 ratification and 957 constitution, begins to refer to Jammu and Kashmir as an integral part of the Indian union. 1963 – Following the 1962 Sino-Indian war, the foreign ministers of India and Pakistan – Swaran Singh and Zulfiqar Ali Bhutto – hold talks under the auspices of the British and Americans regarding the Kashmir dispute. 1964 – Following the failure of the 1963 talks, Pakistan refers the Kashmir case to the UN Security Council. 1965 – Indo-Pakistani War of 1965 Full-scale hostilities erupted in September 1965 when Pakistan attacked India forcing India to attack Lahore in retaliation. India and Pakistan fight their second war. The conflict begins after a clash between border patrols in April in the Rann of Kutch (in the Indian state of Gujarat), but escalates on August 5, when between 26,000 and 33,000 Pakistani soldiers cross the ceasefire line dressed as Kashmiri locals, crossing into Indian-administered Kashmir. but as the war expands, Indian troops cross the international border at Lahore on September 6. The largest engagement of the war takes place in the Sialkot sector, where between 400 and 600 tanks square off in an inconclusive battle. By September 22, both sides agree to a UN mandated ceasefire, ending the war that had by that point reached a stalemate, with both sides holding some of the other’s territory. In 1965 India launched operation Meghdoot and captured 80% of Siachen Glacier. 1966 – On January 10, 1966, Indian Prime Minister Lal Bahdaur Shastri and Pakistani President Ayub Khan sign an agreement at Tashkent (now in Uzbekistan), agreeing to withdraw to pre-August lines and that economic and diplomatic relations would be restored. 971 – Pakistan and India go to war a third time, this time over East Pakistan. Bangladesh was created out of East Pakistan. 1971 was a black year in the history of Pakistan as she lost its eastern wing as India intervened to favour Bengali people and seized the Qasim part. 90, 000 Pakistani soliders surrendered in Bangladesh. India and Pakistan go to war a third time, this time over East Pakistan. Hostilities lasted 13 days, making this one of the shortest war s in modern history. East Pakistan becomes the independent country of Bangladesh on December 6, 1971 1972 -. Pakistani Prime Minister Zulifiqar Ali Bhutto and Indian Prime Minister Indira Gandhi sign an agreement in the Indian town of Simla, in which both countries agree to â€Å"put an end to the conflict and confrontation that have hitherto marred their relations and work for the promotion of a friendly and harmonious relationship and the establishment of a durable peace in the subcontinent†. Both sides agree to settle any disputes â€Å"by peaceful means†. The Simla Agreement designates the ceasefire line of December 17, 1971, as being the new â€Å"Line-of-Control (LoC)† between the two countries, which neither side is to seek to alter unilaterally, and which â€Å"shall be respected by both sides without prejudice to the recognised position of either side†. Nuclear Arm Race 1974 – On May 18, India detonates a nuclear device at Pokhran, in an operation codenamed â€Å"Smiling Buddha†. India refers to the device as a â€Å"peaceful nuclear explosive†. 1985- In December 1985, President Zia and Prime Minister Rajiv Gandhi pledged not to attack each other’s nuclear facilities. 986, the Indian and Pakistani governments began high-level talks to resolve the Siachen Glacier border dispute and to improve trade. 1988 – The change in leadership brought a new era of relation between the two rivals. In Dec 1988 Benazir Bhutto Shaheed and Rajiv Gandhi resumed talks on different issues melding cultur ed exchange, civil aviation and not to attack each other nuclear facilities. At that time BB said. â€Å"Burry the Hatchet; we have had enough of it. Let’s start a new chapter. India has a new generation leadership. Rajiv I belong to a new generation. We have some kinship. He father was assassinated and so was my father. He lost his brother and so have I we both can start from clean state. † The two countries sign an agreement that neither side will attack the other’s nuclear installations or facilities. Both sides agree to share information on the latitudes and longitudes of all nuclear installations. This agreementis later ratified, and the two countries share information on January 1 each year since then. 1989 – Armed resistance to Indian rule in the Kashmir valley begins. Muslim political parties, after accusing the state government of rigging the 1987 state legislative elections, form militant wings. Pakistan says that it gives its â€Å"moral and diplomatic† support to the movement, reiterating its call for the earlier UN-sponsored referendum. India says that Pakistan is supporting the insurgency by providing weapons and training to fighters, terming attacks against it in Kashmir â€Å"cross-border terrorism†. Pakistan denies this. Militant groups taking part in the fight in Kashmir continue to emerge through the 1990s, in part fuelled by a large influx of â€Å"mujahideen† who took part in the Afghan war against the Soviets in the 1980s. Indo-Pakistani Cold War Bilateral tensions increased in early 1990, when Kashmiri separatists from Pakistan occupied Kashmir backed by the Pakistan’s ISI perpetrated violence in Indian Kashmir. Subsequent high-level bilateral meetings relieved the tensions between Pakistan and India, 1991 – A formal â€Å"no attack† agreement was signed in January 1991. The two countries sign agreements on providing advance notification of military exercises, maneuvers and troop movements, as well as on preventing airspace violations and establishing overflight rules. 992 – A joint declaration prohibiting the use of chemical weapons is signed in New Delhi. 1993- but relations worsened again after terrorist bombings in Bombay, in March 1993. Talks between the Foreign Secretaries of both countries in January 1994 resulted in deadlock. 1996 – Following a series of clashes, military officers from both countries meet at the LoC in order to ease tensions. 1997, high level talks were resumed after 3 years. Prime Minister of India and Pakistan met twice and foreign secretaries conducted 3 rounds of talks in which they identified 8 outstanding issues to focuss. These 8 issues were †¢ Kashmir issue †¢ Water crisis †¢ Sir creek issue †¢ Rann of kutch †¢ MFN status †¢ Siachen issue †¢ State sponsored issue †¢ Nuclear Deterrence 1998 – In September 1997 the talks broke down on structural issue where as in May 1998 the situation became harder because of nuclear experiment conducted by Pakistan. India detonates five nuclear devices at Pokhran. Pakistan responds by detonating six nuclear devices of its own in the Chaghai Hills. The tests result in international sanctions being placed on both countries. In the same year, both countries carry out tests of long-range missiles. Improvement in Relations In the late 1990s, the Indo-Pakistani relationship veered sharply between rapprochement and conflict. After taking office in February 1997, Prime Minister Nawaz Sharif moved to resume an official dialogue with India. A number of meetings at the foreign secretary and Prime Ministerial level took place, with positive atmospherics but little concrete progress 1999 in feb,Indian Prime Minister Atal Bihari Vajpayee meets with Nawaz Sharif, his Pakistani counterpart, in Lahore. The two sign the Lahore Declaration, the first major agreement between the two countries since the 1972 Simla Accord. Both countries reaffirm their commitment to the Simla Accord, and agree to undertake a number of ‘Confidence Building Measures’ (CBMs). Some of the diplomatic gains are eroded, however, after the Kargil conflict breaks out in May. Kargil is the first armed conflict between the two neighbours since they officially conducted nuclear weapons tests. 2001 – Tensions along the Line of Control remain high, with 38 people killed in an attack on the Kashmiri assembly in Srinagar. In July, Pakistani President Pervez Musharraf and Indian Prime Minister Atal Behari Vajpayee meet for a two-day summit in the Indian city of Agra. That summit collapses after two days, with both sides unable to reach agreement on the core issue of Kashmir. On December 13, an armed attack on the Indian parliament in New Delhi leaves 14 people dead. India blames Lashkar-e-Taiba and Jaish-e-Muhammad for the attacks. 2002 – President Musharraf pledges that Pakistan will combat extremism on its own soil, but affirms that the country has a right to Kashmir. 2003 – After Musharraf calls for a ceasefire along he LoC during a UN General Assembly meeting in September, the two countries reach an agreement to cool tensions and cease hostilities across the defacto border. 2004 – Vajpayee and Musharraf hold direct talks at the 12th SAARC summit in Islamabad in January, and the two countries’ foreign secretaries meet later in the year. This year marks the beginning of th e Composite Dialogue Process, in which bilateral meetings are held between officials at various levels of government (including foreign ministers, foreign secretaries, military officers, border security officials, anti-narcotics officials and nuclear experts). In November, on the eve of a visit to Jammu and Kashmir, the new Indian prime minister, Manmohan Singh, announces that India will be reducing its deployment of troops there. 2006 – India redeploys 5,000 troops from Jammu and Kashmir, citing an â€Å"improvement† in the situation there, but the two countries are unable to reach an agreement on withdrawing forces from the Siachen glacier. In September, President Musharraf and Prime Minister Singh agree to put into place an Indo-Pak institutional anti-terrorism mechanism. 007 – The Samjhota express carnage of 18th February 2007 added fuel to fire. the train service between India and Pakistan (the Samjhauta Express) is bombed near Panipat, north of New Delhi. Sixty-eight people are killed, and dozens injured. The fifth round of talks regarding the review of nuclear and ballistic missile-related CBMs is held as part of the Composite Dialogue Process. The second round of the Joint Anti-Terrorism Mechanism (JATM) is als o held. 2008 – India joins a framework agreement between Turkmenistan, Afghanistan and Pakistan on a $7. 6bn gas pipeline project. A series of Kashmir-specific CBMs are also agreed to (including the approval of a triple-entry permit facility). In July, India blames Pakistan’s Inter Services Intelligence (ISI) directorate for a bomb attack on the Indian embassy in Kabul, which kills 58 and injures another 141. In September, Pakistani President Asif Ali Zardari and Indian Prime Minister Singh formally announce the opening of several trade routes between the two countries. In October, cross-LoC trade commences, though it is limited to 21 items and can take place on only two days a week. On November 26, 2008, a series of ten co-ordinated attacks were committed by terrorist which began across Mumbai which is the Indian financial capital and the largest city. The attack was started on 26 November 2008 and ended on 29 November 2008. In these attacks 173 people were killed including 35 foreigner where as 38 were wounded. India blamed Lashkar-e-Taiba .. Another reason was that Obama Discussed to solve Kashmir issue to bring stability in the South Asian region. This attack was done to divert his attention. In the wake of the attacks, India breaks off talks with Pakistan. 009 – The Pakistani government admits that the Mumbai attacks may have been partly planned on Pakistani soil, while vigorously denying allegations that the plotters were sanctioned or aided by Pakistan’s intelligence agencies. In August, India gives Pakistan a new dossier of evidence regarding the Mumbai attacks, asking it to prosecute Hafiz Mohammad Saeed, the head of Jamaat-ud-Dawa, an Isla mic charity with ties to Lashkar-e-Taiba. 2010 – In January, Pakistani and Indian forces exchange fire across the LoC in Kashmir, the latest in a string of such incidents that have led to rising tension in the area. In February, India and Pakistan’s foreign secretaries meet in New Delhi for talks. This meeting is followed by the two countries’ foreign ministers meeting in Islamabad in July. In May, Ajmal Kasab is found guilty of murder, conspiracy and of waging war against India in the Mumbai attacks case. He is sentenced to death. 2011 – In January, Indian Home Secretary GK Pillai says India will share information with Pakistan regarding the 2001 Samjhauta Express bombing. The two countries’ foreign secretaries meet in Thimpu, Nepal, in February, and agree to resume peace talks â€Å"on all issues†. 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Identifying Drug Concentrations Of Extemporaneously Prepared Sertralin

Question: Investigating the ease of identifying drug concentrations of extemporaneously prepared sertraline. Answer: Drug formulation consist of active ingredient and excipient. The proper design and formulation of dosage form requires proper standards of preparing formulation which include physical, chemical and biological characteristics. The active ingredient must be compatible with excipients and preservative in order to prepare stable formulation. In absence of licence drug, pharmacist prepare formulation with proper guidelines referred by drug regulatory bodies. These formulation are referred as extemporaneously prepared formulations. Stewart and Tucker surveyed that 116 drugs were extemporaneously prepared in Australian hospitals by pharmacists for paediatric use. The major problem associated with extemporaneously prepared formulation is unpleasant taste and lack of stability. Clinical data associated with these problems is not easily available in the research article. Adverse events were not reported which linked with extemporaneously prepared formulation. Policies protocol for extemporaneous preparation: An extemporaneous preparations should be used only when commercial product is not available and where you can prepare the product in compliance with accepted standards. Before starting preparation of extemporaneous products, some protocol should be followed by the pharmacies. Competent staff should be used to undertaken the task to be performed in the laboratory. Requisite facility and equipments must be available for preparation of the extemporaneous products. Proper safety measures should be taken while preparing the product. Ingredients must be taken from recognised pharmaceutical manufacturer and quality of the product must be maintained as per usage in preparation and manufacturing of product. Proper handling techniques must be considered while using hazardous products so that any risk related to substance can be avoided. Product should be properly labelled as per labelling guidelines which includes manufacturing date, expiry date, proper use of product, safety measures and stor age of the product where preparation is dispensed, patient and prescription details, date of dispensing and pharmacist involved in preparation. Limitations of extemporaneous preparations Extemporaneous preparations have been associated with quality defects, infectious disease outbreaks. Federal surveillance requirements are not available, hence quality and safety of compound is unknown. Limitations of Extemporaneous preparations includes the risk of non-standardised formulations, non-uniformity in dosing, microbiological contamination and a lack of stability in formulation. Pharmacies are not required to report adverse events related to extemporaneous preparations, the risk extent of compounded drug associated with morbidity and mortality cannot be assessed. Unlicensed drugs: Extemporaneous preparations in the pharmacies are at low quality assurance and at highest risk whereas licensed drugs manufacturers provide most robust quality assurance, efficacy and safety. Unlicensed drugs has cheaper cost than licensed drugs, because of low quality assurance and risk. Most unlicensed drugs are manufactured under special license represents intermediate level of quality and risk. The only difference between licensed and special drugs is that license drugs has evidence for pharmaceutical quality, safety and efficacy in clinical use whereas special drugs is much weaker and is not subjected to regulatory assessment. The study was conducted in U.S. in which unlicensed drugs were prescribed by doctors to outpatients teens. The study evaluated that as licensed drugs are expensive and for above 18 years, therefore sertraline extemporaneous products prepared from unlicensed drugs were given to most teen outpatient. Off label medicines Doctors may prescribe a cheaper off labelled alternative medicine, as long as this medicine is approved by the authoritative clinical guidelines and it is as effective as licenced version. The study was conducted to search new off labels indications for off labels drugs for psychotropic drugs. The efficacy of three dose levels sertraline compared with placebo in the treatment of nondepressed adults outpatient with obsessive compulsive disorder. A significant improvement was seen with patient in the sertraline group with 50 mg and 200 mg dose as compared to placebo group. The FDA approved sertraline for the treatment of OCD in 1997 (Bazzano, 2009). Legal review Sertraline was approved by FDA in 1991 on the recommendation of psychopharmacological drug advisory committee. In 2002, FDA approved sertraline for children aged from 6 yrs to older for OCD. In 2005, FDA added black box warning concerning paediatric suicidal behaviour. Problems with extemporaneous products Problems related to extemporaneous products are chemical instability, microbiological instability and physical instability. Extemporaneously prepared liquid formulations mainly are susceptible to chemical reaction leading degradation. Microbial growth in oral liquid formulation may cause foul odour, turbidity and adversely affect palatability and appearance. Extemporaneously prepared oral suspension are susceptible to suspension and this lead to sedimentation of insoluble drug. Chemical instability: Drugs in extemporaneously prepared may be susceptible to chemical reaction such as hydrolysis, oxidation and reduction and leads to degradation. Factors which may increase the rate of chemical reaction includes presence of trace metals which catalyse the oxidation. The rate of chemical degradation increases with increase in temperature. Microbiological instability: Microbial growth in an oral liquid may cause foul odour, turbidity and adversely affect palatability and appearance. By products of microbial metabolism changes pH, decrease chemical instability and solubility of drugs. Physical instability: Extemporaneously prepared drug suspension capable of causing sedimentation of insoluble drugs, thus forming caking. Difficulty in re-suspending the drug after shaking may cause wrong distribution of drug in the vehicle and causes erratic dose measurement. Specials- extemporaneous not sterile formulations Unlicensed medications are prescribed by the doctors and is known as specials in the industry. They are specially formulated for a specific patient needs and that is why they are unlicensed. Thus, there is no commercial interest. Specials extemporaneous products formulate in the industry, when drug is available in the tablet form and need to be formulated in the liquid form. Manufacturing of unlicensed drugs under the manufacture of special licence drugs is called special drugs. These drugs have intermediate quality and safety in comparison to licence products. But much better quality assurance and less risk assessment than extemporaneous formulation. Risks with drugs: The technical and clinical risk associated with extemporaneous preparations are: Formulation failure: The causes if formulation failure are numerous and can be complex, including physical incompatibilities, drug/excipient binding issues, drug degradation. Calculation error: Common calculation errors associated with extemporaneous preparations include converting units one to another (e.g. mg to g or conversion from weights in volumes to millimoles). Calculation errors leads to 1000 folds overdose (Kirsch, 2005). Starting materials: All staring material mainly those of animal origin, should be certified free from TSE. Care should be taken with the use of carcinogenic sugars such as sucrose in paediatric formulations as it has been associated with dental cavities. Health and safety risks: The risk to the operator should be considered. A control risk assessment should be carried out and any risk should be identified and evaluated before undertaking extemporaneous preparations. Legislation laws- EU for pediatric formulations It is recognized that extemporaneous pediatric formulations are not ideal. European Union in 2006, approved laws for companies to do the necessary research in children. Due to amendment of these laws, new scientific data has been generated for the appropriate usage of medications in children. The appropriate formulation allows children to participate in clinical trials for dose finding, efficacy and safety. Children has very heterogeneous population that includes newborns, infants, toddlers, preschoolers, school-age children, and adolescents. Therefore, different formulations are need to be developed with same active ingredient for appropriate testing in clinical trials. Procedure for pharmacists The preparations procedure includes all practical processes required for extemporaneous prepare, package, labelling, and ready to supply to assign patient. The processes includes prescription verification, worksheet and label generation, assembly of components, weighing, measurements of liquids, grinding tablets into uniform powders, mixing, reconciliation and packaging and labelling. Stability issues Due shortage of data available, pharmacist faced many problems related to extemporaneous product may not find a proper validated formula. In absence of publishing data, pharmacists should considered taking advice from quality assurance pharmacist or other personnel expert in preparing extemporaneous formulations. Considering stability issues following hints should be kept in mind such as: Shelf life: It is recommended that extemporaneous product should not be stored for more than 28 days if preserved and 7 days if unpreserved. Dosage form: The choice of dosage should be depend on the clinical situation and also the patient (such as age, ability to swallow). Chemical instability Drugs in extemporaneously prepared may be susceptible to chemical reaction such as hydrolysis, oxidation reduction which leads to degradation. Factors which may increase the rate of chemical reaction includes presence of trace metals which catalyse the oxidation. The rate of chemical degradation increases with increase in temperature. Safety considerations with excipients Excipient are expected to be pharmacologically inactive. All sweeteners containing sucrose and fructose may affect blood sugars, sorbitol and xylitol may cause osmotic diarrhea. Propylene glycol is commonly used as a solvent in oral, topical and injectable drugs. Patient aged less than 4 yrs. may accumulate propylene glycol due to decreased metabolism. Extemporaneous preparations without sufficient preservatives are more subtle to microbial contamination. Quality assurance and safety Quality assurance of extemporaneously prepared pharmaceuticals is of prime importance. Quality system should include all aspects of quality assurance and good preparation practice. It should describe the quality policy, should state scope of pharmaceutical quality system, should assess risk assessment, include process performance and quality monitoring, and policy and procedures for corrective and preventive actions. It should also include testing of stability, potency and sterility and safety consideration of excipients (Lowey A. and Jackson M., 2008). Excipients/preservatives One time dose of medication with preservative showed no toxicity risk in even premature neonates (McRorie, 1996). Multiple dose of medication with preservatives caused life threatening toxicity in neonates. The USFDA reported 16 death associated with benzyl alcohol in neonates which are caused from benzyl alcohol syndrome, the normal metabolic pathway for benzyl alcohol in adults are immature in premature neonates, thus leading to accumulation of benzyl alcohol (Brown, 1982). Ethanol caused CNS depressant, use of sucrose in formulations causes dental carries if used for long times. The examples discussed need to be used with extra care in preparing extemporaneous formulations particularly in case of children. Extemporaneous preparations of drugs/ increase stability of extemporaneous products When preparing extemporaneous drugs, shelf life of product should considered. Shelf life can be increased with proper use preservatives, which can increase stability of extemporaneous products. Selection of preservative should be based on various factors such as: Inhibit growth of microorganism, should be water soluble, not be in dissociated form, non-irritating and non-sensitizing, should be compatible with other active ingredients and should have adequate stability. Lack of stability studies Preparation of extemporaneous formulation in case of paediatric is based on experience rather than data from specific stability and sterility study. Published clinical studies in paediatric patient lack of dosage form and more than 20% articles lack to provide formulation used in the study. Lack of bioavailability pharmacokinetic and safety information Bioavailability and pharmacokinetic studies are rarely conducted for extemporaneous products. This is due to lack of financial resources and complexity of study conducted at healthcare premises. Thus, treatment involving extemporaneous products observed their efficacy and tolerability in patient. Reporting of adverse reactions to medicines According to USP compounding standards, adverse events related to extemporaneous formulation should be reported to USP MEDMARX program. Some state board stated to report adverse event in FDA Medwatch program, but none of these programs are mandatory for reporting adverse events from extemporaneous products, but are related to handle adverse events from manufacturing drug products. Safety/ limitations of extemporaneous products Extemporaneous products are not generally evaluated by controlled trials to establish effectiveness and tolerability in patients. As these studies are very expensive than bioavailability and pharmacokinetic studies, thus cannot be conducted by majorly extemporaneous products. Patient receiving extemporaneous products, should be monitored assure effectiveness and tolerability. Pediatric patients/ geriatric patients Therapeutic needs children are sufficiently different from those of adult. According to American society of paediatric, many children have been treated with medications which have no sufficient information also called off label drugs. Therefore, it has been seen that use of extemporaneous formulation and off label drugs are nor ideal. As paediatric drug development is now integral part of the development of new drug. Initial clinical testing need to be done in adult to demonstrate acceptable bioavailability and palatability. Once formulation is chosen, initial clinical study are done on children, once safety and efficacy of formulations are demonstrated. Lack of safety information in relation to geriatric extemporaneous drugs is major problem. Specific clinical data related to formulation for geriatric patient is missing in the research articles. In recent survey it was found that geriatric extemporaneous formulations data is missing in many renounced journals. Adverse events related to geriatric population does not filed. Introduction into the drug sertraline Sertraline is an antidepressant, belong to selective serotonin reuptake inhibitor class. It was introduced by Pfizer in 1991. It is primarily prescribed for major depressive disorders and obsessive compulsive, panic and social anxiety to children and adults. It is also effective for the treatment of social phobia and post traumatic disorders. Chemical structure of sertraline Chemical name of sertraline is (1S,4S)-4-(3,4-dichlorophenyl)-N-methyl-1,2,3,4-tetrahydronaphthalen-1-amine. Excipients of sertraline The inactive ingredients of sertraline are dibasic calcium phosphate dihydratehydroxypropyl cellulose, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, sodium starch glycolate and titanium dioxide. Pharmokinetics (ADME) /pharmodynamics/physical/chemical/properties Chemical and physical properties: Sertraline has mol. Wt. 306.22g/mol. It has molecular formula C17H17Cl2N with melting point 243-245C. Water solubility is 3.5mg/L. Pharmokinetics (ADME) /pharmodynamics A study was conducted to determine the pharmacokinetic and pharmacodynamics properties of sertraline. It is found that sertraline is absorbed readily through the GI tract. It comes in first order kinetics. Maximum plasma concentration reached in 4-8.4 hr. Serum levels are in steady state at 10-120 ng/mL of sertraline its desmethyl metabolites. Plasma protein binding is extensive (up to 98%) to both albumin alpha1-acid glycoprotein. Distribution of oral administered sertraline is biphasic with a prolonged absorption phase. The elimination phase begins 12-16 hrs. after the administration of drug. The volume of distribution has not been determined in humans but it is found that in rats it is more than 20 L/kg. Sertraline and its metabolites exhibit extensive distribution into tissues outside the blood. The elimination half-life of sertraline in humans is 24-25 hr. The clinically active desmethyl metabolite is eliminated more slowly than the parent drug with a half-life of approximatel y 66 hr. Unchanged sertraline is not detected in the urine. Side effects of sertraline and physiochemical properties Side effects of sertraline are mild agitation, mild sedation, moderately to severe GI effects and moderate to severe sexual effects (Hardman, 1996). Physiochemical properties: Sertraline has melting point 245C. Water solubility is 3.5mg/L. It is soluble in DMSO. The pharmacokinetic properties of sertraline are confirmed by physiochemical properties. In the study it was found out that sertraline has 9.16 logK value which indicates that the molecule is present mainly in the ionized (BH+) form in different compartments of the human body. Inonized state of GI tract is unfavourable to the absorption of sertraline which is balanced by high lipophilicity of sertraline. The logP value of sertraline is equal to zero which indicates the lack of H-bond formation and explains its high brain concentration (Deak, 2008). Degrades of sertraline A study was developed for the determination of degradation of sertraline. The spectrophotometric method was extended to stability study of sertraline. The drug was exposed to acidic, alkaline and oxidative and photolytic degradation. Oxidative degradation of drug was determined and with first order of rate of reaction (Deak, 2008). Extemporaneous formulation of sertraline Each mL of oral solution contains sertraline hydrochloride equivalent to 20 mg of sertraline. Other inactive ingredients are glycerine, alcohol, menthol and butylated hydroxytoluene (BHT). The oral concentrate must be diluted prior to administration. Toxicity Sertraline show dangerous interaction with MAO inhibitors (particularly long-acting MAO inhibitors).The resulting reactions referred as "serotonin syndrome". This syndrome typically includes restlessness, muscle twitches and myoclonus, hyper reflexia, sweating, penile erection, shivering and tremor with seizures coma. The reaction is often self-limiting if the diagnosis is made quickly the offending agents are discontinued (Hardman, 1996). Mechanism of action Sertraline is a selective 5-HT reuptake inhibitor. Sertraline through inhibition of 5-HT release, may cause beta-adrenoceptor down regulation. The exact mechanism of action sertraline is not fully known, but it selectively inhibit the reuptake of serotonin at the presynaptic membrane. This results in an increased synaptic concentration of serotonin in the CNS, which leads to numerous functional changes associated with enhanced serotonergic neurotransmission. According to given hypothesis, it has been found that obsessive-compulsive disorder is caused by the dysregulation of serotonin, as it is treated by sertraline which results in correcting the balance (Ellenhor, 1997). Articles related to sertraline liquid formulation A study was conducted on formulation and evaluation of fast dissolving buccal films of sertraline. In this study, the buccal films were prepared from polymers such as polyvinyl pyrrolidone, carbopol 934P in different ratios by solvent casting method. Propylene glycol or PEG 400 as plasticizers and mannitol or sodium saccharin as sweeteners. This formulation was evaluated by in-vitro drug release studies by USP dissolution apparatus and experimental data showed that this buccal film formulation release 90-95% sertraline drug in one hr. A study was conducted on the formulation development of sertraline hydrochloride micro emulsion for intranasal delivery. Objective of this study was to improve solubility of sertraline hydrochloride (STH) and then to formulate micro emulsions containing STH to accomplish rapid onset of action and to bypass the first-pass metabolism. Nasal absorption of micro emulsion sertraline drug was found to be 66-67% in in-vitro study. These results showed that sertraline micro emulsion is useful in depression. References: Aquilina A. 2013. The extemporaneous compounding of paediatric medicines at Mater Dei Hospital. Journal of the Malta College of Pharmacy Practice. Available at: https://www.mcppnet.org/publications/issue19-9.pdf.Australian government. SIRPDIS006A - Assist in preparing extemporaneous prescriptions. Available at: https://training.gov.au/Training/Details/SIRPDIS006A.Bazzano A. 2009. Off-Label Prescribing to Children in the United States Outpatient Setting. Academic Pediatrics. 9(2): 8188.Dek K. 2008. Physico-chemical profiling of centrally acting molecules for prediction of pharmacokinetic properties. https://phd.semmelweis.hu/mwp/phd_live/vedes/export/deakkatalin.e.pdf.Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 931.Extemporaneous preparation. 2012. Available at: https://www.dysphagia-medicine.com/extemporaneous-preparation.html.Glass B. 2006. Stability considerations in liquid dosage forms extemporaneously prepared from commercially available products. Pharm Pharmaceut Sci. 9(3):398-426.Guidelines for dispensing of medicines. Available at: https://apps.who.int/medicinedocs/documents/s17807en/s17807en.pdfGuidance for registered pharmacies preparing unlicensed medicines 2014. Available at: https://www.pharmacyregulation.org/sites/default/files/guidance_for_registered_pharmacies_preparing_unlicensed_medicines_23_05_14.pdf.Hardman, J.G., L.E. Limbird, P.B. Molinoff, R.W. Ruddon, A.G. Goodman (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill, 1996., p. 468Hardman, J.G., L.E. Limbird, P.B. Molinoff, R.W. Ruddon, A.G. Goodman (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill, 1996., p. 454)Jackson M and Lowey A (2010). Handbook of Extemporaneous Preparation. London. Published by Pharmaceutical Press.Kumar A. 2009. Fo rmulation development of sertraline hydrochloride microemulsion for intranasal delivery. Int.J. ChemTech Res. 1(4): 941-947.Lowey A., Jackson M. 2008. How to ensure the quality and safety of unlicensed oral medicines. The Pharmaceutical Journal. Available at: https://www.pharmaceutical-journal.com/opinion/comment/how-to-ensure-the-quality-and-safety-of-unlicensed-oral-medicines/10028707.article.Mahajan A. 2012. Formulation Evaluation of fast dissolving buccal films of Sertraline. Int. J. Drug Dev. Res. 4 (1): 220-226.Maldonado S., Schaufelberger D. 2011. Pediatric Formulations. American Pharmaceutical Review. Available at: https://www.americanpharmaceuticalreview.com/Featured-Articles/37186-Pediatric-Formulations/.Patel V. 2011. Extemporaneous dosage form for oral liquids. Pharmacophore. 2 (2): 86-103.Pub chem. National Center for Biotechnology Information. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/sertraline#section=Top.Professional Standards and Guidance for the Sa le and Supply of Medicines. Available at: https://www.rpharms.com/code-of-ethics-pdfs/coepsgssmeds.pdf.Rosenberg P. 2010. Sertraline for the treatment of depression in Alzheimer disease. Am J Geriatr Psychiatry.18(2):136-45.Royal pharmaceutical society. 2011. Pharmaceutical Issues when Crushing, Opening or Splitting Oral Dosage Forms. Available at: https://www.rpharms.com/support-pdfs/pharmaceuticalissuesdosageformsjune-2011.pdf.Sellers S. 2012. Pharmacy Compounding Primer for Physicians. Springer Open Choice. 72(16): 20432050.The Association of Pharmaceutical Specials Manufacturers Limited. 2011. Available at: https://apsm-uk.com/members/q-and-a.aspx.Walash M., Belal F., El-Enany N. 2011. Development and validation of stability indicating method for determination of sertraline following ICH guidlines and its determination in pharmaceuticals and biological fluids. Chem Cent J. 5(61). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3236309/.World health organisation (2011) . Report for WHO on findings of a review of existing guidance/advisory documents on how medicines should be administered to children, including general instructions on compounding preparations and manipulation of adult dosage forms. Available at: https://www.who.int/medicines/areas/quality_safety/quality_assurance/Review-findings-PaediatricMedicnesAdmin_QAS11-400Rev1_22082011.pdf.