Yomna Tarek Abo-shadi , Yomna Mohamed Abd el-Fatah Faculty of Pharmacy,

1. Literature Review of Gender and Drugs in Eastern Mediterranean Region IndecusMedicus YomnaTarekAbo-shadi, Yomna Mohamed Abdel-Fatah Faculty of Pharmacy, Alexandria University, Egypt

2. Abstract Problem statement:In recent years, concerted efforts have been taken by international and regional health organizations to promote women’s health and emphasize gender-related issues. One of the important concerns is shortage of scientific studies on areas related to women's health. This study was carried out to review the research studies available in the database of Index Medicus for the WHO Eastern Mediterranean Region (IMEMR). Objectives: To search the IMEMR on available studies on women and drugs, and encourage academic institutions to carry out scientific studies on important issues related to women and health. Design: This study was carried out by searching the IMEMR using key words relevant to women and medicine. IMEMR provides free access to the prestigious health and biomedical sciences literature published in the eastern Mediterranean Region. It contains more than 107,500 citations of peer-reviewed health and biomedical literature published in 483 journals from the region’s 19 countries. Results:A search of the IMEMR database using the key words women and drugs and gender and drugs resulted in 144 and 40 research articles, respectively. The main topics covered by these articles are (1) ovarian induction and related issues emphasizing that clomifene citrate may be correlated to increasing the risk of ovarian cancer; (2) pregnancy disorders and drugs indicating that irrational use of drugs and herbs can decrease pregnancy outcomes; (3) labour-related issues providing suggestions to manage complications related to cesarean section and anaesthesia; and (4) hormonal replacement therapy studying the effect of this therapy on bone mineral density and on insulin resistance in diabetic postmenopausal women. There were fewer reports found on the important topics of self-medication, contraceptives, mental health of women, dysmenorrhea, breast diseases, suicide and self harm. When searching the database with key words related to women and different disease conditions, several articles were found related to women and cancer, women and infection, women and mental health, women and trauma and women and sexual health. A few reports were also found related to women and musculoskeletal problems, sensory impairment and psychosocial considerations of menopause. Outcomes: A review report on research studies published in the Index Medicus concerning women and medicine in EMR countries. Conclusion: IMEMR provides an important database for research studies on women health. The database search indicated that many topics are well studied while other important areas related to women and medicines need more attention and research by academic community in EMR.

3. Introduction • After the emergence of significant interest in issues related to women health in recent years, we are interested to know if these issues have the same level of attention by the scientific research community in the WHO Eastern Mediterranean Region? • In order to answer this question, we searched the WHO, IndecusMedicus of Eastern Mediterranean Region (IMEMR). • Few biomedical journals from the Eastern Mediterranean Region of the World Health Organization are indexed in international indexing and abstracting services. • These journals publish scientific articles and information which is relevant to the countries of the Region and which is, in most cases, submitted by researchers from the Region. They contribute to the continuous education and scientific networking of many researchers. More important, they document and disseminate local health knowledge.

4. Introduction • The IMEMR covers currently journals from 19 countries in the Region: Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libyan Arab Republic, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates and Yemen.Itincludes all public health topics, medicine and all its subspecialties,environmentalhealth,dentistry, pharmaceutical, nursing, health management and administration and veterinary sciences in all languages of the Region. The Index itself is published in English. • IMEMR provides free access to the health and biomedical sciences literature published in the Eastern Mediterranean Region. It contains more than 107,500 citations of peer-reviewed health and biomedical literature published in 483 journals from the region’s 19 countries. • WHO/ EMRO also publishes the Eastern Mediterranean Health Journal, which is indexed in WHO/IMEMR. This journal publishes research articles from the countries of the region relevant to public health research areas. • The proper choice of keywords for searching the IMEMR is important to obtain useful results.

5. Objectives • The main objectives of this study are: • To search IMEMR database to get statistics that illustrate the extent of interest of the scientific research community in the countries of Eastern Mediterranean WHO Region with regard to various issues related to women health, especially the use of medicine. • To encourage academic institutions and approved research organizations in the region to increase heir research articles in areas related to women health issues.

6. Method • The method used for this research is to search the database using carefully selected keywords relevant to the topic of this study. • The main key words used in this study are: • Women and Drugs . • Women and Self medication. • Women and Herbal medicine. • Women and Antibiotics . • Women and Vitamins. • Women and Access to medicines . • Women and Access to health services. • Women and social and economic. • The outcome of this research was then reviewed and discussed to find out to what extent the issues related to women health and use of medicines were studied by the academic institutions in the region.

7. Results • Figure 1: Search results using keywords: Women and Medicines, Self medication, Herbal medicine, Antibiotics and Vitamins. • It is clear from the data shown in this figure that there are very few research studies in IMEMR database related to women and Medicines, Self medication, Herbal medicine, Antibiotics and Vitamins. • This indicates that research in the academic institutions in the region should be encouraged to pay more attention to research studies in topics related to women health. No. ofResearch articles

8. Results • Figure 2 : Search results using keywords: Women and Access to medicines, Access to Health services and Socioeconomic Status. • The results in this figure shows that the number of research articles on women and Access to medicine is only 6 articles out of articles on Access to medicines The 6 articles are mainly from Pakistan (3 articles) . No.ofResearch articles

9. Results • The number of research articles on Women and Access to health services are 11 articles out of articles on Access to health services . These articles are mainly from Pakistan (5 articles), Egypt (3 articles) and Iran (3 articles). • The number of research articles on Women and Socio-economic status (59 articles) are mainly come from Pakistan (18 articles) ,Iran (16 articles) and Egypt (12 articles).

10. Results • Women and socio-economic status. The findings in these articles indicate that low level of socio-economic status and awareness of women can lead to: 1) High risk of Maternal and fetal mortality and morbidity through: • HEV for pregnant woman in last trimester. • Pregnancy Hypertension. • Anemia, malnutrition and low birth weight baby. • Genital mycoplasma, vaginal infection and labor complications. 2)Late cervical cancer screening prevention. 3) Breast cancer. 4) Menopausal sexual dysfunction. 5) Postmenopausal osteoporosis. 6) Dependence on voluntary organizations and small hospitals with limited specializations and low health care quality.

11. Results • Women and use of medicines The results of the research articles on women and medicines showed that these studies covered the following disease conditions: A. Ovulation Induction • Ovulation Induction to treat women infertility is achieved by some agents as Clomiphene citrate and luteinizing hormone releasing hormone ,but they can cause some adverse effects such as: • Increarse risk of endometrioid ovarian cancer (clomiphene citrate) • Luteal phase defect (by:Bromocriptine, Antiestrogen and HMG/HCG). • Risk of myoma incidence. B. Poly Cystic Ovary Syndrome (PCOs) • It is a complex endocrine disorder in reproductive women. Perhaps linked to insulin resistance leading to hyperinsulineamia .Clomiphene citrate is a successful drug for ovulation induction for PCOs. • Clomipheneovulatory response can be increased by decreasing insulin secretion by Metformin , But some discrepancy in ovulation and pregnancy rate may occur. N-Acetyl-Cysteine is also a safe treatment.

12. Results C. Post Partum Hemorrhage (PPH) • PPH can be prevented by: • Some drugs such as oral or rectal Misoprostol which is effective as methyl ergometrine, but in addition it stabilize at room temperature , easy for administration and recommended for routine use anywhere. • Oxytocics which is administered after the second stage of labor. • Use of Oxytocin or Syntometrine[ergometrine+Oxytocin]. • Elevation of free radicals levels as Plasma Lipid Epoxide and Serum Nitric Oxide is evident in failed response to medical methods or ecbolic drugs. D. Cesarean Section (C/S) • C/S induction rate is higher by Dinoprostone than Misoprostol. • The use of suppository Diclofenac is an appropriate replacement therapy for pain relief after C/S. • Nalbuphine{3mg} was superior to Propofol {20mg} in treatment of intrathecal morphine induced pruritis after C/S.

13. Results E. Labor • Labor epidural anesthesia can be considered as reliable and safe method for vaginal delivery and reducing the number of unnecessary cesarean section. • Some aspects in labor pain control: • Origin of labor pain, indications and contra-indications of epidural anesthesia , techniques and drugs. • Pethidine is more analgesic than tramadol, but higher frequency of side effects. • Some painless labor complications: headache , motor nerve block ,meningitis, respiratory depression ,nausea, vomiting and urinary retention. • Atropine, Hyoscine and Promethazine reduce the rate of labor progress and increase risk of complications.

14. Conclusion and recommendation 1-WHO/IMEMR is a comprehensive database for the published research articles from various academic and research institutions in the region. The database is researchable and provides a good source of information on the scientific research activities . 2-The results of the search carried out in this study on topics related to women health and use of medicine indicated that the numbers of published research articles are very few. 3-Certain topics are studied to a reasonable extent while other important topics are not sufficiently studied. 4-Examples of important areas that need more attention from the scientific community in the region are: • Medicines during pregnancy. • Herbal medicines and pregnancy. • Women and healthy diet. • Women and chronic diseases risk factors.