Healthcare professionals' understanding and perception of drug-related issues linked to off-label pharmacological medications used for COVID-19

BACKGROUND

To evaluate the opinions of healthcare workers regarding drug therapy problems linked to anti-infective medicines used for the treatment of COVID-19 infection in Pakistan.

RESEARCH METHODOLOGY

This cross-sectional study was conducted from January to October 2022 using a self-administered questionnaire developed by the authors, having three sections: demographics, knowledge, and perception. The study was validated by research experts and pilot-tested on 30 subjects. The study included medical doctors, nurses, pharmacists from Punjab's government and private medical institutes.

RESULTS

In this study, 382 of 400 participants replied. The mean knowledge score was 9.52 (SD 2.97), showing that participants had adequate knowledge of COVID-19 pharmacological interventions. The knowledge scores were significantly higher of those who treated COVID-19 patients and were from Lahore. Many doctors considered that elderly patients and those with blood disorders were at greater risk of experiencing drug-related problems. Most pharmacists support electronic prescription systems. Many doctors thought the lack of unified treatment guidelines, multiple prescribers, and self-medication were key obstacles in managing COVID-19 patients.

CONCLUSION

Most respondents had adequate knowledge. Older patients with comorbidities are at risk of adverse effects. Self-medication, polypharmacy, and multiple prescriptions can lead to misdiagnosis and complications. Electric prescriptions, team effort, and training programs can decrease these issues.

Evaluation of healthcare professionals' understanding of fluoroquinolones' safety profile, usage, and boxed warnings in Pakistan

INTRODUCTION

Fluoroquinolones (FQs) is a distinct class of antibiotics which are prescribed and used quite frequently worldwide, despite the box warnings (BW) issued by Food and Drug Administration (FDA). Literature has shown in spite of BWs related to FQs there is minimal impact on health care professionals (HCPs) prescribing habits, potentially attributing towards limited and insufficient awareness. In Pakistan, FQs are mostly prescribed antibiotics for microbial treatments, therefore the purpose of this study was to determine the level of knowledge about the safety profile, use, and BW of FQs among HCPs working in Pakistan.

METHODS

A cross-sectional study was undertaken among the HCPs of Khyber Pakhtunkhwa province of Pakistan from October 2022 to December 2022. A validated questionnaire was used to assess the knowledge of HCPs regarding FQs, its safety profile and BW. A random convenient sample technique was used while recruiting HCPs in this study. As the HCPs comprised physicians, dentists, pharmacist and nurses, all were approached in person and the study objective was fully elaborated and explained to them. The statistic test like: one-way ANOVA, independent-t test, multivariate logistic regression were used keeping the p-value < 0.05 as statistically significant.

RESULTS

A total of n = 250 HCPs were approached, of which n = 186 HCPs completed the questionnaire with a response rate of 74.4%. FQs prescribing pattern was only assessed among the prescribers, i.e., physicians and dentists (39/186). The mean knowledge score for indications was 5.29 ± 3.05, while for the adverse effects was 7.70 ± 2.61. The highest score for knowledge for indications and adverse effect score was achieved by physicians followed by dentist. The mean knowledge score for the BW was 3.46 ± 2.93 and among the HCPs for the BW of FQs, 20.4% of the HCPs had appropriate knowledge score (score ≥ 50%). The knowledge score was significantly higher in males (p = 0.039), dentists (p = 0.001), HCPs having master/specialization level of education (p = 0.003), HCPs working in government sector hospitals (p = 0.010) and secondary care hospitals (p = 0.001) while the multivariate logistic regression analysis showed that HCPs working in primary care hospital (OR: 6.2) and secondary care hospital (OR: 20.3) were associated with the tendency to achieve 50% or above knowledge score.

CONCLUSION

 Findings of this study reveals the unsatisfactory knowledge of HCPs regarding the safety profile, use, and BW of FQs putting patients at heightened risks of FQs associated AEs. Therefore, it is crucial to implement a national antimicrobial stewardship program, seminars and lectures aimed at continuously updating the knowledge of HCPs, regardless of their specialties, and effectively restrict the misuse of antimicrobial and disseminate FDA BWs in clinical practice.

Knowledge, attitude and perceptions of pharmacists regarding renal dose adjustment among chronic kidney disease patients in Pakistan

BACKGROUND

Chronic kidney disease (CKD) poses a significant public health challenge. CKD patients have compromised renal function, which not only alters the pharmacokinetics of drugs but also their pharmacodynamics. Adjusting drug doses for these patients is essential to achieve the intended clinical outcomes, prevent adverse drug events, and halt further progression of the disease. Pharmacists play a pivotal role in ensuring safe and appropriate therapy for CKD patients. However, there is a noticeable absence of national dosing guidelines for CKD in Pakistan, coupled with a scarcity of studies exploring the knowledge, attitude, and perception of renal dose adjustments in the country. This study aimed to evaluate the knowledge, attitudes, and perceptions of pharmacists in the Khyber Pakhtunkhwa province and Islamabad regarding renal dose adjustments.

METHODOLOGY

A cross-sectional study was conducted to gauge the knowledge, attitude, and perception of pharmacists working in various cities of Khyber Pakhtunkhwa and the capital city, Islamabad, from February to May 2023. The Renal Dosing Questionnaire-13 (RDQ-13) scale was employed for this purpose. The survey link was disseminated through emails, and the RDQ-13 scale was also completed in person by pharmacists from hospitals, clinics, community, and retail settings who interact with CKD patients. Univariate linear regression was employed, and factors with a p value < 0.25 were subjected to multivariate linear regression. For comparing knowledge, attitude, and perception scores of pharmacists, the independent t test and one-way ANOVA were utilized as appropriate. A p value < 0.05 was deemed statistically significant.

RESULTS

Of the 384 pharmacists approached, 270 completed the RDQ-13 scale, resulting in a response rate of 70.3%. The overall knowledge score regarding renal dose adjustment was 21.24 ± 2.18 (mean ± SD). Attitude scores averaged at 10.04 ± 1.81, and perception scores at 7.19 ± 2.15. Multivariate analysis indicated a positive correlation between the pharmacists' perception scores and gender, with male pharmacists scoring higher than their female counterparts.

CONCLUSIONS

The study underscores the importance of instituting targeted training programs for pharmacists, ensuring access to dependable resources, and promoting research and results dissemination in the realm of renal pharmacotherapy to enhance public health outcomes.

Challenges of having a child with thalassemia in Pakistan: A phenomenological study

BACKGROUND

Thalassemia is a persistent hemolytic disease and has debilitating effects on patients and their parents. Parents of these children experience pain and suffer from additional emotional strain as they provide daily and lifetime care and are mostly concerned about the health and future of their children.

AIM

The study aimed to understand the experiences of parents of children with thalassemia related to their family, financial, social, treatment, and psychological issues in Pakistan.

METHODS

This descriptive phenomenological study recruited 21 parents of children with thalassemia through purposive sampling until data saturation was achieved. Analysis of transcribed interviews was performed through Colaizzi's method and themes and subthemes revolving around diagnosis, challenges, and treatment issues were extracted.

FINDINGS

A total of 21 Pakistani parents participated in this study. Most of the participants were females (n = 16, 76.19%), housewives/stay-at-home moms (n = 13 (61.90%), and were uneducated (n = 6, 28.57%). Regarding genetic traits, only three (14.28%) parents declared that they had genetic traits of thalassemia. The findings of our study revealed that thalassemia is enormously influenced by psychosocial and economic problems because of this disease in their families.

CONCLUSION

Our findings indicated that parents of these children face multi-faceted challenges, such as physical, socio-emotional, financial, and familial. These findings may lead to an adequate understanding of their individual needs and efficient utilization of supportive and care programs.

PRACTICE IMPLICATIONS

An understanding of such experiences, involving those distinctive to Pakistani culture, is especially vital to inform the care of these children and enhance their quality of life.

Phylogenetic relationships of a novel bat fly species infesting the geographically widespread Old World fruit bat, Rousettus leschenaultii, in Southern Asia

The global epidemiological significance of bats and their blood-sucking ectoparasites is increasingly recognized. However, relevant data are scarce from Pakistan where the Palearctic and Oriental zoogeographic regions meet. In this study, 200 bats belonging to five species were examined for the presence of ectoparasites in Pakistan. Bat flies were found only on Leschenault's fruit bat (Rousettus leschenaultii). The prevalence of infestation did not correlate with habitat type and host traits including age, reproductive status, and sex. All bat flies represented the same Eucampsipoda species which was shown to be morphologically different from all species of its genus with known south Asian distribution and belonged to a separate phylogenetic group. These results highlight the existence of a hitherto undescribed bat fly species in southern Asia, which is not shared by the fruit bat species (R. leschenaultii) and insectivorous ones (e.g., Rhinopoma microphyllum) thus probably playing a role only in intraspecific transmission of pathogens.

Erratum: Can Pharmacists' Counseling Improve the Use of Inhalers and Quality of Life? A Prospective "Pre" and "Post" Education Analysis in Mardan, Pakistan [Corrigendum]

[This corrects the article DOI: 10.2147/JAA.S405943.].

Can Pharmacists' Counseling Improve the Use of Inhalers and Quality of Life? A Prospective "Pre" and "Post" Education Analysis in Mardan, Pakistan

Introduction

Asthma is one of the common major non-communicable respiratory diseases, and is associated with a lower health-related quality of life (QOL). Poor inhalation is a significant contributing factor to poor control of asthma. Community pharmacist has a vital role to play in assisting patients and ultimately improving their asthma conditions through the use of inhalers.

Aim

This study aimed to assess the effectiveness of "pre" and "post" educational intervention by a community pharmacist within a community pharmacy on asthma patients' QOL, inhaler technique, and adherence to therapy during the endemic phase of COVID-19.

Methods

A "pre" and "post" interventional study was performed at a community pharmacy in the city of Mardan, Pakistan, in 2022 during the COVID-19 pandemic. Patients were divided into two groups, ie control and pharmacist-led education groups. After assigning patients to both groups, the baseline data were collected and followed for one month to compare the reduction in errors in the use of inhalers, QOL, and adherence to therapy. A paired sample t-test was performed, keeping a p-value <0.05 as statistical significance.

Results

A total of 60 patients were recruited, majority (58.3%) were females, and 28.3% were from the age group of 46-55 years old. A statistically significant difference was observed in the pre- and post-education QOL score among patients in the pharmacist-led education group, from a mean ± SD at pre-education of 40.23±10.03 to a mean±SD at post-education of 48.10±5.68. Similarly, a statistically significant difference was observed for the correct use of inhalers, ie MDIs and DPIs. Similarly, a statistically significant difference was observed in the adherence status between pre-education and post-education by pharmacists.

Conclusion

The findings of the study revealed a positive impact of community pharmacist-led education on QOL, inhaler technique, and adherence to therapy among patients with asthma.

Self-harm and suicidal ideation in Pakistani youth amid COVID-19 pandemic: findings of a large, cross-sectional study

Suicide is the fourth leading cause of death among young people. COVID-19 pandemic has exacerbated various factors which could lead to suicidal ideation. Therefore, this study was aimed to assess self-harm and suicidal ideation among university students in Pakistan. We conducted an online, cross-sectional study among students of four major Pakistani universities. The generalized anxiety scale and patient health questionnaire were used to screen students for anxiety, depression and suicidal ideation/self-harm. Suicidal ideation/self-harm was determined from the ninth-item (score ≥1) of the patient health questionnaire. Brief-COPE was used to assess coping methods. This study included 1134 respondents (age 21.76 ± 3.48 years; female 70.5%). Around 32% students reported having thoughts of death and/or self-harm in the past 2 weeks (several days 14.8%, over half the days 7.1%, and nearly every day 10.2%). Moreover, these thoughts were equally prevalent among the demographics. Suicidal ideation/self-harm was found to be increased by the severity of generalized anxiety and depression (p < 0.001). In conclusion, the rate of suicidal ideation/self-harm is alarmingly high in Pakistani university students during the COVID-19 pandemic. There is a dire need to initiate the psychological measures to prevent suicidal behaviors in Pakistani youth. Addressing mental health disparities and preparing support systems to mitigate mental health consequences as the pandemic evolves will continue to be needed urgently.

Quality of life and wellbeing among breast cancer patients in Lahore, Pakistan

Background

Breast cancer has a high incidence rate, emphasizing the necessity of enhanced information on health-related quality of life (HrQOL) in this population of patients. The aim of this study was to identify the factors influencing the QOL experienced by patients in Pakistan.

Methods

A cross-sectional study was conducted on women with breast cancer, and four instruments were used on a random sample of 130 Pakistani women: FACIT-B Version 4 questionnaire,WHO causality assessment scale, Naranjo's algorithm, and a demographic/clinical characteristics section. Data analysis included descriptive analysis, independent sample t-test, and analysis of variance (ANOVA) test.

Results

The patients' mean age was 49.10 (standard deviation (SD) 10.89); 98.5% were married. The mean score was 18.34 for physical wellbeing (SD 5.92; interquartile range (IQR) 11), 16.33 for social/family wellbeing (SD 6.3; IQR 11.25), 13.6 for emotional wellbeing (SD 3.55; IQR 6), 17.13 for functional wellbeing (SD 3.73; IQR 6), and 24.86 for breast cancer subscale (SD 3.64; IQR 4). The study found that the age, entitlement, recurrence, marital status, salary, number of doses, duration of cancer treatment, and chemotherapy sessions were significantly related to QOL terms in the assessment of the FACIT-B scale. The WHO causality evaluation scale determined that 78.1% of the responses were "probable" and 20.1% were "possible". According to Naranjo's algorithm assessment scale, 80% of adverse drug reactions (ADRs) were "probable", whereas 18.4% were declared "possible". Chemotherapy-induced anemia was the most often reported ADR in 64.6% of patients, followed by chemotherapy-induced nausea and vomiting (61.5%).

Conclusion

Healthcare practitioners must acknowledge and take into account the significance of QOL in addition to therapy for breast cancer patients in order to enhance their health. The findings of this study will aid in filling gaps in current unknown knowledge and identifying sites where patients require additional assistance. Because cancer and chemotherapy clearly have a negative impact on individuals' QOL, oncologists must concentrate on strategies that help cancer patients during their sickness and treatment while also enhancing self-care and QOL. Those with cancer will benefit from emotional wellbeing and adaptation to their disease.

Clinical Disease Characteristics and Treatment Trajectories Associated with Mortality among COVID-19 Patients in Punjab, Pakistan

BACKGROUND

Data on Pakistani COVID-19 patient mortality predictors is limited. It is essential to comprehend the relationship between disease characteristics, medications used, and mortality for better patient outcomes.

METHODS

The medical records of confirmed cases in the Lahore and Sargodha districts were examined using a two-stage cluster sampling from March 2021 to March 2022. Demographics, signs and symptoms, laboratory findings, and pharmacological medications as mortality indicators were noted and analyzed.

RESULTS

A total of 288 deaths occurred out of the 1000 cases. Death rates were higher for males and people over 40. Most of those who were mechanically ventilated perished (OR: 124.2). Dyspnea, fever, and cough were common symptoms, with a significant association amid SpO2 < 95% (OR: 3.2), RR > 20 breaths/min (OR: 2.5), and mortality. Patients with renal (OR: 2.3) or liver failure (OR: 1.5) were at risk. Raised C-reactive protein (OR: 2.9) and D-dimer levels were the indicators of mortality (OR: 1.6). The most prescribed drugs were antibiotics, (77.9%), corticosteroids (54.8%), anticoagulants (34%), tocilizumab (20.3%), and ivermectin (9.2%).

CONCLUSIONS

Older males having breathing difficulties or signs of organ failure with raised C-reactive protein or D-dimer levels had high mortality. Antivirals, corticosteroids, tocilizumab, and ivermectin had better outcomes; antivirals were associated with lower mortality risk.

A systematic review on the effectiveness of herbal interventions for the treatment of male infertility

Background: Male infertility is an emerging health issue in the world today. Surgical interventions for the treatment of male infertility are available but are quite expensive. Herbal interventions pose a popular alternative for the treatment of infertility. However, much has to be learned regarding their safety and efficacy. Objective: The aim of the study was to investigate the efficacy of herbal interventions in male infertility and also assess the possibility of these interventions as complementary and alternative medicine (CAM) in the future. Method: From inception until 16 December 2021, all articles emphasizing the efficacy of herbal interventions in the treatment of male infertility are included in this review. Seven databases are searched. The literature obtained is screened and extracted. Semen parameters, hormonal concentration, and conception are the outcomes of interest. Results: A total of 19 articles were included in this review. Herbal interventions might improve semen parameters in males with infertility. Among all the interventions, Hochu-ekki-to and W. somnifera have shown the most promising results and should be studied further in a larger sample size. Conclusion: This systematic review has demonstrated the efficacy of herbal interventions, especially Hochu-ekki-to and W. somnifera, in treating male infertility.

Evaluation of Conspiracy Beliefs, Vaccine Hesitancy, and Willingness to Pay towards COVID-19 Vaccines in Six Countries from Asian and African Regions: A Large Multinational Analysis

Vaccination protects people from serious illness and associated complications. Conspiracy theories and misinformation on vaccines have been rampant during the COVID-19 pandemic and are considered significant drivers of vaccine hesitancy. Since vaccine hesitancy can undermine efforts to immunize the population against COVID-19 and interferes with the vaccination rate, this study aimed to ascertain the COVID-19-vaccine-related conspiracy beliefs, vaccine hesitancy, views regarding vaccine mandates, and willingness to pay for vaccines among the general population. A web-based, cross-sectional survey was conducted (April−August 2021) among the adult population in six countries (Pakistan, Saudi Arabia, India, Malaysia, Sudan, and Egypt). Participants were recruited using an exponential, non-discriminate snowball sampling method. A validated self-completed electronic questionnaire was used for the data collection. All the participants responded to questions on various domains of the study instrument, including conspiracy beliefs, vaccine hesitancy, and willingness to pay. The responses were scored according to predefined criteria and stratified into various groups. All data were entered and analyzed using SPSS version 22. A total of 2481 responses were included in the study (Pakistan 24.1%, Saudi Arabia 19.5%, India 11.6%, Malaysia 8.1%, Sudan 19.3%, and Egypt 17.3%). There was a preponderance of participants ≤40 years old (18−25 years: 55.8%, 26−40 years: 28.5%) and females (57.1%). The average score of the COVID-19 vaccine conspiracy belief scale (C19V-CBS) was 2.30 ± 2.12 (median 2; range 0−7). Our analysis showed that 30% of the respondents were found to achieve the ideal score of zero, indicating no conspiracy belief. The mean score of the COVID-19 vaccine hesitancy scale (C19V-HS) was 25.93 ± 8.11 (range: 10−50). The majority (45.7%) had C19V-HA scores of 21−30 and nearly 28% achieved a score greater than 30, indicating a higher degree of hesitancy. There was a significant positive correlation between conspiracy beliefs and vaccine hesitancy (Spearman’s rho = 0.547, p < 0.001). Half of the study population were against the vaccine mandate. Respondents in favor of governmental enforcement of COVID-19 vaccines had significantly (p < 0.001) lower scores on the C19V-CBS and C19V-HS scale. Nearly 52% reported that they would only take vaccine if it were free, and only 24% were willing to pay for COVID-19 vaccines. A high prevalence of conspiracy beliefs and vaccine hesitancy was observed in the targeted countries. Our findings highlight the dire need for aggressive measures to counter the conspiracy beliefs and factors underlying this vaccine hesitancy.

Evaluation of knowledge and practices about administration and regulations of high alert medications among hospital pharmacists in Pakistan: findings and implications

BACKGROUND

A death of a nine months old child in Pakistan following the rapid administration of potassium chloride raised serious concerns on the awareness of appropriate use of high alert medications (HAMs) among healthcare professionals (HCPs). This study aimed to ascertain HAMs-related knowledge among hospital pharmacists in Pakistan.

METHODOLOGY

A cross-sectional study using exponential non-discriminative snowball sampling was conducted among hospital pharmacists in healthcare settings in Punjab, Pakistan. A validated study tool was used to determine knowledge on administration, regulation, and practices related to the HAMs. Barriers to conducting HAMs training in the hospitals were assessed from an open-ended question. All quantitative data were analyzed using SPSS 22.0 while the content analysis was performed on the qualitative data.

RESULTS

A total of 202 hospital pharmacists were included in the study. The mean knowledge score for HAMs administration and regulation were 5.86 ± 1.89 (95% CI 5.60-6.12) and 7.25 ± 1.70 (95% CI 7.02-7.49), respectively. Approximately half of the respondents (49.5%) achieved scores ≥ 70%, demonstrating sufficient knowledge of HAMs. In the multivariable-adjusted model, increasing age and work experience were found to be the positive predictors of good HAMs knowledge. The mean practice score was 36.42 ± 1.97 (95% CI 34.05-38.77), with 62.4% of pharmacists following good HAMs-related practices. We identified several barriers to conducting HAMs training through qualitative analysis. These barriers included lack of knowledge, poor attitude and behavior of medical and paramedical staff, false beliefs, lack of active support by hospital administration, lack of cooperation between HCPs, lack of opportunities, heavy workload, insufficient human resources, financial constraints, and lack of motivation.

CONCLUSIONS

A significant proportion of the hospital pharmacists had unsatisfactory knowledge and practices of HAMs. These findings underscore that training on HAMs should be conducted periodically as a part of hospital-based pharmacy education to maximize drug safety.

Knowledge, perceptions, and attitudes by residents in Punjab and Khyber Pakhtunkhwa, Pakistan in connection with bats

BACKGROUND

Fruit bats play an important role in pollination and seed dispersal, and their conservation is important to maintain the productivity of some crops and natural ecosystems. The objective of this study was to investigate the knowledge, attitudes, and perception of fruit bats by orchard farmers and agricultural communities in Pakistan.

METHODS

The present survey was conducted in two districts (i.e. Sheikhupura and Malakand districts) within Punjab and Khyber Pakhtunkhwa provinces based on the higher number of fruit growing areas and bat roosting sites. A total of 200 (100 per district) close-ended questionnaires with 53 questions were administered to randomly selected respondents within the selected communities associated with fruit orchards, including orchard owners, laborers, and members of the surrounding community. Each questionnaire was divided into seven sections (i.e., demographic information, environmental and public health effects of bats, knowledge about bats, perception and control of bats, non-lethal methods adopted to control bats, and different myths about bats).

RESULTS

A majority of respondents (59%, n = 118) mis-classified bats as birds instead of mammals despite more than 84% reporting that they have observed bats. Nearly 71.5% of orchard farmers perceived that their fruits are contaminated by bats during consumption, and a majority believe that bats destroy orchards (62.5%) and are responsible for spreading disease. Mythology about bats was ambiguous, as 49% of those surveyed did not perceived bats to bring good luck (49%), and 50% did not perceived them to be bad omens either. Most respondents have never killed a bat (68%) nor would they kill a bat if given the opportunity (95%). Regarding the control of bats, the greatest percentage of respondents strongly disagree with shooting bats (36%) and strongly agree with leaving bats alone (42.5%).

CONCLUSIONS

This study provides a better understanding of the sociodemographic factors associated with knowledge, attitude and perception of bats from fruit orchard owners, labourers and local people. We recommend educational interventions for targeted groups in the community, highlighting the ecosystem services and importance of bat conservation to improve people's current knowledge regarding the role of bats and reduce direct persecution against bats.

Impact of Pharmacist-Led Diabetes Self-Care Education on Patients With Type 2 Diabetes in Pakistan: A Randomized Controlled Trial

Introduction: There is a little evidence on efficacy of pharmacy-based interventions on clinical outcomes of type 2 diabetes mellitus (T2DM) patients in Pakistan.

Objective: To appraise the impact of pharmacist-led self-care education on glycemic control, self-care practices and disease knowledge of T2DM patients with poor glycemic control (HbA1c ≥ 7%).

Methods: In this 6-months, randomized controlled trial (RCT), n = 75, T2DM patients seeking care at a diabetes clinic were randomized in to two groups. Intervention group (n = 38) received two face-to-face educational sessions (at enrollment and on week 12), whereas control group (n = 37) received usual care. Outcome measures such as glycemic control, self-care practices and disease knowledge were assessed at the time of enrollment and after 6-months in both groups.

Results: Thirty-three intervention and thirty-three participants from the control group completed the study. Mean glycated hemoglobin (% HbA1c) significantly reduced in the intervention group from 9.00 ± 1.43 to 8.09 ± 1.16 (p < .01). However, no significant change was observed in the control group (9.20 ± 1.24 to 8.93 ± .97; p = .06). Cohen’s d effect size of the intervention on HbA1c was .78. Percentage of participants achieving glycemic control (HbA1c < 7%) were significantly higher (p < .05) in the intervention group as compared to the control group (twenty-four vs. six), after 6 months of the trial. A significant (p < .01) improvement in mean scores for disease knowledge and self-care activities was also observed in the intervention group participants, whereas no significant improvements (p > .05) were observed in the control group.

Conclusion: The study demonstrated an improvement in glycemic control, disease knowledge and self-care activities of T2DM patients who received pharmacist-led educational intervention. The study findings support clinical significance of integrating pharmacy-based interventions in diabetes management.

A qualitative insight into the perceptions and COVID-19 vaccine hesitancy among Pakistani pharmacists

A qualitative exploration of pharmacists’ perceptions regarding COVID-19 conspiracies and their willingness to get vaccinated. A semi-structured questionnaire guide was developed using ground theory to conduct in-depth interviews. A total of 36 participants gave consent for an audio-recorded interview. Results have shown that most of the respondents believed that SARS-CoV-2 is a natural virus, not man-made, that causes a disease just like other viruses and it is absurd to believe that the vaccine is being used by foreign powers for the implantation of microchips just to control humans. A general opinion thatwhich reflected from the in-depth interview is that the pharmaceutical companies may be hiding some important information on COVID-19 to promote the sale of their product. Some doubts on the reliability and trustworthiness on the COVID-19 vaccine safety and efficacy data were noticed among the respondents. Factors leading to COVID-19 vaccine hesitancy were adverse reaction, cost of COVID-19 vaccine, and limited data on safety and efficacy profile of COVID-19 vaccine. COVID-19 vaccine hesitancy among health professionals is a major hindrance to our current fight against COVID-19 pandemic. Findings of this study are alarming, and the stakeholders must consider this ongoing vaccination campaign as an opportunity to formulate a mechanism to ensure high vaccination rate among general public and healthcare providers in Pakistan.

KEY POINTS

What was already known?

According to World Health Organization (WHO), vaccine hesitancy is one of the ten major threats to global healthcare system and it is a major barrier to achieve herd immunity around the globe.

Pakistan has begun vaccinating its people in a systematic phase-wise manner under which the healthcare workers and elderly people are prioritized for vaccination.

Previous experience tells us that vaccine hesitancy is a major problem in Pakistan and it is better to understand perceptions of pharmacists about COVID-19 vaccine who are the primary source of information for most of general population.

What this study adds:

This study is first of its kind to explore vaccine hesitancy among Pakistani pharmacists and the results of this study show that majority of the participants were willing to get COVID-19 vaccine and few of them have even got themselves vaccinated at the start of vaccination campaign.

Many among the willing participants considered cost of vaccine, adverse reactions, limited data, safety, and efficacy as major hindrance to their decision to get vaccine.

Few participants were found highly vaccine-hesitant because of their staunch belief in the prevalent myths and rumors about COVID-19 vaccine.

Effectiveness of Pharmacological Intervention Among Men with Infertility: A Systematic Review and Network Meta-Analysis

Background. Infertility is an emerging health issue for men. Comparative efficacy of different pharmacological interventions on male infertility is not clear. The aim of this review is to investigate the efficacy of various pharmacological interventions among men with idiopathic male infertility. All randomized control trials evaluating the effectuality of interventions on male infertility were included for network meta-analysis (NMA) from inception to 31 April 2020, systematically performed using STATA through the random effect model. The protocol was registered at PROSPERO (CRD42020152891). Results. The outcomes of interest were semen and hormonal parameters. Treatment effects (p < 0.05) were estimated through WMD at the confidence interval of 95%. Upon applying exclusion criteria, n=28 RCTs were found eligible for NMA. Results from NMA indicated that consumption of supplements increases sperm concentration levels [6.26, 95% CI 3.32, 9.21] in comparison to SERMs [4.97, 95% CI 1.61, 8.32], hormones [4.14, 95% CI 1.83, 6.46], and vitamins [0.15, 95% CI -20.86, 21.15)] with placebo, whereas the use of SERMs increased percentage sperm motility [6.69, 95% CI 2.38, 10.99] in comparison to supplements [6.46, 95% CI 2.57, 10.06], hormones [3.47, 95% CI 0.40, 6.54], and vitamins [-1.24, 95% CI -11.84, 9.43] with placebo. Consumption of hormones increased the sperm morphology [3.71, 95% CI, 1.34, 6.07] in contrast to supplements [2.22, 95% CI 0.12, 4.55], SERMs [2.21, 95% CI -0.78, 5.20], and vitamins [0.51, 95% CI -3.60, 4.62] with placebo. Supplements boosted the total testosterone levels [2.70, 95% CI 1.34, 4.07] in comparison to SERMs [1.83, 95% CI 1.16, 2.50], hormones [0.40, 95% CI -0.49, 1.29], and vitamins [-0.70, 95% CI -6.71, 5.31] with placebo. SERMs increase the serum FSH levels [3.63, 95% CI 1.48, 5.79] better than hormones [1.29, 95% CI -0.79, 3.36], vitamins [0.03, 95% CI -2.69, 2.76], and supplements [-4.45, 95% CI -7.15, -1.76] in comparison with placebo. Conclusion. This review establishes that all interventions had a significantly positive effect on male infertility. Statistically significant increased sperm parameters were noted in combinations of zinc sulfate (220 mg BID), clomiphene citrate (50 mg BID), and testosterone undecanoate and CoQ10; tamoxifen citrate and FSH were shown to improve the hormonal profile in infertile males.

A snapshot of the global policies and practices of medicine use reviews by community pharmacist in chronic diseases: A narrative review

Medicine use review is a tool to improve medication adherence and safety. Current narrative review was planned to explore global policies and practices of medicine use review by community pharmacists in chronic diseases and its impact and way forward for low- and middle-income countries. Key words, such as ″medicine use review″, ″medication therapy management″ and ″community pharmacy″ were used for search on PubMed and CINAHL databases for articles published from 2004 to 2019. Medicine use review has opened an avenue of ongoing collaboration between community pharmacists and general practitioners. High-income countries have witnessed a gradual yet cautious adoption of these services through effective policy shift. In terms of practices and impact, the situation in high-income countries was promising where on an average ″type-II″ medicine use review was widely in practice and had improved clinical, humanistic and economic outcomes in chronic disease. However, in low- and middle-income countries, a paucity of effective policies was noted. Nevertheless, an emergent recognition of the potential of community pharmacists to contribute to the management of chronic diseases was evident.

Effectiveness and safety profiling of zolpidem and acupressure in CKD associated pruritus: An interventional study

BACKGROUND

Chronic kidney disease (CKD)-associated pruritus (CKD-aP) contributes to poor quality of life, including reduced sleep quality and poor sleep quality is a source of patient stress and is linked to lower health-related quality of life. This study aimed to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-aP.

METHOD

A multicenter, prospective, randomized, parallel-design, open label interventional study to estimate the effectiveness of zolpidem (10 mg) oral tablets versus acupressure on sleep quality and quality of life in patients with CKD-aP on hemodialysis. A total of 58 hemodialysis patients having sleep disturbance due to CKD-aP completed the entire 8-week follow-up. The patients were divided into a control (acupressure) group of 28 patients and an intervention (zolpidem) group of 30 patients.

RESULTS

A total of 58 patients having CKD-aP and sleep disturbance were recruited. In the control group there was a reduction in the PSQI score with a mean ± SD from 12.28 ± 3.59 to 9.25 ± 3.99, while in the intervention group the reduction in PSQI score with a mean ± SD was from 14.73 ± 4.14 to 10.03 ± 4.04 from baseline to endpoint. However, the EQ5D index score and EQ-visual analogue scale (VAS) at baseline for the control group with a mean ± SD was 0.49 ± 0.30 and 50.17 ± 8.65, respectively, while for the intervention group the values were 0.62 ± 0.26 and 47.17 ± 5.82, respectively. The mean EQ5D index score in the control group improved from 0.49 ± 0.30 to 0.53 ± 0.30, but in the intervention group there was no statistical improvement in mean EQ5D index score from 0.62 ± 0.26 to 0.62 ± 0.27 from baseline to week 8. The EQ 5D improved in both groups and the EQ-VAS score was 2.67 points higher at week 8 as compared to baseline in the control group, while in the intervention group the score was 3.33 points higher at week 8 as compared to baseline. Comparing with baseline, the PSQI scores were significantly reduced after week 4 and week 8 (P =  < .001). Furthermore, at the end of the study, the PSQI scores were significantly higher in the control as compared to the intervention group (P = .012).

CONCLUSION

An improvement in sleep quality and quality of life among CKD-aP patients on hemodialysis has been observed in both the control and intervention groups. Zolpidem and acupressure safety profiling showed no severe adverse effect other that drowsiness, nausea and daytime sleeping already reported in literature of zolpidem.

Prevalence and determinants of restless leg syndrome in type 2 diabetes mellitus (T2DM) in Pakistan

BACKGROUND AND AIMS

Restless legs syndromes (RLS) are intrinsic sleeping disorder and its prevalence rate is 10-15% in general population but it is observed that prevalence rate is different in diabetes patients. Current study aims to find prevalence and determinants of RLS in people living with type 2 diabetes mellitus in Pakistan.

METHOD

A multicenter cross-sectional observational study was conducted in 388 diabetes patients attending daily diabetes clinics and teaching hospitals in Pakistan's twin city between August 2019 and February 2020. The chi-square test and linear regression were used to detect RLS-related factors in type 2 diabetes mellitus.

RESULTS

The prevalence of RLS found was; 3.1% patients with diabetes were suffering from very severe RLS, 23.5% from severe RLS, 34% from moderate RLS, 21.1% from mild RLS and 18.3% from non-RLS. Gender, age, education, blood glucose fasting (BSF), blood glucose random (BSR) and HBA1c were found to be significant predictors of RLS in patients with diabetes.

CONCLUSION

Policy makers can develop local interventions to curb the growing RLS prevalence by keeping in control the risk factors of RLS in people living with type 2 diabetes.

Prevalence of non-adherence to antihypertensive medication in Asia: a systematic review and meta-analysis

Background Hypertension and its associated complications are one of the leading causes of morbidity and mortality in Asia. Racial disparities in terms of treatment outcomes among hypertension patients have been reported in literature with Asian patients resulting in poorer treatment outcomes. Non-adherence to antihypertensive therapy is frequently associated with poor treatment outcomes. Aim of the review The aim of this review was to estimate the prevalence of non-adherence to antihypertensive medications among patients with hypertension residing in Asia. Method PubMed, Google Scholar, MEDLINE, Embase, Scopus, CINHAL and Cochrane library were searched for studies published between 2000 and 2019 involving hypertensive patients. Studies investigating the prevalence of medication non-adherence in Asian countries, rated either good or fair on National Institute of Health quality assessment tool and published in English language were included in our review. Data were extracted by one author and checked by another using a structured and pilot-tested data extraction sheet. A random-effects meta-analysis was performed using STATA version 14.3®. Results Sixty-Six studies from 22 Asian countries including 2,532,582 hypertensive patients were included. Mean (± SD) age of participants was 58(± 6) years. Overall, the estimated prevalence of non-adherence to antihypertensive medication in Asia was 48% (95% CI: 41-54, P = 0.001). The rate of non-adherence was higher among females 49% (95% CI: 41-56, P = 0.001) compared to males 47% (95% CI: 40-53, P = 0.001). As per the region, the highest prevalence of non-adherence was found in South Asia 48% (95% 44-51, P = 0.877) followed by East Asia 45% (31-59, P = 0.001) and the Middle East 41 (95% 30-52, P = 0.001). Similarly, higher rate of non-adherence was observed in low and lower middle-income countries i.e. 50% (95% CI: 47-54, P = 0.220) as compare to upper-middle and high-income countries i.e. 37% (95% CI: 25-49, P = 0.001) and 44% (95% CI: 29-59, P = 0.001) respectively. Conclusion The prevalence of non-adherence to antihypertensive medication is high in Asia. This may partly explain poor treatment outcomes and incidence of higher mortality rate in Asia frequently reported in the literature. There is a need to implement appropriate policies and clinical practices to improve medication adherence.

Multilevel Engagements of Pharmacists During the COVID-19 Pandemic: The Way Forward

Severe acute respiratory syndrome caused by the novel coronavirus (SARS-CoV-2) was first reported in China in December 2019 which was later declared to be a public health emergency of international concern by the World Health Organization (WHO). This virus proved to be very contagious resulting in life-threatening respiratory intricacies posing overall public health and governance challenges. Amid the coronavirus pandemic and the unprecedented increase in healthcare demands, only inventive and adaptive practice among healthcare professionals is the need of the hour. Pharmacy services are an important mainstay in the public health and have considerable potential to combat the coronavirus disease 2019 (COVID-19) pandemic. Pharmacists working in several localities and health facilities are linked to patients either directly or indirectly. They can act swiftly in public health response such as drafting professional service guidance to pharmacists working in various healthcare facilities, ensuring effective medicine supply system, monitoring and resolving drug shortage issues, establishing and promoting remote pharmacy services, counseling the public on infection prevention basics, educating about proper use of personal protective equipment, discouraging self-medication, participating in clinical trials, small-scale manufacturing of sanitizers and disinfectants, busting the prevailing myths, and conducting drug evaluation and active surveillance. These interventions will help ease unprecedented burden on healthcare facilities during the ongoing pandemic and eventually will add value to patients and the healthcare system. The current manuscript accentuates the potential roles and activities that pharmacists can initiate in various healthcare facilities to help in relieving pressure on the overwhelmed healthcare system. The information and suggestions offered in this review could help in the restructuring of existing pharmacy services by governments, public health bodies, and policy makers in response to the COVID-19 pandemic. Moreover, this manuscript will underscore any unrealized potential among pharmacists working in various sectors including community, hospital, industry, and drug regulatory authorities.

Knowledge, attitude and preventive practices related to COVID-19 among health professionals of Punjab province of Pakistan

INTRODUCTION

Considering health professionals among high-risk individuals, we aimed to evaluate their knowledge, attitude and practices (KAP) regarding COVID-19.

METHODOLOGY

This cross-sectional study was conducted among the health professionals (medical doctors, nurses, pharmacists, physiotherapists, hospital technicians and technologists) providing services at seven hospitals of Punjab province of Pakistan. A self-administered questionnaire was used to evaluate knowledge, attitude and practices regarding COVID-19.

RESULTS

All of the participants (N = 429) reported that they were aware of COVID-19 and social media was the major source (65%) of this information. Mean knowledge score was 12 ± 2.1, with 75.5% of participants having satisfactory knowledge. Doctors were found to have significantly better knowledge scores than the other health professionals (p = 0.001). Mean attitude score was 8.0 ± 1.2, with a wide majority of health professionals (86.5%) having positive attitudes. Regarding preventive practices, around 64% reported of always covering nose and mouth with a tissue paper during sneezing or coughing and nearly 65% disposed of the dirty tissue paper in trash bin. Only 40% of the participants reported that 'if they do not have tissue, they cough or sneeze into upper sleeves'. Around 45% reported that they used face mask during their working hours in hospitals nowadays. Mean practice score was 23.3 ± 3.6, with 73.4% of health professionals having satisfactory practices.

CONCLUSIONS

The overall COVID-19 related KAP of Pakistani health professionals are satisfactory, however some misperceptions and malpractices uncovered in the present study must be addressed to effectively combat COVID-19.

Point prevalence surveys of antimicrobial use: a systematic review and the implications

Introduction: In view of increasing concerns with antimicrobial resistance (AMR), the World Health Organization (WHO) instituted a Global Action Plan (GAP) to address this. Area covered: One of the strategies to achieve the goals of GAP is to conduct regular surveillance of antimicrobial use through point prevalence surveys (PPS). In this review, PubMed, EBSCO, Proquest, Cinahl, and Scopus were searched for PPS of antimicrobial use published in English between January 2000 and December 2019. After systematic database screening of 2,893 articles, 60 PPS met the inclusion criteria and consequently were incorporated in this systematic review. Expert opinion: This review highlighted that most of the PPS were conducted in upper-middle and high-income countries. Prevalence of antimicrobial use was significantly higher in non-European hospitals compared with European hospitals. The domination of third-generation cephalosporin and fluoroquinolones use across all the regions suggests substantial use of broad-spectrum antimicrobials across countries. Among all identified regions around the world, India was the region where the highest use of antimicrobials was observed. Although PPS is a useful tool to assess the pattern of antimicrobial use and provides a robust baseline; however, a standardized surveillance method is needed. In order to optimize antimicrobial use, more efforts are required to improve antimicrobial use.

Knowledge, attitude and preventive practices related to COVID-19: a cross-sectional study in two Pakistani university populations

Objective

The aim of this study was to assess COVID-19-related knowledge, attitudes, and preventive practices of two Pakistani university populations.

Methods

A cross-sectional study was conducted among students and employees of two higher education institutions in Lahore, Pakistan, namely the University of Lahore and the Gulab Devi Educational Complex. Participants were recruited using a convenient sampling method. A validated 45-item, self-administered questionnaire was used to collect data. Total possible scores were 0–14 for knowledge (scores < 7, 7–10 and > 10 were considered to indicate poor, moderate and good knowledge, respectively); 0–7 for attitude (scores > 5 were considered to indicate a good attitude); and 0–18 for COVID-19 preventative practices (scores > 12 were considered to indicate good preventative practices).

Results

Of the 417 enrolled participants, 416 reported that they were aware of COVID-19 and social media was the major source of their information. Mean scores were 10.12 ± 2.20 for knowledge (good, moderate and poor knowledge in 50.2%, 42.8% and 7.0% of participants, respectively); 5.74 ± 1.28 for attitude (65.4% of individuals had a positive attitude); and 11.04 ± 3.34 for COVID-19 preventative practices (only 36.5% of participants had good preventive practices).

Conclusion

Pakistani university students and employees have good knowledge and attitudes regarding COVID-19, but unsatisfactory preventive practices. Therefore, health regulators should use multiple communication approaches, such as electronic, print and social media, phone messages, etc., to increase awareness and improve practices related to COVID-19.

Knowledge, Attitude, and Barriers Toward ADRs Reporting Among Health-Care Professionals at Tertiary Care Health Settings in Peshawar, Pakistan: A Web Based Study

Background: Underreporting of adverse drug reactions (ADRs) is considered a major determinant of poor ADR signal detection in Pakistan. Considering this, the study was proposed to evaluate healthcare professionals' (HCPs) knowledge attitude toward and the barriers that discourse ADRs reporting. Methods: A cross-sectional survey was distributed among HCPs in 3 major tertiary care facilities of Peshawar. A self-administered, 31 items questionnaire was circulated online to collect the required information. Relative index ranking was used to identify the top barriers to the ADR reporting process. Results: HCPs (n = 322) were requested, and over one-third (n = 122) responded. Of the total, 97 (79.5%) were males, and by designation, 59(48.4%) were resident medical officers. About 45% of the HCPs did not identify the appropriate pharmacovigilance (PV) definition. More than half of the HCPs (52.2%) distinguished the appropriate PV purpose. Nearly 80% HCPs did not know the acceptable reporting time frame, while 22.1% HCPs knew that regulatory body for ADRs does not exist in Pakistan. The majority (95.08%) of the HCPs either strongly agreed or agreed that reporting an ADRs is a professional obligation and all the HCPs were of the opinion that PV should be taught in detail to HCPs. Exploring the barriers, it was identified that the key barriers to ADRs reporting were "unavailability of professional environment to discuss ADRs," Relative Importance Index (RII) = 0.813, "lack of incentives for reporting" (RII = 0.774), "lack of knowledge regarding reporting" (RII = 0.693), and "insufficient knowledge of pharmacotherapy in detecting ADRs" (RII = 0.662). In addition to these, "complicated reporting forms" (RII = 0.616), "lack of motivation for reporting ADRs" (RII = 0.610), and "absence of professional confidence" were seen as major hindrances in effective reporting of ADRs (RII = 0.598). Conclusion: Concerning PV and ADR reporting poor knowledge was noted. However, the majority of the HCPs showed an explicit attitude regarding ADRs reporting. The majority of the HCPs disclosed unavailability of professional environment to discuss about ADRs, lack of incentives, and how to report the main factors hindering the ADRs reporting. It is emphasized that health authorities carve out a niche for a well purposeful PV center and pledge educational activities and trainings for increasing understanding and approaches regarding reporting of ADR.

Public Perception About the Zika Virus in Working Professionals: A Qualitative Inquiry

AIMS

The Global Outbreak Alert and Response Network recently warned that the Zika virus-containing mosquitoes are being found in Pakistan and the health sector is on high alert. It is thus significant to understand public beliefs and perceptions of the Zika virus and vaccination in the current scenario of Pakistan.

METHODS

Twenty semistructured qualitative interviews were conducted and analyzed through an inductive approach to analysis.

RESULTS

The findings were presented in three main categories which were coded: Reality vs. Conspiracy, Vaccination Concerns, and Public Worries. The majority believed that the Zika virus is a real problem and that authorities might be trying to hide the Zika cases in Pakistan. Moreover, they believed that health organizations are being incompetent by failing to take timely remedial measures to manage the Zika. However, 20% have an opposing view and believed that the Zika virus is a conspiracy against Pakistan from the West.

CONCLUSION

Overall, most participants were concerned about the lack of treatment and preventive methods and emphasized the need to create awareness among the public. It is observed that the participants' perceptions ranged from perceiving the Zika virus as real to as a conspiracy.

Community Pharmacist's Role in Providing Oral Health-care Services: Findings from Malaysia

Introduction

Pharmacists have been well recognized as an active and have a more integrated role in the preventive services within the National Health Services. This study assessed the community pharmacists' attitudes, beliefs, and practices toward oral health in the Malaysian setting.

Materials and Methods

A cross-sectional survey-based study was used to conduct this project. An anonymous self-administered questionnaire was developed and distributed among community pharmacists within Kuala Lumpur and Selangor states areas, Malaysia. The data collection was carried out from the beginning of November to the end of December 2018.

Results

Of the 255 pharmacists, 206 agreed to participate in the study, yielding a response rate of 80.8%. Overall, approximately half of the pharmacists provided two to five oral health consultations per week and two to five over the counter (OTC) oral health products recommendations per week. The main services provided by community pharmacists in were the provision of OTC treatments (93.7%), referral of consumers to dental or medical practitioners when appropriate (82.5%), and identify signs and symptoms of oral health problems in patients (77.2%). In addition, more than 80% of the pharmacists viewed positively and supported integrating oral health promotion and preventive measures into their practices. The most commonly reported barriers to extending the roles of pharmacists in oral health care include lack of knowledge or training in this field, lack of training resources, and lack of oral health educational promotion materials.

Conclusion

The study shows that community pharmacists had been providing a certain level of oral health services and play an important role in oral health. The findings highlighted the need of an interprofessional partnership between the pharmacy professional bodies with Malaysian dental associations to develop, and evaluate evidence-based resources, guidelines, the scope of oral health in pharmacy curricula and services to deliver improved oral health care within Malaysian communities.

Exploration of a New Source of Sustainable Nanomaterial from the Koh-e-Suleiman Mountain Range of Pakistan for Industrial Applications

The present study aimed to explore a new source of montmorillonite and to develop an extraction and purification protocol for its isolation from raw clay samples acquired from the Koh-e-Suleiman mountain range in Pakistan. The process involved the collection of raw clay from the source, identification and quantification of montmorillonite. Granulometric extraction and purification protocols increased the montmorillonite content from 21.8-25.1% in the raw clay to 90.1-93.9% after small-scale extraction and 85.33-89.33% on a larger scale. A techno-economic analysis highlighted the practicality and economic benefits of large-scale extraction for industrial applications. This study highlights the existence of a substantial new source of this valuable clay which is currently used across multiple industries including construction, pottery making, pharmaceuticals, cosmetics and engineering. It is intuitively expected that the large-scale extraction of the material will improve the economic condition of the region by providing employment opportunities to locals and may be a valuable resource for export.

Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan

Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.

Prevalence of and Factors Contributing to Glue Sniffing in the South Asian Association for Regional Cooperation (SAARC) Region: A Scoping Review and Meta-analysis

Background: Although glue sniffing has been linked with significant morbidity and mortality, it is still under-researched and poorly recognized issue globally. Objective: A scoping review was performed to identify the factors and outcomes related to glue sniffing in India, Pakistan, Nepal and Bangladesh. Methods: Ten databases; Medline via Ovid, Google scholar, EBSCOhost (CINAHL Plus), ProQuest Central, PsycInfo, IndMED, Ovid Embase, Scopus, PubMed, and Science Direct were searched from their inception to January 2019 for both qualitative and quantitative studies examining any aspect of glue-sniffing. Studies published only in English language were included. Prevalence of glue-sniffing in SAARC region was the primary outcome measure. Findings: Of 8951studies screened, 344 were assessed for eligibility and 31 studies were included. The majority of the studies were conducted in India (15) and Pakistan (11). Meta-analysis of proportion, using random effects model, for both primary and secondary outcomes found that the highest incidence of glue sniffing was 57% (0.57, CI 95% 0.49-0.66) in India. The overall incidence of tobacco and naswar (snuff) as was 83% (0.83, 95% CI 0.80-0.86). Conclusions: The prevalence of glue sniffing, especially among street children, is alarmingly high and presents a challenge for health and social services for countries in SAARC region. More research work is required to examine long term impact of glue sniffing on physical and mental health.

Efficacy and safety of lavender essential oil (Silexan) capsules among patients suffering from anxiety disorders: A network meta-analysis

A systematic review and network-meta analysis (NMA) were performed to estimate significance of the anxiolytic effect of lavender essential oil taken as silexan capsules versus other comparators (i.e., placebo/paroxetine/lorazepam). The outcome of interest was Hamilton Anxiety Scale (HAMA). Weighted mean differences (WMD) were calculated to estimate the treatment effect at the confidence interval of 95%. League tables were generated using treatment effect, for all pairwise comparisons, where WMD < 0 favors the column-defining treatment. Five studies were identified with a total of 524 participants receiving treatment with silexan 80 mg and 121 participants taking silexan 160 mg. The NMA results indicated that consumption of silexan 160 mg resulted in higher decline of HAMA score [WMD −1.14 (−1.10, 3.39)] in comparison to silexan 80 mg, placebo [−2.20 (−4.64, 0.24)] and paroxetine [−1.24 (−5.34, 2.85)]. The effect of silexan 80 mg was observed to be same as that of paroxetine. Overall, silexan 160 mg was noticed to be a more efficient treatment giving significant decline in HAMA score across other comparators. However, no improvements in HAMA score was observed for the group receiving lorazepam 0.5 mg when compared to silexan 160 mg, silexan 80 mg, paroxetine 20 mg, and placebo.

Streptomyces sp. MUM256: A Source for Apoptosis Inducing and Cell Cycle-Arresting Bioactive Compounds against Colon Cancer Cells

New and effective anticancer compounds are much needed as the incidence of cancer continues to rise. Microorganisms from a variety of environments are promising sources of new drugs; Streptomyces sp. MUM256, which was isolated from mangrove soil in Malaysia as part of our ongoing efforts to study mangrove resources, was shown to produce bioactive metabolites with chemopreventive potential. This present study is a continuation of our previous efforts and aimed to investigate the underlying mechanisms of the ethyl acetate fraction of MUM256 crude extract (MUM256 EA) in inhibiting the proliferation of HCT116 cells. Our data showed that MUM256 EA reduced proliferation of HCT116 cells via induction of cell-cycle arrest. Molecular studies revealed that MUM256 EA regulated the expression level of several important cell-cycle regulatory proteins. The results also demonstrated that MUM256 EA induced apoptosis in HCT116 cells mediated through the intrinsic pathway. Gas chromatography-mass spectrometry (GC-MS) analysis detected several chemical compounds present in MUM256 EA, including cyclic dipeptides which previous literature has reported to demonstrate various pharmacological properties. The cyclic dipeptides were further shown to inhibit HCT116 cells while exerting little to no toxicity on normal colon cells in this study. Taken together, the findings of this project highlight the important role of exploring the mangrove microorganisms as a bioresource which hold tremendous promise for the development of chemopreventive drugs against colorectal cancer.

Towards fast and cost-effective up-scaling of Nano-encapsulations by Ionic-gelation method using model drug for the treatment of atopic dermatitis

Chitosan nanoparticles (CSNPs) have proven their excellent drug delivery potential through various routes of administration and therefore, the need for large scale production of CSNPs for the commercialization is paramount. Their particle size and surface charge, drug loading capacity, and morphology were characterized in this study. Finally, drug release studies of both continuous and scalable modes were undertaken to ascertain suitability of CSNPs as a carrier for HC. The particle size of the large and small scale of HC-CSNPs was 253.3±16.4 nm and 225.4 ±9.6 nm, respectively. Besides, the surface charge of the large and small scale of HC-CSNPs was +35.3±0.3 mV and +32.6±2.5 mV, respectively. The size and surface charge of both HC-CSNPs were not proven to be statistically different. Drug loading capacity of large and small scale production of HC-CSNPs was high with 89%, and 83% of HC was loaded into CSNPs, respectively. Moreover, the morphology of both large and small scale production of HC-CSNPs had a similar shape and particle size. The drug release profile of CSNPs prepared by both methods showed a significantly (p<0.05) higher percentage release as compared to the free form. It is expected that positively charged nano-sized HC-CSNPs with high drug loading capacity could enhance the efficiency of drug delivery system to carry and diffuse into the target cells. The results obtained also suggested that the modified method applied could be further developed for large scale production of HC-CSNPs.

The association between CKD-associated pruritus and quality of life in patients undergoing hemodialysis in Pakistan: A STROBE complaint cross-sectional study

Chronic kidney disease (CKD)-associated pruritus is one of the most common symptoms found in patients who undergo dialysis for CKD, leading to a compromised quality of life. This study aimed to investigate the association between CKD-associated pruritus and the quality of life in patients undergoing hemodialysis in Pakistan.A cross-sectional multicenter study was carried out from July 2016 to April 2017 in 2 tertiary care hospitals in Pakistan. Patients aged 18 years and above of both genders, undergoing hemodialysis, understood the Urdu language, and were willing to participate; were included.Of 354 recruited patients with a response rate of 100%, majority (66.1%) of the patients were males. The median (intra-quartile range [IQR]) age of patients was 42.0 [34.0-50.0] years. The prevalence of pruritus was 74%. The median [IQR] score for pruritus was 10.0 (out of possible 25) [8.0-12.0]. Multivariate linear regression revealed a statistically significant association between CKD-associated pruritus with age of patients (β = 0.031; 95% confidence interval [CI] = 0.002-0.061; P = .038), duration of CKD (β = -0.013; 95% CI = -0.023 --0.003; P = .014) and quality of life (β= -0.949; 95% CI = -1.450; -0.449). The median [IQR] score for health-related quality of life was 52.00 [43.00-58.00].Prevalence of CKD-associated pruritus was reported to be 74% and it negatively affected the patient's quality of life. Patients with moderate to severe CKD-associated pruritus have poor quality of life. With an increase in intensity of pruritus, the QOL score decreased among the patients undergoing hemodialysis.

A cross-sectional study: medication safety among cancer in-patients in tertiary care hospitals in KPK, Pakistan

Background

Medication safety in cancer patients receiving complex medication regimens is an important problem in various settings. Medication related events, interceptions and interventions are not well described in this area. We intended to study incidence, types, settings and stages involved, root cause analysis, medication classes involved and the level of harm cause by medication errors in two hospitals providing oncology services comparatively. The severity of incidents and interventions are studied.

Methods

It was a prospective cross sectional study among cancer in-patients of two tertiary care hospitals of KPK. Scale by NCC-MERP was used for evaluation of all medication related incidents. The data obtained was analyzed by IBM SPSS statistics 22 with 95% confidence interval and used the same for other descriptive statistics.

Results

All medication orders were reviewed at both sites (Computerized Prescription Order Entry and HWP systems). Potential ADEs incidence was found high at site 2 (97.5%) while medication errors without harm was high at site 1 (97.5%). Most events occur at prescribing level 87.6 and 81.7% at both sites 1 and 2. Types highly reported involved improper dose 31.4 and 15.5%, monitoring error 14.6 and 15.2% at site 1 and 2. Medications involved in these incidents were antibiotics 44 and 12.7%, antiemetic 7.5 and 15.8% and antineoplastic 2.9 and 9.4% at site 1 and 2. Severity of 3.6 and 36.5% incidents had potential to cause harm at site 1 and 2. Root causes were human factors 62.6 and 72.3%, drug selection 33.6 and 38.8%, and dose selection 39.6 and 15.3% at sites 1 and 2. Contributing factors including staff training 33.6 and 24.3%, system for covering patient care 14.9 and 36.6%, communication system 2.4 and 20.3%, interruptions 9.7 and 7.3% and others 78.8 and 68.6% were highly reported. Preventability of medication errors was 99% at both sites. Intervention was taken in 90.5% events at site 1 (CPOE system) while the incidence lowest at site 2 (HWP system).

Conclusion

Medication related events are high among cancer in-patients at the site lacking updated electronic system for medication prescribing. Proper training about medication safety, reporting and interventions are required.

Assessment of Losartan 50 mg on Survival of Post-Dialysis Euvolemic Hypertensive Patients: Findings from HELD Trial

AIMS AND OBJECTIVE

To estimate the effect of losartan 50 mg on survival of post-dialysis euvolemic hypertensive patients.

METHODOLOGY

A single center, prospective, single-blind randomized trial was conducted to estimate the survival of post-dialysis euvolemic hypertensive patients when treated with lorsartan 50 mg every other day. Post-dialysis euvolemic assessment was done by a body composition monitor. Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm, and the follow-up duration was twelve months. The primary end point was achieving targeted blood pressure (BP) of <140/90 mm Hg and maintaining for 4 weeks, whereas secondary end point was all cause of mortality. Pre-, intra-, and post-dialysis session BP measurements were recorded, and survival trends were analyzed using Kaplan-Meier analysis.

RESULTS

Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard (n = 44) and intervention arms (n = 44), and 36 (81.8%) patients in each arm completed a follow-up of 12 months. A total of eight patients passed away during the 12-month follow-up period (6 deaths among standard arm and 2 in intervention arm). However, the probability of survival between both arms was not significant (p = 0.13). Cox regression analysis revealed that chances of survival were higher among the patients in the intervention (OR 3.17) arm than the standard arm (OR 0.31); however, the survival was found not statistically significant.

CONCLUSION

There was no statistical significant difference in 1 year survival of post-dialysis euvolemic hypertensive patients when treated with losartan 50 mg.

Travel health-related activities and services provided by community pharmacies in Selangor, Malaysia: A cross-sectional analysis

BACKGROUND

Millions of tourists visit Malaysia annually while a large number of Malaysians travel overseas. Taking care of travellers' healthcare needs is important aspect of the healthcare system. Community pharmacies are ideally positioned to provide travel health-related services. However, studies are lacking in this area. Therefore, this study aims to explore the nature and type of travel health-related services provided by Malaysian community pharmacies.

METHODS

A survey was carried out at 135 community pharmacies in nine districts of Selangor, Malaysia, from November 2017 to February 2018, using a self-administered standardized questionnaire.

RESULTS

The majority (n = 95, 85%) of community pharmacies reported to have provided services to both international travellers and outbound Malaysian travellers. The common healthcare services provided to international travellers were monitoring of chronic diseases including hypertension and diabetes, and advice on minor ailments, supplements and medical devices. The key health services provided to outbound Malaysian travellers were advice on vaccination requirements, better management of chronic diseases and necessary medications to manage illness during travel. Most of the respondents supported the provision of travel health-related services through the community pharmacies.

CONCLUSION

The study findings showed that Malaysian community pharmacies provided several travel health-related services to both international and Malaysian outbound travellers. Pharmacists in Malaysia are ideally positioned to have an increased role in travel medicine. They have the training to advise on complex medication issues especially with regard to interactions and polypharmacy. However, further training and courses should be provided that are tailored specifically for the needs of this professional group.

Examining the use of network meta-analysis in pharmacy services research: A systematic review

OBJECTIVES

Pharmacists play an important role in supporting the health care needs of the public, and various studies have examined the impact of pharmacy services on patient care. This systematic review aimed to describe studies evaluating the impact of pharmacy services by means of network meta-analyses.

DATA SOURCES

A systematic literature review of network meta-analyses examining pharmacy services was performed on PubMed, Embase, International Pharmaceutical Abstracts, and Cochrane Database of Systematic Reviews from database inception to November 30, 2018.

STUDY SELECTION

Network meta-analyses that examined the comparative effectiveness of pharmacy services (where pharmacists provide patient care to optimize patient outcomes) in any population, country, or setting.

DATA EXTRACTION

Data were independently extracted by 2 authors with the use of a standardized extraction form. The methodologic quality of articles was assessed with the use of the Cochrane Risk of Bias in Systematic Reviews tool.

RESULTS

Two network meta-analysis studies were identified. The first study compared 53 randomized controlled trials evaluating the effectiveness of transitional care services among discharged patients with heart failure. The study found that pharmacist interventions such as medication reconciliation, patient education, and medication optimization had little impact on improving the all-cause mortality and readmission rate in these patients. The second report compared 43 randomized controlled trials examining the efficacy of pharmacist-based diabetes educational interventions with or without pharmaceutical care on people with type 2 diabetes. It was reported that pharmacy services were effective in reducing glycosylated hemoglobin among people with type 2 diabetes, with larger effect sizes observed when these services involved a combination of 2 or more pharmacy services.

CONCLUSION

This study demonstrated a paucity of studies using network meta-analysis techniques in evaluating pharmacist-provided services. This could be due to the lack of confidence in using this method, because network meta-analysis requires several additional assumptions that require careful consideration while performing the analysis.

Awareness and perception of seasonal influenza (Flu) among health science and Non-Health science university students in Pakistan: A nationwide survey

Seasonal influenza is a highly contagious viral respiratory disorder. Prior knowledge of flu among general community is of paramount importance in order to mitigate its growing burden. In a pandemic, young adults are more likely to be infected increasing the potential for universities to be explosive disease outbreak centers. In this context, current study aims to assess the knowledge and perception of flu among university students from health sciences (HS) and non-HS background. Questionnaire-based cross sectional (August-December 2015) study was conducted among students of 65 universities across Pakistan. The students willing to participate were requested to fill out the self-administered questionnaire and responses were recorded and descriptively analyzed by SPSS. A total of 1694 students (age: 21.12 ± 2.13 years), 95% which belonged to age group 18-25 years, participated in the current study. Most of the participants (91.7%) had suffered from influenza during their life but only 55.7% correctly answered virus as causative agent of flu, while majority of participants, primarily from non-HS disciplines were not aware of flu cause. Very few participants (8.1%) believed that flu can cause death. About 20% students, mainly from non-HS disciplines reported that antibiotic can kill viruses. Similarly, 47.1% respondents agreed on the effectiveness of antibiotic in flu. A large proportion of study population preferred self-medication for influenza. Only 20.1% students were aware of influenza vaccine while majority of students (79.9%) from both disciplines reported that there is no such vaccine. Awareness and health literacy regarding seasonal influenza is poor among university students, especially from non-HS disciplines. These findings necessitate dire need to appropriately structured awareness programs in educational institutes to curb the growing burden of influenza.

Streptomyces sp. MUM273b: A mangrove-derived potential source for antioxidant and UVB radiation protectants

Microbial natural products serve as a good source for antioxidants. The mangrove‐derived Streptomyces bacteria have been evidenced to produce antioxidative compounds. This study reports the isolation of Streptomyces sp. MUM273b from mangrove soil that may serve as a promising source of antioxidants and UV‐protective agents. Identification and characterization methods determine that strain MUM273b belongs to the genus Streptomyces. The MUM273b extract exhibits antioxidant activities, including DPPH, ABTS, and superoxide radical scavenging activities and also metal‐chelating activity. The MUM273b extract was also shown to inhibit the production of malondialdehyde in metal‐induced lipid peroxidation. Strong correlation between the antioxidant activities and the total phenolic content of MUM273b extract was shown. In addition, MUM273b extract exhibited cytoprotective effect on the UVB‐induced cell death in HaCaT keratinocytes. Gas chromatography–mass spectrometry analysis detected phenolics, pyrrole, pyrazine, ester, and cyclic dipeptides in MUM273b extract. In summary, Streptomyces MUM273b extract portrays an exciting avenue for future antioxidative drugs and cosmeceuticals development.