Ahsan Saleem

Evaluation of diabetes awareness among general population of Bahawalpur, Pakistan

AIMS To evaluate diabetes awareness among general population of Bahawalpur, Pakistan. METHODS A questionnaire based descriptive cross sectional study was performed during 2014. Descriptive and inferential statistics were applied using the IBM Statistical Package for Social Sciences version 20. RESULTS Total 383 respondents participated in this study giving a response rate of about 88%. Mean age of the participants was 33±13.3 years and the majority of the participants were females (50.4%). Mean scores of the participants were 20.77±6.65 out of 34 and only one participant scored 34/34 marks. Kruskal-Wallis and Mann-Whitney U test revealed that females scored significantly higher diabetes awareness score than males (p<0.05). Moreover, urban residential status, better education and higher socioeconomic status were significantly associated with higher diabetes awareness. CONCLUSIONS Majority of our study population had adequate awareness regarding diabetes. However, lack of awareness was observed among illiterate, poor and rural participants that indicated the immediate need of diabetes awareness programs for these participants.

Barriers to accepting community practice by pharmacists in Pakistan.

I read with great interest the letter to editor by Saeed Ahmad Khan et al, wherein he appraised the importance of community pharmacy for pharmacists in Pakistan. Community pharmacists are an integral component of patient care, as they deal directly deal with the public. However, severe lack of motivation is observed in Pakistani pharmacists in accepting community pharmacy as a profession due to factors such as inferior remuneration, and lack of respect. PharmD students obtain a degree after 5 years in university. After such arduous studying, it is reasonable to expect appropriate remuneration from the job. A recent study showed that the majority of pharmacy students expected PKR 50000þ (USD z 474.23) monthly salary. But when they start their professional careers in community pharmacies, they are offered only PKR (Pakistani Rupee) 13000–18000 (USD z 123.30–170.72) per month for working 8–10 h per day. In the pharmaceutical industry, they are offered approximately PKR 12000–20000 (USD z 113.81–189.69) per month. However, in sales and marketing they are offered PKR 35000–50000 (USD z 331.96– 474.23) salary per month. Due to such discrepancies and poor pay, it is little wonder that we observe lack of interest in careers in community pharmacy. Hence, graduates prefer pharmaceutical industry and sales and marketing jobs. Worldwide, the role of pharmacists has undergone a paradigm shift and became more clinically oriented, with the introduction of the PharmD. Likewise, pharmacy education has undergone

Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis

Background Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic response of various drugs and increases the risk of toxicity. The data regarding the pattern and predictors of medication dosing errors is scare from the developing countries. Therefore, the present study was conducted to assess the pattern and predictors of medication dosing errors in CKD patients in a tertiary care setting in Pakistan. Methods A retrospective study design was employed and medical charts of all those CKD patients who had an eGFR ≤60ml/min/1.73m2, hospitalization ≥24 hours, and admitted in the nephrology unit during January 2013 to December 2014 were assessed. Descriptive statistics and the logistic regression analysis were done using IBM SPSS version 20. Results In total, 205 medical charts were assessed. The mean age of patients was 38.64 (±16.82) years. Overall, 1534 drugs were prescribed to CKD patients, of which, nearly 34.0% drugs required dose adjustment. Among those drugs, only 41.8% were properly adjusted, and the remaining 58.2% were unadjusted. The logistic regression analysis revealed that the medication dosing errors were significantly associated with the CKD stages, i.e. stage 4 (OR 0.054; 95% CI [0.017–0.177]; p <0.001) and stage 5 (OR 0.098; 95% CI [0.040–0.241]; p <0.001), the number of prescribed medicines ≥ 5 (OR 0.306; 95% CI [0.133–0.704]; p 0.005), and the presence of a comorbidity (OR 0.455; 95% CI [0.226–0.916]; p 0.027) such as the hypertension (OR 0.453; 95% CI [0.231–0.887]; p 0.021). Conclusions It is concluded that more than half drugs prescribed to CKD patients requiring dose adjustment were unadjusted. The predictors of medication dosing errors were the severe-to-end stages of chronic kidney disease, the presence of a comorbidity such as hypertension, and a higher number of prescribed medicines. Therefore, attention should be paid to these risk factors.

Clinical relevancy and determinants of potential drug–drug interactions in chronic kidney disease patients: results from a retrospective analysis

Background Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic responses of various renally excreted drugs and increases the risk of drug-related problems, such as drug–drug interactions. Objectives To assess the pattern, determinants, and clinical relevancy of potential drug–drug interactions (pDDIs) in CKD patients. Materials and methods This study retrospectively reviewed medical charts of all CKD patients admitted in the nephrology unit of a tertiary care hospital in Pakistan from January 2013 to December 2014. The Micromedex Drug-Reax® system was used to screen patient profiles for pDDIs, and IBM SPSS version 20 was used to carry out statistical analysis. Results We evaluated 209 medical charts and found pDDIs in nearly 78.5% CKD patients. Overall, 541 pDDIs were observed, of which, nearly 60.8% patients had moderate, 41.1% had minor, 27.8% had major, and 13.4% had contraindicated interactions. Among those interactions, 49.4% had good evidence, 44.0% had fair, 6.3% had excellent evidence, and 35.5% interactions had delayed onset of action. The potential adverse outcomes of pDDIs included postural hypotension, QT prolongation, ceftriaxone–calcium precipitation, cardiac arrhythmias, and reduction in therapeutic effectiveness. The occurrence of pDDIs was found strongly associated with the age of <60 years, number of prescribed medicines ≥5, hypertension, and the lengthy hospitalization of patients. Conclusion The occurrence of pDDIs was high in CKD patients. It was observed that CKD patients with an older age, higher number of prescribed medicines, lengthy hospitalization, and hypertension were at a higher risk of pDDIs.

Medication misuse among elderly population in Pakistan.

We applaud Garfinkel and colleagues for their recent publication that summarized the issue of polypharmacy and the prescribing of chronic medications [Garfinkel et al. 2015]. Polypharmacy is a very critical issue to address, especially in the elderly population. Pakistan is the sixth most populous country in the world, with an estimated population of 199 million, 8 million (approximately 4.0%) of whom are elderly [Garfinkel et al. 2015]. The majority of this particular group is vulnerable to several acute and chronic diseases [Baig et al. 2000]. Due to the rising prevalence of diseases and comorbidities, polypharmacy use is more prevalent among elderly patients, in order to enhance the therapeutic outcomes and maintain their quality of life [Cohen-Kohler, 2007]. Also, a decline in body physiology, and variations in pharmacokinetics and pharmacodynamics in the elderly, makes them more prone to various drug-related problems, such as altered drug responses [Anathhanam et al. 2012]. Altered drug responses such as prolonged drug half-lives, adverse drug reactions and drug–drug interactions, thus become more frequent, and often result in significant morbidity and mortality in the elderly population [Anathhanam et al. 2012]. A recent study reported that elderly cardiac patients in Pakistan had a significantly higher risk of potential drug–drug interactions compared with nonelderly patients [odds ratio (OR) 0.167–0.353 (95% confidence interval; p<0.001)] mainly due to polypharmacy, which was present in around 98.0% of prescriptions [Murtaza et al. 2015]. The other main threat to the elderly population is self-medication, which is rising due to the easy access of medicines and antibiotics. These can be purchased easily from medical stores, without even a prescription from a registered medical professional [Aqeel et al. 2014]. For the portion of the population lacking access to healthcare, pharmacies and small town dispensaries (which are ubiquitous all over Pakistan) are the primary points to seek healthcare. Unfortunately, some drug retailers selling drugs at these dispensaries are not qualified, and lack information on the indications, contraindications and the associated side effects of the drugs being dispensed, thus putting the lives of the elderly population at risk [Mahmood et al. 2014]. The majority of the elderly population in Pakistan is still living in a joint family system and being cared by their family members; however, many are moving toward the trend of a nuclear family system, and leaving their elderly parents on their own [Sabzwari and Azhar, 2011]. For instance, people migrate from one city to another seeking jobs, leaving their parents back in their hometowns, living independently from them. To cope with such circumstances, proper arrangements should be made to ensure adequate elderly-care facilities: a recent study reported that nearly one-third of elderly patients are unable to take their medicines regularly, mainly due to their poor socioeconomic status, forgetfulness and unacceptability of medicines [Baig et al. 2000]. Another important factor affecting the health of elderly patients in Pakistan is the age of retirement. In Pakistan, the retirement age is 60 years old, after which the majority of people become unable to earn enough money to support their family. Thus they become largely dependent on their family members for financial support. Due to scarce resources and limited access to pension plans in Pakistan, only government employed people get benefits [Sabzwari and Azhar, 2011]. Furthermore, when nongovernmental employees get ill they fail to get benefits from subsidized healthcare care facilities, due to a pre-ference for private healthcare facilities. There are also very limited resources available, as well as a lack of planning by the government for its elderly population, making healthcare expenditure unaffordable for many [Baig et al. 2000]. Although most modern countries have implemented various health insurance plans, in Muslim countries such as Pakistan, people avoid health insurance schemes, as they are strictly forbidden in Islam [Khan et al. 2011]. Such limitations and poor circumstances make elderly patients either suffer through their ailments without seeking proper medical care services, or use alternative medicines, due to poor choices in seeking healthcare providers, low health literacy, and a common belief that modern medicines have more side effects than alternative medicines [Anwar et al. 2015]. These alternative medicines can include homeopathy, unani medicines, herbal medicines and even spiritual healers. Such medical pluralism distorts the understanding of, and belief in, complementary and alternative medicines, and poses a threat to elderly patients, as some of these health systems including some medicines that are yet not approved by the official authorities in Pakistan. In addition, there are currently no specific clinical guidelines for physicians regarding the management of elderly patients in Pakistan. Although various clinical practice guidelines, such as the Beers Criteria and STOPP/START criteria exist and are helpful in selecting the most appropriate and well tolerated drugs for elderly patients, they are aimed specifically at western populations [Wu et al. 2015]. Thus, there is a need for Pakistani population-specific guidelines, in order to minimize medication misuse in high-risk populations such as elderly patients. Irrational medication use in the elderly population can be attributed to their low level of health literacy, and various hindrances in health-seeking behavior. In conclusion, there is an immediate need for a national action plan for elderly health in Pakistan. Neglecting the health of the elderly population may cause huge health and economic burdens on the society of, and the healthcare system of Pakistan.

Is there a link between the growing drug selling outlets, licensure type, and rising OTC antibiotics utilization in Pakistan?

We read with great interest the letter to the editor by Khalid et al, wherein the authors shed light on the public health problems associated with the OTC use of antibiotics in developing countries with a special focusonPakistan.Theauthorsmainly associated public health problems of OTC antibiotics with the lack of control over antibiotics saleswithout prescription, poor performance of drug regulatory authorities, and the lack qualified pharmacists. We applaud them formaking this valuable contribution, however, we would like to input additional details to further emphasize this important issue. Pharmacy is generally acknowledged as the most reliable, respected, and highly paid professionworldwide. People prefer seeking help and medicinerelated information from practicing pharmacists due to their expertise in medicines. However, the situation seems entirely opposite inPakistan, as themajority of the population is lacking knowledge about the role of the pharmacist. The lack of knowledge and confusion about the pharmacist’s role in the community can be attributed to the lack of confidence and acceptance of pharmacists toward community practice due to several psychosocial barriers. The poor pharmacist–community interaction yields a perception of pharmacy owners as having insufficient knowledge. This is exacerbated by sheer numbers, as there are approximately 63,000 retail/community drug selling outlets in Pakistan for a populationof nearly 199million.TheU.S. alsohas

Why do physicians prefer brand medicines over generic medicines in Pakistan? A quantitative approach

Generic medicines are recommended and used largely due to their cost effectiveness. Still, physicians prefer brand medicines rather than their generic counterparts. Therefore, the current research was aimed to evaluate the preferential attitude of physicians towards brand medicines over generic medicines in Pakistan.

Insulin perception among insulin-naïve type-2 diabetes mellitus patients in Pakistan

Abstract This cross sectional study was conducted to assess insulin perception among insulin naïve type-2 diabetes mellitus (T2DM) patients who attended an outpatient department in a tertiary care hospital in Pakistan. A total of 160 T2DM patients participated in the study, whereby the majority (64.4%) were females, nearly 50% were jobless and 20% were doing a government job. Nearly 65% patients were unwilling to use insulin and approximately every 9 in 10 (90%) patients had negative perception regarding insulin therapy. Furthermore, the insulin perception was significantly associated with the gender (95% CI = 8.691–16.378; p < 0.001), level of education (95% CI = 0.835–4.577; p < 0.005), and monthly income (95% CI = 0.071–3.785; p < 0.042) of patients. In conclusion, the majority of insulin-naïve T2DM patients were unwilling to initiate the insulin therapy due to their negative perception. Therefore, healthcare professionals should provide sufficient information regarding insulin therapy and try their best to minimize insulin resistance in patients. In addition, policy-makers should be aware of the low-utilization of insulin therapy by patients especially for those with poor living conditions. We recommend, policies should be developed and implemented to promote health literacy and health equity throughout the country.

A quantitative study to assess breast cancer awareness among females in Bahawalpur Pakistan

Abstract The study was aimed to assess breast cancer awareness among females in Bahawalpur, Pakistan. We performed a quantitative cross sectional study from January to April 2015. We enrolled adult women over the age of 18. Trained researchers conducted the interviews in-person. We used SPSS (Statistical Package for the Social Sciences) version 15 to perform the data analysis. In total, 423 females participated in the study and the mean age of the respondents was 35.15 ± 12.66 year, of which, the majority were married (66.0%), and 45.4% had graduate level education. The participants had a severe lack of awareness regarding breast cancer risk factors. We found that the breast cancer awareness scores were significantly associated with old age (p = 0.012), personal history of cancer (p = 0.005), and occupation (p = 0.040) of respondents. We found no associations with marital status, level of education, residence area, and family history of breast cancer. In conclusion, we observed a severe lack awareness of in the study population of breast cancer risk. To raise breast cancer awareness in this population, there is a great need of culturally appropriate, socially-acceptable and effective breast cancer awareness educational programs.