Allah Bukhsh

Factors associated with anxiety in type 2 diabetes mellitus patients in Pakistan

The aim of this study was to assess the factors associated with anxiety in type 2 diabetes mellitus patients (T2DM) by using Hamilton Anxiety Rating Scale (HAM-A). A cross-sectional quantitative study was conducted after necessary ethical approval from Medicare Hospital Rawalpindi and Capital Development Authority Hospital Islamabad in accordance with Declaration of Helsinki. Three hundred thirty-eight patients with type 2 diabetes mellitus were selected by non-stratified random sampling technique from August 2016 to February 2017. Majority of the T2DM patients (n = 258, 66.5%) had mild anxiety, followed by mild to moderate anxiety (n = 82, 21.1%). A significant association (p < 0.01) was observed between anxiety and patients’ gender, education, and occupation; whereas, statistically insignificant association (p > 0.05) was observed between HAM-A score and patients’ age, family history, and life style. Linear regression analysis revealed gender (OR = − 0.308, CI-0.57-0.299) as a significant predictor (p < 0.01) for anxiety. Findings of this study demonstrate that large proportion of the diabetic patients is suffering with type of anxiety. A significant association of anxiety was identified with gender, education, and occupation of type 2 diabetes patients.

Efficacy of Pharmacist Based Diabetes Educational Interventions on Clinical Outcomes of Adults With Type 2 Diabetes Mellitus: A Network Meta-Analysis

Background: Comparative efficacy of different pharmacist based interventions on glycemic control of type 2 diabetes patients is unclear. This review aimed to evaluate and compare the efficacy of different pharmacist based interventions on clinical outcomes of type 2 diabetes patients. Methods: A systematic search was conducted across five databases from date of database inception to September 2017. All randomized clinical trials evaluating the efficacy of pharmacist based interventions on type 2 diabetes patients were included for network meta-analysis (NMA). The protocol is available with PROSPERO (CRD42017078854). Results: A total of 43 studies, involving 6259 type 2 diabetes patients, were included. NMA demonstrated that all interventions significantly lowered glycosylated hemoglobin (HbA1c) levels compared to usual care, but there was no statistical evidence from this study that one intervention was significantly better than the other for reducing HbA1c levels. Pharmacist based diabetes education plus pharmaceutical care showed maximum efficacy for reducing HbA1c levels [−0.86, 95% CI −0.983, −0.727; p < 0.001]. Pharmacist based diabetes education plus pharmaceutical care was observed to be statistically significant in lowering levels of systolic blood pressure [−4.94; 95%CI −8.65, −1.23] and triglycerides levels [−0.26, 95%CI −0.51, −0.01], as compared to the interventions which involved diabetes education by pharmacist, and for body mass index (BMI) [−0.57; 95%CI −1.25, −0.12] in comparison to diabetes education by health care team involving pharmacist as member. Conclusion: The findings of this review demonstrate that all interventions had a significantly positive effect on HbA1c, but there was no statistical evidence from this study that one intervention was significantly better than the other for achieving glycemic control.Pharmacist based diabetes education plus pharmaceutical care showed maximum efficacy on HbA1c and rest of the clinical outcomes.

Measles in Pakistan: Time to make steps towards eradication

World Health Organization (WHO) measles surveillance data report a reduction in cases of measles globally from 67,524 cases in 2015 to 16,846 in 2016, and a reduction in deaths from 546,800 to 114,900 during period of 2000-14. Pakistan is among the five nations where almost a million children did not receive their first dose of measles vaccination, and outbreaks of the disease resulted in 4386 cases in 2011, 14,687 cases in 2012 with 310 deaths. In 2013, about 25,401 cases of measles were reported and 321 affected children died. The measles vaccination coverage is very low in Pakistan for both 1st dose and booster dose. To prevent outbreaks of measles in Pakistan a national vaccination program should be launched side by side with a polio eradication program in each district and township and a campaign should be launched to educate parents on measles vaccination for childrens to reduce the measles case fatality rate.

Knowledge and Practice of Pharmacists toward Antimicrobial Stewardship in Pakistan

Background: The irrational use, “over the counter supply”, and unregulated supply chains of antimicrobials are contributing toward antimicrobial resistance. Antimicrobial stewardship programs regulate antimicrobials usage to prevent resistance and reduce health care burden. Objective: To assess the knowledge and practice of pharmacists’ working in various healthcare settings toward antimicrobial stewardship in Pakistan. Method: A cross-sectional study was conducted among pharmacists working in different sectors between March to June 2017. Results: A total of 181 pharmacists participated, of whom (n = 145, 80.1%) were males. The majority of participants were in the 20–30 age group (n = 147, 81.2%) and hold Doctor of Pharmacy degrees. More than 80% of pharmacists agreed that “antimicrobial stewardship is essential to improve patient care”; while (n = 159, 87.8%) pharmacists agreed that “pharmacist should be trained on the use of antimicrobial”. Close to 90% of pharmacists agreed that “adequate training should be provided to pharmacists on antimicrobial use”. Regarding the practice of antimicrobial stewardship, (n = 72, 39.8%) pharmacists often/always “make efforts to prevent or reduce the transmission of infections within the community”; (n = 58, 32%) pharmacists never “dispense antimicrobials without a prescription”; and (n = 60, 32%) pharmacist often/always “communicate with prescribers if unsure about the appropriateness of an antibiotic prescription”. Conclusions: Increased antimicrobial stewardship efforts can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. Pharmacists in Pakistan have good knowledge and adopt positive practices toward antimicrobial stewardship. Pharmacist and other health care professionals should collaborate within multi-disciplinary teams to reduce the problem of antimicrobial resistance and improve the quality of life of patients.

Awareness and knowledge of Chikungunya infection following its outbreak in Pakistan among health care students and professionals: a nationwide survey

Background The World Health Organization (WHO) declares Chikungunya (CHIK) infection to be endemic in South Asia. Despite its first outbreak in Pakistan, no documented evidence exists which reveals the knowledge or awareness of healthcare students and workers (HCSW) regarding CHIK, its spread, symptoms, treatment and prevention. Since CHIK is an emergent infection in Pakistan, poor disease knowledge may result in a significant delay in diagnosis and treatment. The current study was aimed to evaluate the awareness and knowledge of CHIK among HCSW. Methods A cross-sectional study was conducted among HCSW from teaching institutes and hospitals in seven provinces of Pakistan. We collected information on socio-demographic characteristics of the participants and their knowledge by using a 30-item questionnaire. The cumulative knowledge score (CKS) was calculated by correct answers with maximum score of 22. The relationship between demographics and knowledge score was evaluated by using appropriate statistical methods. Results There were 563 respondents; mean age 25.2 ± 5.9 years with female preponderance (62.5%). Of these, 319 (56.7%) were aware of CHIK infection before administering the survey. The average knowledge score was 12.8 ± 4.1 (% knowledge score: 58.2%). Only 31% respondents had good disease knowledge while others had fair (36.4%) and poor (32.6%) knowledge. Out of five knowledge domains, domain III (vector, disease spread and transmission) and V (prevention and treatment) scored lowest among all i.e. percent score 44.5% and 54.1%, respectively. We found that socio-demographic characteristics had no influence on knowledge score of the study participants. Conclusion Approximately one-half of participants were not aware of CHIK infection and those who were aware had insufficient disease knowledge. Findings of the current study underscore the dire need of educational interventions not only for health care workers but also for students, irrespective to the discipline of study.

Interprofessional Education in Pharmacy: Review of Case Studies

Abstract Interprofessional education (IPE) is a collaborative pedagogical approach for preparing future healthcare practitioners to be effective team members in the healthcare system, to address growing and complex medical issues. This chapter briefly highlights the background, historical perspective, trends, and barriers towards implementing IPE in established pharmacy programs of developed countries like the United States, United Kingdom, and in developing countries under the South Asian Association for Regional Cooperation (SAARC).

Incidence of methicillin resistant Staphylococcus aureus (MRSA) in burn intensive care unit: a systematic review

Background Burn victims admitted in burn intensive care units (ICU) are at a high risk of nosocomial infections generated by methicillin resistant Staphylococcus aureus (MRSA). This systematic review aims to estimate the incidence of MRSA among burn patients admitted to the ICU setting, with an emphasis on the incidence rate and antibiotic resistance profile of the MRSA strains. Methods A systematic literature search was performed in five electronic databases limited to publication dates from 1st January 2000 until 31st August 2017. After screening n=481 articles, n=21 were found to meet the inclusion criteria of this systematic review. Results Results from the meta-analysis revealed that the risk for MRSA isolates in the burn ICU was 55.0% higher (OR 0.55, 95%CI 0.32-0.94). Therefore, timely testing, appropriate hygiene practice and suggested wound care must be practiced while handling such patients. Conclusion Further studies are needed to identify the risk factors of MRSA infections among burn patients and to develop new antimicrobial agents for MRSA infections.

Effectiveness of conventional interferon and ribavirin combination therapy in chronic Hepatitis C patients in Pakistan

Pakistan is the world’s sixth most populated country with –10% carriers of the Hepatitis C virus (HCV) pathogen (>10 milion) [1]. The prime aim of HCV therapy is to achieve sustained radication of HCV (i.e. Sustained Virological Response (SVR) or peristent absence of HCV ribonucleic acid (RNA) for 6 months), and o prevent progression. A combination therapy of PEG interferon alpha-2b/alpha-2a) plus ribavirin for 24–48 weeks is considered s the gold standard for treating Hepatitis C patients [2]. However, a ombination therapy of conventional interferon and ribavirin is still ommon practice in Pakistan because of the high cost of PEG intereron. Secondly, the majority of Pakistani HCV patients (79–95%) re infected with HCV 3a genotype, which is comparatively more ensitive to conventional interferon than other HCV genotypes. Earier studies conducted in Pakistan have shown 81% SVR among CV+ patients, but according to statistics reported in 2008–2015, a assive decline in the SVR against 3a genotype has been observed, nd the current responses reported to be 55.8–63.31% [3–6]. This eduction in SVR could be attributed to genetic mutations and some pecial characteristics of genotype 3, such as alterations in lipid etabolism and insulin resistance [7]. In a developing country like Pakistan, PEG Interferon for 24 eeks is quite unaffordable for most patients. The cost for six onths duration therapy with PEG interferon is 0.312 million Pakstani rupees (PKR) (≈2944 USD), which is approximately 9 times igher than conventional interferon [8]. PEG interferon-based treatment protocols have better outcomes n HCV genotypes 1 and 4 but no significant difference was observed n genotypes 2 and 3 [9,10]. The side-effect profiles of PEG intereron alfa-2b plus ribavirin and interferon alfa-2b plus ribavirin ere similar with no new or unique adverse events. Although ore flu-like side effects were observed with PEG interferon than onventional interferon, this might be attributed to the higher oses of the former. Injection site reactions and reduced complince are major problems associated with conventional interferon 10]. Criteria must be set for making a decision for therapy selection etween PEG Interferon and conventional interferon in combinaion with ribavirin. The factors that could be of vital importance for aking this decision include: age of patient, gender, HCV genotype, apid Virological Response (RVR) i.e. undetectable HCV RNA after ne month of anti-HCV therapy, and End Treatment Response (ETR)

A pharmacological evidence for the presence of antihistaminic and anticholinergic activities in Equisetum debile Roxb

Objective: The study was designed to evaluate possible antihistaminic and anticholinergic activities of Equisetum debile. Materials and Methods: Effects of crude ethanolic (Ed.Eth) and effects of crude aqueous (Ed.Aq) extracts of E. debile were studied using isolated guinea pig ileum, rabbit jejunum, and rabbit trachea. Tissue responses were recorded using isotonic and isometric transducers, connected with PowerLab data acquisition system. Results: A dose-dependent (0.1–0.3 mg/ml) rightward shift was demonstrated in histamine concentration-response curves. Whereas a complete relaxation of carbachol (1 μM)-induced contractions in isolated rabbit jejunum (3 mg/ml) and tracheal (10 mg/ml) preparations was observed, similar to dicyclomine at 1 and 3 μM, respectively. However, no significant difference between the effects of Ed.Eth and Ed.Aq was observed. Conclusion: Study provides pharmacological evidence for the presence of antihistaminic and anticholinergic activities in crude extracts of E. debile and also highlight its medicinal significance in the management of airway and gastrointestinal disorders.

Psychometric Properties of the Urdu Version of Diabetes Knowledge Questionnaire

Objective Patient education is a key element in the treatment of diabetes. Assessment of diabetes knowledge is important for optimum treatment. For the assessment of diabetes knowledge, validated tool is essential. None of such validated tool is available in Urdu language. Therefore, the aim of this study was to translate and examine the psychometric properties of the 24-item Urdu version of Diabetes Knowledge Questionnaire (DKQ) among type 2 diabetes patients. Methods Standard “forward–backward” process was used to translate DKQ into Urdu language. Later, it was validated on a convenience sample of 130 patients with type 2 diabetes, between July and September 2016. Internal consistency was assessed by reliability analysis, one-way analysis of variance was applied for known group validity and multivariate linear logistic regression was applied for identifying significant predictors for patients’ DKQ score. Results Good internal consistency was observed for DKQ (Cronbach’s α = 0.702). The mean HbA1c of the patients was 8.55% (±1.91). DKQ scores of patients’ with “good glycemic control” (14.22 ± 2.4) were observed significantly higher (P < 0.05) than patients with “poor glycemic control” (12.56 ± 2.75). Multiple linear regression revealed that patients’ HbA1c (OR −0.17, CI −1.111, −0.023) and patients’ education (OR 0.17, CI −0.032, 0.758) were significant predictors for DKQ sum score. Conclusion Urdu version of the DKQ is a valid and reliable instrument for adequate estimation of disease knowledge and its association with glycemic control in type 2 diabetes patients in Pakistan.