Imran Masood

Major contributions towards finding a cure for cancer through chemotherapy: a historical review.

The history of cancer chemotherapy is as old as cancer itself. With the increase in the complexities of cancer and the development of resistance towards existing anticancer agents, increased attention is now being paid to the advancement of chemotherapy. Some chemotherapeutic agents were discovered by accident or trial-and-error methods while others were found to be useful for neoplasia when they were being evaluated for some other purpose. Broadly, these agents have been classified as alkylating agents, antimetabolites, platinum compounds, antitumor antibiotics and natural products. Hormones and compounds interfering with hormone metabolism are widely used in cancer treatment, besides monoclonal antibodies and small molecules targeting angiogenesis. In this review an attempt is made to discuss the major breakthroughs that have shaped the course of cancer chemotherapy, helping to decrease the mortality as well as lessen the suffering of patients.

Evaluation of diabetes awareness among general population of Bahawalpur, Pakistan

AIMSnTo evaluate diabetes awareness among general population of Bahawalpur, Pakistan.nnnMETHODSnA 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.nnnRESULTSnTotal 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.nnnCONCLUSIONSnMajority 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.

Evaluation of knowledge, attitude, and perception regarding Halal pharmaceuticals, among general medical practitioners in Malaysia

Objective: To evaluate the knowledge, attitude, and perception (KAP) regarding Halal pharmaceuticals, among general medical practitioners in Malaysia. Materials and Methods: This was a cross-sectional study, carried out between September 2012 and November 2012 period, using a structured, self-administered questionnaire. Clinics were chosen based on systematic random sampling technique across Malaysia. Descriptive statistics (mean, standard deviation, frequency, percentage, median, and interquartile range) were used to summarize the data. Chi-square and Fishers exact tests were used as appropriate to assess the association between demographic characteristics, and KAP scores. Results: Results revealed that general medical practitioners have a good knowledge and positive attitude and perception towards Halal pharmaceuticals. Mean knowledge score was 7.72 ± 1.65, out of maximum possible score of 9. Mean attitude score was 34.24 ± 6.77 out of maximum score of 45 and mean perception score was 46.98 ± 5.84 out of maximum possible score of 55. Mean overall KAP score out of maximum possible 109 was 88.90 ± 12.75. There was a significant, positive, and fair correlation (0.25-0.5) between knowledge and attitude (r = 0.443, P Conclusion: It can be concluded that better knowledge of Halal pharmaceuticals is associated with positive attitude towards the use of Halal pharmaceutical products. However, it still remains unknown how this positive attitude influence prescribing practices of general practitioners.

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.

Effect of Educational Intervention on Osteoporosis Knowledge among University Female Students in Quetta, Pakistan

Objective: The study intended to assess the impact of educational intervention on knowledge of osteoporosis among female university students of Quetta. Methods: This interventional study was conducted on female university students by using convenience sampling technique. A total of 163 female students were enrolled for the study, these are those female students who did not heard about the disease named as osteoporosis. These subjects were provided with a selfexplanatory brochure that contains basic information regarding osteoporosis. The intervention was completely theoretical in nature. After two days interval participants were contacted again and asked to complete a pre-validated questionnaire containing 20 questions related to osteoporosis knowledge. Descriptive analysis was used to demonstrate the demographic characteristics of the study population. Inferential statistics (Mann-Whitney U test and Kruskal Wallis tests and Wilcoxon mean rank test, p<0.05) were used to assess the significance among study variables and to assess the impact of educational intervention on knowledge. Results: Average score of knowledge was 14.18 ± 2.7. Although educational intervention had a significant effect on knowledge scores of the respondents (Wilcoxon rank test p<0.005) (considering the pre-intervention knowledge score as zero) certain demographic characteristics (academic degree and living status) does affect knowledge scores of the study respondents. Conclusion: Although adequate improvement of knowledge scores of osteoporosis was reported after educational intervention, yet efforts should be made to bring change in the attitudes and practices of the female students by the help of intensive educational programs based on behavioral learning theories for better disease knowledge and prevention.

Pattern of medication selling and self-medication practices: A study from Punjab, Pakistan

Background Access to medicines without prescription is a major contributing factor for self-medication practices. This study was designed to examine the ratio of non-prescribed medicines sales and self-medication practices in Punjab, Pakistan. This study also evaluates the reasons for self-medication within its communities. Methods An observational study was conducted in 272 systemically selected pharmacies to analyze medicines-related sales, with or without prescription. A cross-sectional survey was performed between June 2015 and November 2016. Consumers were interviewed about their self-medication practices. Results Of the pharmacies surveyed, 65.3% participated in the study. A total of 4348 medicines were purchased for self-medication by 3037 consumers (15.2% of all study participants), of which 873 (28.7%) participated in an interview. Majority (81.2%) medicine purchaser, (90.9%) interview participants, and (59.4%) drug users were male. On average, each community pharmacy sold 7.9 medicines without prescription each day, to an average of 5.5 customers. Many participants (28.9%) had matriculation in their formal education. The medicines most often sold for self-medication were analgesics and antipyretics(39.4%). More than 25% of participants reported fever symptoms and 47.8% assumed their illness was too trivial to consult a doctor. Media advertisements were the most common source of information for participants (46.7%). Conclusion Many types of medicines were often sold without prescription from community pharmacies. Self-medication was common practice for a wide range of illnesses. Pakistan also needs effective implementation of policies to monitor medication sales. Public education about rational medication and limits to advertising medicine are very necessary.

Direct and indirect cost of diabetes care among patients with type 2 diabetes in private clinics: a multicenter study in Punjab, Pakistan

ABSTRACT Background: Diabetes mellitus (DM) has a very high prevalence and poses a huge financial encumbrance on patients. This study aimed to evaluate the cost of diabetes care among patients with type 2 diabetes in private clinics of southern Punjab, Pakistan. Research design and methods: This was a descriptive, cross-sectional, prevalence-based, cost-of-illness (COI) study conducted in six private clinics of southern Punjab from July to September 2016, using a pretested questionnaire. Study participants were recruited using a random selection method. Continuous variables, including direct and indirect costs, were summarized using descriptive statistics. Inferential statistics were also used to analyze the correlation between the variables and cost. Results: The mean annual direct cost per patient with diabetes was estimated to be 332 USD. Medications accounted for the largest share (60.4%) of this cost. Age, locality, high socioeconomic status, and prolonged disease duration were significantly associated with the direct costs of illness (p < 0.05). Moreover, 19% of total earnings among very low-income patients were spent on diabetes care. Conclusions: A substantial proportion of patients’ income is spent on diabetes care in Punjab. Our findings support the substantial individual and societal burden caused by diabetes.

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.