Muhammad Atif

Potential problems and recommendations regarding substitution of generic antiepileptic drugs: a systematic review of literature

Despite the availability of generic antiepileptic drugs (AEDs), still patients and neurologists hesitate to make a switch due to assorted reasons. The objectives of this review were to evaluate the risks associated with the generic substitution of AEDs. In this context, we also summarized the recommendations of various international societies to treat epileptic patients. We used a number of electronic databases to identify the relevant published studies which demonstrated the potential problems and recommendations regarding generic substitution of AEDs. Of 204 articles found initially, 153 were selected for additional review. Subsequently, 68 articles were finally selected. This review concluded that potential problems linked with the generic substitution of AEDs could be bioequivalence issues, failure of drug therapy, emergence of adverse events and increase in the frequency of seizures. The reasons could be the pharmacokinetics properties of AEDs and unique characteristics of some epilepsy patients. Consequently, the generic substitution of AEDs affects the successful treatment and quality of life of the patients. Various guidelines recommend the well-controlled epileptic patients to avoid switching from brand-to-generic products, generic-to-brand products or generic to some other generic products.

Assessment of Knowledge towards Tuberculosis among general population in North East Libya

The study aimed to evaluate the level of Tuberculosis (TB) related knowledge among general public in North East Libya. A cross sectional study was undertaken in 2009. A prevalidated questionnaire consisting of 23 items was sent to 1500 residents among five cities in North East Libya. In addition to the demographic details, the survey instrument was designed to collect information relating to transmission, diagnosis, risk factors, treatment and prevention of TB. Descriptive analysis was used to elaborate demographic information. Inferential statistics (Chi-square test and one-way ANOVA) were used whenever appropriate. P value of less than 0.05 was considered as significant. All data was analyzed using SPSS version 16.0. The overall knowledge towards TB among general population was measured as low. Mean knowledge score was 11.4±3.9 which was significantly higher among Libyans (11.7±3.8) than non Libyans (9.7±4.7, t=26.13) (P<0.001). In addition, respondents with tertiary education had significantly higher knowledge scores (11.8± 3.5) compared to those of intermediate (11.6± 4.4) and illiterate (7.7±5.5), [F=19.34, P=0.001]. This study reveals that knowledge towards TB within the population is poor. It is therefore suggested that specialized educational programs should be developed for community members to promote awareness towards TB.

Rights and Responsibilities of Tuberculosis Patients, and the Global Fund: A Qualitative Study

Background Implementation of the Charter to protect patients’ rights is an important criterion to achieve patient-centered approach and receive financial support from the Global Fund. Our study aims to explore the knowledge of tuberculosis (TB) patients about their rights and responsibilities at the Chest Disease Unit of the Bahawal Victoria Hospital, Bahawalpur, Pakistan. Methods This was a qualitative study. The data from purposefully selected TB patients was collected by in-depth interviews. Eligibility criteria included confirmed diagnosis of TB and enrollment in the TB program. A pilot tested interview protocol was based upon the objectives of the study, and was used uniformly in each interview to maintain the consistency. The sample size was limited by applying the saturation criteria. All interviews were audiotaped and transcribed verbatim. Inductive thematic content analysis was applied to analyze the data and draw conclusions. Results Out of the total 16 patients, four were female, and seven were illiterate. Eight patients were known cases of multi-drug resistant TB. Analysis of the data yielded seven themes; tuberculosis care services, moral support and stigmatization, dignity and privacy, complaints, fear of losing job, information sharing and compliance to the treatment plan, and contribution to eradicate TB. First five represented the rights section while latter two were related to the responsibilities section of the Charter. Conclusion Discriminatory access to TB care services and the right to privacy were two major concerns identified in this study. However, the respondents recognized their responsibilities as a TB patient. To ensure uninterrupted investment from the Global Fund, there is a need to implement fair TB care policies which support human rights-based approach.

Differential pricing of pharmaceuticals: a bibliometric review of the literature

The objective of this study was to perform a bibliometric review of the literature related to differential pricing of pharmaceuticals.

The reasons why Pakistan might be at high risk of Crimean Congo haemorrhagic fever epidemic; a scoping review of the literature

Pakistan has faced a number of significant healthcare challenges over the past decade. In 2000, one of these events - a deadly epidemic of Crimean Congo Haemorrhagic Fever (CCHF) - struck Pakistan. The people of Pakistan are at a very high risk of acquiring CCHF, due to a number of factors which emerge from a scoping review of the literature. First, the underdeveloped healthcare system of the country is currently not prepared to cope with challenges of this nature. Healthcare professionals and medical institutes are not sufficiently equipped to properly diagnose, manage and prevent CCHF. Second, a large percentage of the general public is unaware of the spread and control of the vector. The agricultural sector of Pakistan is vast and thus many people are involved in animal husbandry and the handling of livestock which can lead to the transmission of the CCHF virus. Even in urban areas the risk of transmission is significantly higher around the time of Eid-ul-Azha, when Muslims slaughter animals. Finally, the political upheavals faced by the country have also increased Pakistan’s vulnerability because a large number of refugees from Afghanistan, a CCHF endemic country, have migrated to Pakistan as a result of the Afghan war. Most of the refugees and their animals settle in Baluchistan and Khyber Pakhtunkhwa provinces, which consequently have a higher prevalence of CCHF. This scoping review of the literature highlights the potential causes of high risk CCHF and draws conclusions and makes recommendations that policy-makers in Pakistan may wish to consider in-order to improve on the current situation.

Pharmaceutical Policy in Pakistan

Pakistan is a lower middle-income country, and healthcare in the country is regulated by the Ministry of National Health Services Regulation and Coordination. The overall poor performance in health care is reflected in the form of enormous burden of communicable and non-communicable diseases, and high maternal, neonatal and infant mortality rates. These issues are coupled with a reduced health sector investment and a lack of health insurance schemes. There is no pharmacovigilance system, and there are also problems with counterfeit medications. Nevertheless, Pakistan has a dynamic pharmaceutical sector ranking10th largest in the Asia-Pacific region and fulfilling 70% of the country’s medicinal demands. Many finished pharmaceutical products from Pakistan have been deemed acceptable by countries across Asia, Africa and the United States.

The relationship between epilepsy and sexual dysfunction: a review of the literature

Background and objectivesRegardless of the disease states that people suffer from, maintaining sexual function is an important indicator of quality of life. The objective of this review was to figure out the relationship between epilepsy, antiepileptic drugs (AEDs) and sexual dysfunction.ResultsIn various epidemiological and clinical studies, epilepsy has been correlated with a reduction in sexual function. This sexual dysfunction is not always detected in epileptic patients until systematic efforts are put in place, as part of the assessment and treatment process. Therefore, precise evaluations of the incidence of treatment related sexual dysfunction in epileptic patients is still lacking.ConclusionsThis literature review concluded that sexual function is influenced by the pathophysiology of epilepsy, as well as through the use of AEDs. To maximize quality of care in patients with epilepsy and those patients with other disease states who receive AEDs, it is important to address the status of the patient’s sexual function as part of the initial routine assessment and with any treatment related follow-up. Minimizing the effects of AED related sexual dysfunction can be achieved by raising awareness among patients, providing education and training for physicians regarding sexual dysfunction and obtaining a baseline sexual history from the patient so are important recommendations. In addition, systematic studies are needed to explore the risk and mechanism of such treatment related side effects on sexual function.

Duration of treatment in pulmonary tuberculosis: are international guidelines on the management of tuberculosis missing something?

BACKGROUND Despite evidence of an association between tuberculosis (TB) treatment outcomes and the performance of national tuberculosis programmes (NTP), no study to date has rigorously documented the duration of treatment among TB patients. As such, this study was conducted to report the durations of the intensive and continuation phases of TB treatment and their predictors among new smear-positive pulmonary tuberculosis (PTB) patients in Malaysia. STUDY DESIGN Descriptive, non-experimental, follow-up cohort study. METHODS This study was conducted at the Chest Clinic of Penang General Hospital between March 2010 and February 2011. The medical records and TB notification forms of all new smear-positive PTB patients, diagnosed during the study period, were reviewed to obtain sociodemographic and clinical data. Based on standard guidelines, the normal benchmarks for the durations of the intensive and continuation phases of PTB treatment were taken as two and four months, respectively. A patient in whom the clinicians decided to extend the intensive phase of treatment by ≥2 weeks was categorized as a case with a prolonged intensive phase. The same criterion applied for the continuation phase. Multiple logistic regression analysis was performed to find independent factors associated with the duration of TB treatment. Data were analyzed using Predictive Analysis Software Version 19.0. RESULTS Of the 336 patients included in this study, 261 completed the intensive phase of treatment, and 226 completed the continuation phase of treatment. The mean duration of TB treatment (n = 226) was 8.19 (standard deviation 1.65) months. Half (49.4%, 129/261) of the patients completed the intensive phase of treatment in two months, whereas only 37.6% (85/226) of the patients completed the continuation phase of treatment in four months. On multiple logistic regression analysis, being a smoker, being underweight and having a history of cough for ≥4 weeks at TB diagnosis were found to be predictive of a prolonged intensive phase of treatment. Diabetes mellitus and the presence of lung cavities at the start of treatment were the only predictors found for a prolonged continuation phase of treatment. CONCLUSIONS The average durations of the intensive and continuation phases of treatment among PTB patients were longer than the targets recommended by the World Health Organization. As there are no internationally agreed criteria, it was not possible to judge how well the Malaysian NTP performed in terms of managing treatment duration among PTB patients.

Depression and mild cognitive impairment (MCI) among elderly patients with type 2 diabetes mellitus in Pakistan: possible determinants

This descriptive, cross-sectional, questionnaire-based study was designed to assess the extent of depression and mild cognitive impairment (MCI) and their possible determinants among the elderly with type 2 diabetes mellitus in Pakistan. The study was carried out at the diabetes outpatient clinics of two tertiary care hospitals in Lahore, district of Punjab in Pakistan using convenience sampling techniques between December 1, 2015 and February 28, 2016. All consenting patients were interviewed to complete the Geriatric Depression Scale (GDS-15) and the Montreal Cognitive Assessment (MoCA). Standard scoring schemes were used for these scales. Multiple logistic regression analysis was carried out to identify any statistically significant variables from the univariate analysis, to segregate independent factors. A p value < .05 was taken as the mark of statistical significance for tests. A total of 490 elderly patients with type 2 diabetes mellitus were approached. Of those, 400 patients agreed to participate, resulting in a response rate of 81.6%. GDS-15 scores suggest that only 130 (32.5%) patients were not depressed to some degree. High HbA1C and MCI were significant predictors of depression. MoCA scores indicated that 269 (67.3%) patients had MCI, and depression was the only predictor of MCI among the study patients. The implications of the findings include the need by healthcare providers to consider the assessment and management of depression and MCI as part of diabetes treatment protocols so that elderly patients can achieve positive diabetes outcomes and have improved health-related quality of life.

Perceptions among general medical practitioners toward implementation of medication reconciliation program for patients discharged from hospitals in Penang, Malaysia.

Objective This study aims to explore the perceptions of general practitioners (GPs) from the state of Penang toward the feasibility of implementing the medication reconciliation program in Malaysia. Methods A cross-sectional descriptive study using a validated, self-completed anonymous 18-item questionnaire was undertaken over a period of 2 months in 2010. The study was conducted in the state of Penang, Malaysia. A letter consisting of survey questionnaires and prepaid return envelope were mailed to 429 GPs identified from the Private Medical Practice Control Department Registry. Results A total of 86 responses were received with response rate of 20.1%. Majority (90.1%) of the respondents agreed that medication reconciliation can be a feasible strategy to improve medication safety, and 97.7% confirmed that having an accurate up-to-date list of the patient’s previous medication will be useful in the rational prescribing process. However, about half (56.9%) of them felt that standardization of the medication reconciliation process in all clinics will be difficult to achieve. Three quarters (73.2%) of the respondents believed that the involvement of GPs alone is insufficient, and 74.5% agreed that this program should be expanded to community pharmacy setting. More than 90% of the respondents agreed upon the medication reconciliation card proposed by the researchers. Conclusions General practitioners in Penang are generally in favor of the implementation of medication reconciliation program in their practice. Because medication reconciliation has been shown to reduce many medicine-related problems, it is thus worth considering the feasibility of nationwide implementation of such program.