Sidra Mahmood

Prescribing of bisphosphonates and antibiotics in Pakistan: challenges and opportunities for the future

The management of patients with osteoporosis and the rational use of antibiotics are growing concerns in Pakistan. The first step is to assess utilisation patterns, prescribing behaviour and the potential rationale among a range of medicines including bisphosphonates and antibiotics, and subsequently use the findings to suggest potential future policies for all key stakeholders to improve patient care in the future.

Prevalence of Vitamin D deficiency in Pakistan and implications for the future

ABSTRACT Background and aims: vitamin D deficiency (25-hydroxyvitamin D) affects over one billion people worldwide. Vitamin D deficiency results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of vitamin D deficiency in Pakistan despite appreciable levels of sunshine. However, none have assessed vitamin D deficiency across all age groups, genders, incomes, and locations to guide future strategies. Methods: Questionnaire and blood sampling among 4830 randomly selected citizens. Results: High levels of deficiency among all age groups, genders, income levels, and locations. Amongst the selected citizens, 53.5% had vitamin D deficiency, 31.2% had insufficient vitamin D, and only 15.3% normal vitamin D. Conclusion: High rates of vitamin D deficiency in Pakistan despite high levels of sunshine and previous Food Acts asking for food fortification with vitamin D. Public health strategies are needed to address high deficiency rates, including food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature. This will involve all key stakeholder groups.

Review of beneficial and remedial aspects of Cardiospermum halicacabum L.

Eco-friendly and bio-friendly plant based commodities have recently been given consideration for the avoidance and treatment of various human infections including microbial diseases throughout the world. Cardiospermum halicacabum L. belonging to family Sapindaceae is a herbaceous plant, extensively dispersed in tropical and subtropical areas of world. It grows in plains of Africa, America, Bangladesh, India and Pakistan. The herb is pubertal or glabrous, yearly or perpetually having a slim twig that climbs by tendrillar hooks. Leaves are ternate bicomponent and leaflets acuminate at top. The roots, leaves and seeds of herb are employed as herbal medication.The presence of flavones, aglycones, triterpenoids, glycosides, variety of fatty acids and volatile esters are confirmed by phytochemical screening. Secondary metabolites present include alkaloids, carbohydrates, proteins, saponins lignin, steroids, and cardiac glycosides. β-arachidic acid, apigenin, apigenin-7-O-glucuronide, chrysoeriol-7-Oglucuronide and 80 luteolin-7-O-glucuronide along with two crystalline compounds beta-sitosterol and beta-D-glycoside. Acetic acid, 1,6,10-Dodecatriene, 7,11,dimethyl-3- methylene-(E)-, phenol, 2,6-bis (1,1-dimethylethyl)-4-methylmethylcarbamate, 3-O-methyl-d-glucose, 1,14Tetradecanediol, 3,7,11,15-Tetramethyl-2-hexadecen-1-ol, phytol, pseudoephedrine, 2-propenamide were also recognized in ethanolic extract. The plant possess activities like antimicrobial, antifungal, antiparasitic, antidiarrheal, anxiolytic, rubifacient, antipyretic and management of painful, arthritic inflammatory conditions. Further investigations are needed to assess its isolated mode of action on various activities.

Hepatoprotective effects of Justicia adhatoda L. against carbon tetrachloride (CCl 4 ) induced liver injury in Swiss albino mice

) induced liver damage in Swiss albino mice. Liver injury was assessed by estimation of biochemical parameters which includes liver function tests and supplemented by histopathological examination of liver. Aqueous, ethanolic and methanolic extracts of different concentrations were given orally and activities of these extracts were compared with standard drug (silymarin). The results showed that

Seroepidemiological surveillance of antitetanus antibodies in Pakistani childbearing women: A population based survey

Maternal and Neonatal Tetanus is a severe, often fatal ailment characterized by sweeping augmented strictness and convulsive spasms of skeletal muscles. Vaccination is the most steadfast method of forbearance against this disease and has inculcated to lessen mortalities. The present study was carried out with a view to assess the serum levels of tetanus antitoxins in randomly selected rural and urban women to find out the effect of age, number of pregnancy, parity and number of injections at the time of delivery. The study was cross-sectional in design and hospital-based. The gold standard mouse neutralization assay was employed despite being costly and cumbersome. Antibody titre of each sample was determined by seroneutralization method. 1504 women, randomly selected from various hospitals of age 15 to 40 years, 1064 (0.000) were vaccinated, which are significant while 440 were unvaccinated women and taken as control. The 65% (p = 0.000) women had antibody titre higher than protective level which is significant, 28% equal to protective level and 6.7% below protective level. Average antibody titre of 3rd trimester was higher than 2nd trimester (p = 0.000) which is significant. Immunization awareness and practice was higher in 30 years in women (63%) of both rural and urban areas but practice was comparatively higher in urban (74%) than rural area (67%). These finding shows that tetanus vaccination in our population is generally effective and cannot be protected by herd immunity, as tetanus is not communicable disease. Key words: Antitetanus antibodies, seroneutralization, childbearing age, Pakistan. INTRODUCTION Tetanus caused by Clostridium tetani , is a vaccine-preventable, global infectious disease with significant morbidity and mortality. The global status of serological immunity against tetanus varies between countries as a result of different national vaccination policies and methods, and the criteria used for determination of serum levels of tetanus antitoxin. Protective immunity was noted

Sero-surveillance of measles amongst vaccinated and non-vaccinated children: An age stratified population based survey in Pakistan

Measles is one of the most contagious human diseases; it remains a leading cause of death among young children and its elimination is one of the major global public health priorities. It is estimated that in year 2008 approximately 100,000 deaths in children aged less than 5 years was attributable to measles. The increase in measles vaccination coverage in the developing world has produced significant changes in the epidemiology of the infection. The present age stratified cross sectional survey was conducted in Islamabad, Pakistan and its adjoining areas during January to June, 2009 to determine the measles protective titre in children of 1 to 15 years. 927 blood samples of children were collected to ascertain the measles antibodies by ELISA assay. 588 were males and 339 were female (p = 0.001). Measles IgG antibodies sero-positive ratio in children among examined population was 741 (79.9%), sero-negative 174 (18.77%) (p = 0.001). Out of 174 seronegative children, 135 (14.5%) were vaccinated while 39 (4.20%) children were non-vaccinated. The children were divided into three groups, that is, 1 to 5 years (pre school age), 6 to 10 years (primary school group) and 11 to 15 years (secondary school going children). Sero-positive antibodies percentage increased age. Measles IgG antibodies ratio is higher in male children as compared to female. Sero-surveillances should be conducted at regional and provincial levels to assess the actual level of protective titre throughout the country and to evaluate the country’s vaccination program. The routine coverage of immunization should also increase from 80 to 100%.

Assessment of frequently accessible homeopathic mother tinctures for their pharmacopoeal specifications in Pakistan

The homeopathic system of medicine has attained ample attentiveness being one of the premium systems of cure accessible to mankind, and lingers to hold the awareness of remedial publications and the correspondence at the same time. The foremost superlative of cure is swift, undeviating refurbishment of health or inhibitive of the disease in its entire scope, most trustworthy and non detrimental way. The probable means of their accomplishments seem conflicting by way of conformist procedural deliberation and the investigation corroboration for which leftovers are arguable. Mother tinctures are liquid preparation ensuing from the extraction of an appropriate source that is, animal substance material with alcohol or water mixture within a specific ratio. Adverse events taking place during homeopathic treatment are seldom accredited to the homeopathic medicine itself. Nevertheless, sanctuary appraisal should also deem possible impurities of the source material or contagion and failures of good manufacturing practice. This is the first study conducted in Pakistan to appraise the physical and chemical parameters of five frequently accessible mother tinctures that is, Aconitum napellus, Arnica montana, Bryonia alba, Atropa belladonna and Matricaria chamomilla, and manufactured by five confined leading companies by employing customary methodology for the following specifications that is, alcohol contents, weight/ml, specific gravity and pH. Most of the parameters of mother tinctures comply with German Homoeopathic Pharmacopoeia and manufacturers own specifications. There is dire need to enact law to control the sale, manufacture, storage and export of complementary and alternative medicines at earliest possible time in true letter and spirit, along with the adaptation of good manufacturing practice (GMP), quality control (QC) and quality assurance (QA) guideline.

Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future

Abstract Introduction and objectives: There is a paucity of antipsychotic prescribing and utilization data in Pakistan that needs addressing, especially with issues of availability, affordability, gender differences, and domestic violence, to develop pertinent strategies. The objective of this study was to address these issues by describing current antipsychotic utilization patterns in Pakistan among adult patients attending tertiary care hospitals and private practitioners. Methods: A three staged approach was used including (1) assessment of total antipsychotic utilization, expenditure, and costs per unit between 2010 and 2015, (2) an in-depth retrospective study of prescribing patterns, including co-morbidities among representative hospital patients in Pakistan, and (3) assessment of the quality of prescribing against WHO targets. Results: Total use of antipsychotics increased 4.3-fold and the cost/unit increased by 13.2% during the study period. Risperidone and olanzapine were the most prescribed antipsychotics with more limited use of other typical and atypical antipsychotics. The number of medicines per encounter was 4.56. Prescription using generic instead of brand names was 21.4%. Seven per cent were prescribed more than one antipsychotic concurrently. Conclusion: There has been an appreciable increase in antipsychotic utilization in recent years in Pakistan, especially atypical antipsychotics, with little polypharmacy. Ongoing utilization of typical antipsychotics may be due to comorbidities such as diabetes and cardiovascular disease. Issues of international non-proprietary name prescribing need investigating along with the high number of medicines per encounter and gender inequality.