Determinants of Adherence to Antihypertension Medications Among Patients at a Tertiary Care Hospital in Islamabad, Pakistan, 2019.

INTRODUCTION: Medication nonadherence leads to poor health outcomes, frequent complications, and high economic impact. Our objective was to assess the determinants of adherence to medication regimens among patients with hypertension. METHODS: We conducted a cross-sectional study of patients with hypertension attending the cardiology clinic of a tertiary care hospital in Islamabad, Pakistan. Data were collected by using semistructured questionnaires. A score of 7 or 8 on the 8-item Morisky Medication Adherence Scale was classified as good adherence, 6 as moderate, and less than 6 as nonadherence. Logistic regression was performed to determine covariates associated with medication adherence. RESULTS: We enrolled 450 patients with hypertension (mean age, 54.5 y; SD, 10.6). Medication adherence was good among 115 (25.6%) patients and moderate among 165 (36.7%); 170 (37.8%) patients were nonadherent. Most patients (72.7%) had uncontrolled hypertension. Nearly half (49.6%) were unable to afford monthly medication. In bivariate analysis, nonadherence was associated with female sex (odds ratio [OR], 1.44; P = .003) and long waiting times in the health care facility (OR, 2.93; P = .005); the presence of comorbidities (OR, 0.62; P = .01) was associated with good adherence. In multivariate analysis, nonadherence was associated with unaffordability of treatment (OR, 2.25; P = .002) and uncontrolled hypertension (OR, 3.16; P < .001). Good adherence determinants included adequate counseling (OR, 0.29; P < .001) and education (OR, 0.61; P = .02). CONCLUSION: Addressing identified barriers, including medication affordability and patient counseling, should be included in Pakistan's national policy on noncommunicable disease.

Pakistan's COVID-19 Outbreak Preparedness and Response: A Situational Analysis.

The COVID-19 pandemic continues to devastate countries around the world. Pakistan has had a largely successful control strategy with fewer hospitalizations and mortality than its neighboring countries of China, Iran, and India. The aim of our study was to assess Pakistan's state of preparedness for and response to the COVID-19 outbreak, including its multifaceted approach in surveillance, response, and diagnostic services. The study was a situational analysis based on the 2020 World Health Organization COVID-19 Strategic Preparedness and Response Plan. The authors collected national data from January to August 2020 from the government of Pakistan's COVID-19 website and Pakistan's Directorate of Central Health Establishments. We also conducted an extensive review of recently published articles on COVID-19, literature, news alerts, and publicly available data on COVID-19 in Pakistan. To address the COVID-19 pandemic, the country drafted a national action plan, developed mobile applications and the national 1166 helpline, conducted thermal screening and active case finding at all points of entry, and established and strengthened a surveillance system for contact tracing and case-based surveillance, with coordination at the federal and provincial levels. Additionally, a total of 134 laboratories have been designated in major cities for testing of COVID-19; 735 hospitals have been designated for the management of cases in isolation wards at federal, provincial, and regional levels; and dedicated quarantine places have been ensured. Despite being a resource-constrained country, the government of Pakistan has mounted a coordinated national effort using the best available resources. The government is rightly focusing on 4 major areas-surveillance, management, response, and coordination-in controlling the COVID-19 pandemic in Pakistan.

Sulfonamide Derived Esters: Synthesis, Characterization, Density Functional Theory and Biological Evaluation through Experimental and Theoretical Approach.

A series of new solid esters was synthesized by using greener chemistry strategy involving simple reaction of an alcohol with sulfonamide ligand. Characterization study of these methyl (1), ethyl (2) isopropyl (3) and n-butyl (4) ester of 4-((4-chlo-rophenylsulfonamido)methyl)cyclohexanecarboxylic acid was done by using FTIR, NMR mass spectrometry and X-ray crystallography. The compounds were optimized with Gaussian software according to basis set B3LYP/6-31G(d,p) and their different parameters related to structure were calculated. Furthermore, all compounds of the series were screened for their in vitro biological applications involving anti-bacterial (Chromohalobactor salixgens, Halomonas halofila, Escherichia coli, Staphylococcus aureus, Bacillus subtilis, and Shiegella sonnei), anti-fungal (Aspergillus niger), anti-oxidant (DPPH scavenging activity) and enzyme inhibition (acetylcholine esterase and butyrylcholine esterase) study. Sulfonamide based esters were also docked against selected enzymes (AChE and BChE) using MOE software for their mode of binding. Results obtained from these biological evaluations showed that such compounds have potential against targeted activity.