Impact of a pharmacist-led patient-centred care intervention along with textmessage reminders, on the management of newly diagnosed tubercular patients: A protocol for a randomized controlled trial.

Objectives: Non-adherence to tuberculosis (TB) treatment is the leading cause of the increase in drug resistance cases. This study will determine the effectiveness of pharmaceutical-care-based interventions coupled with short messages delivered by a pharmacist on treatment outcomes and adherence among TB patients. Methods: The study will be conducted in TB Control Center of Pakistan Institute of Medical Sciences Hospital, Islamabad and District Bannu TB Control Center time period will be from August 2019 to September 2021. The patients will be included into the control group (usual care) or the intervention group pharmaceutical care and SMS reminder. The primary outcome includes a change in mean score from baseline in treatment outcomes and adherence, measured by Morisky Medication Adherence Scale, and clinic appointment attendance registration. Secondary outcomes include health-related quality of life of patients, disease knowledge, and patient satisfaction with the intervention. Result: The major issues in patients with TB are cure rate and medication adherence. The method anticipated in this manuscript could set the foundation of pharmaceutical care and mobile SMS for the future provision of care to improve TB treatment outcomes. Conclusion: The study will make available fundamental information about the influence of the patient centered program on the adherence and clinical outcomes of patients with TB.Trial status and registration: Clinical Trials.gov assigned Identifier NCT04645836.

Impact of video-led educational intervention on uptake of influenza vaccine among the elderly in western China: a community-based randomized controlled trial.

BACKGROUND: Influenza vaccination coverage rate among the elderly is low in China. We aimed to evaluate the impact of video-led educational intervention on influenza vaccine uptake among the Chinese elderly. METHODS: A randomized controlled trial was conducted in 8 communities of Xi'an, a representative city in western China. Elderly aged over 60 years were randomized to the control group and intervention group (12-minute video education on influenza and its vaccination). Participants' knowledge, attitudes, and practices (KAP) of influenza was assessed by using a questionnaire survey before and after the intervention. The primary outcomes were participants' willingness to get influenza vaccinated and their actual uptake rates in the 2020-21 flu season. Secondary outcomes were the variations of pre- and post-intervention KAP scores. Intention-to-treat analysis was performed to analyze the data, and sensitivity analyses were conducted to examine the robustness of the results. RESULTS: A total of 350 people were enrolled, with 175 individuals for each group. Participants in the intervention group were more willing to receive influenza vaccination than those in the control group (64.6% vs. 51.4%, p<0.05). The influenza vaccination uptake rate occurred in 10.3% of participants in the intervention group and 3.4% in the control group (odds ratio, 3.23; 95% CI 1.25-8.32, p<0.001). The post-intervention KAP scores in the intervention group were significantly higher compared to those in the control group (p<0.001). CONCLUSION: Video-led education was an effective and feasible approach to improve old people's willingness and uptake of influenza vaccination in western China.

Impact of the COVID-19 outbreak on mental health status and associated factors among general population: a cross-sectional study from Pakistan.

The recent outbreak of coronavirus disease (COVID-19) has significantly affected the mental health of people globally. This study aimed to investigate the mental health status and associated factors among residents of Pakistan. An online questionnaire survey was conducted from April 3 to May 7, 2020, using convenience and snowball sampling techniques. Data regarding demographics, physical health status and contact history during the last 2 weeks were collected. Furthermore, the Depression, Anxiety, and Stress scales (DASS-21) were utilized to measure the mental health of the participants. The analyses included descriptive statistics and regression analysis. Of the 1663 participants who completed this survey, 1598 met the inclusion criteria. The results revealed mild to moderate depression among 390 participants (24.4%), mild to moderate anxiety among 490 participants (30.7%) and mild to moderate stress among 52 participants (3.3%). A majority of the participants rated their health as good (n = 751, 47.0%). Moreover, students reported significantly higher scores on depression (B = 1.29, 95% CI = 0.71-1.88; p < 0.05), anxiety (B = 0.56, 95% CI = -0.06 to 1.18; p < 0.05) and stress (B = 0.56, 95% CI = -0.12 to 1.23; p < 0.05). Physical symptoms, including fever, cough and myalgia, and contact history in the last 14 days reported significant associations with depression, anxiety and stress (p < 0.05). The mental health status of the people was noted to be affected during the COVID-19 outbreak. Assessment of several factors with significant associations with depression, anxiety and stress may aid in developing psychological interventions for vulnerable groups.

Impact of video-led educational intervention on the uptake of influenza vaccine among adults aged 60 years and above in China: a study protocol for a randomized controlled trial.

BACKGROUND: Influenza is a global health threat to older adults, and the influenza vaccine is the most effective approach to prevent influenza infection. However, influenza vaccination coverage among Chinese older adults is far less than in developed countries such as the United States (4.0% vs. 64.9%). This study aims to increase influenza vaccination coverage in Chinese adults ≥60 years using a video-led educational intervention conducted by medical students. METHODS: A cluster randomized controlled trial will be conducted in 4 districts of Xi'an city, Shaanxi Province, China, using a stratified sampling approach. Adults aged ≥60 years will be recruited from 8 community hospitals. A self-administered questionnaire of knowledge, attitudes, and practices (KAP) will be employed to record the KAP score. During the 6-month interventional period, participants in the intervention group will receive educational videos focused on influenza and influenza vaccination, coupled with a group discussion conducted by the medical students. For those in the control group, no intervention will be provided. The outcomes measured in both groups will be the influenza vaccination coverage and the KAP scores of all participants. DISCUSSION: Medical students are more likely to educate older adults about scientific knowledge of influenza and its vaccine compared to clinical practitioners, who, most of the time, remain over-occupied due to the extensive workload. Video-led counseling and education could be a useful option to optimize older adults' understanding of influenza and influenza vaccination. This eventually could improve the uptake of influenza vaccine among Chinese older adults. TRIAL REGISTRATION: Chinese Clinical Trial Registry; ChiCTR2000034330 ; Registered 3rd July 2019.

The genus Cassia L.: Ethnopharmacological and phytochemical overview.

Nature gifts medicinal plants with the untapped and boundless treasure of active chemical constituents with significant therapeutic potential that makes these plants a beneficial source in the development of phytomedicines. Genus Cassia, with approximately 500 species, is a large group of flowering plants in the family Fabaceae. Cassia species are widely distributed throughout different regions mainly tropical Asia, North America, and East Africa. In the folk medicinal history, these plants are used as laxative and purgative agents. In the Ayurveda system of medicine, they are used to cure headache and fever. Cassia plants exhibit pharmacological activities at large scales such as antimicrobial, anticancer, antiinflammatory, antioxidant, hypoglycemic, hyperglycemic, antimutagenic, and antivirals. The phytochemical investigations of genus Cassia demonstrate the presence of more than 200 chemical compounds, including piperidine alkaloids, anthracene derivatives (anthraquinones), flavonoids, pentacyclic triterpenoids, sterols, phenylpropanoids, and γ-naphthopyrones. The literature illustrated anthraquinones and flavonoids as major secondary metabolites from this genus. However, some Cassia plants, with rich contents of anthraquinones, still show toxicology properties. As Cassia plants are used extensively in the herbal system of medicine, but only senna dosage forms have achieved the status of the pharmaceutical market as standard laxative agents. In conclusion, further investigations on isolating newer biologically active constituents, unknown underlying mechanisms, toxicology profiles, and clinical studies of Cassia species are needed to be explored. This review article specifies the systematic breach existing between the current scientific knowledge and the fundamentals for the marketization of genus Cassia products.

Efficacy of Text Messaging and Personal Consultation by Pharmacy Students Among Adults With Hypertension: Randomized Controlled Trial.

BACKGROUND: Hypertension is one of the leading risk factors for ischemic heart diseases, and high rates of hypertension prevalence have either remained the same or increased in developing countries in recent years. Unfortunately, about 20% to 50% of patients with chronic diseases have been nonadherent to their drug therapy. SMS text messaging and pharmacy student-led consultations have the potential to help patients manage their blood pressure (BP). OBJECTIVE: The aim of this study was to assess the effectiveness, feasibility, and acceptability of SMS text messaging and consultation to manage the BP of Chinese patients with hypertension. METHODS: We conducted a two-arm cluster randomized controlled trial among patients with hypertension in Xi'an City, Shaanxi Province, China, and recruited 384 patients from 8 community health care centers. Patients were randomized into an intervention group to receive SMS text messages and consultations or into a control group to receive usual care for 3 months. We sent SMS text messages at 3-day intervals and collected data at baseline (including demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge about hypertension, BP, and medication adherence) and the 3-month follow-up (including BP, medication adherence, and knowledge about hypertension). RESULTS: We assessed 445 patients with hypertension and excluded 61 patients who were not eligible or who had not filled out their questionnaires. The mean age of the patients was 68.5 (SD 7.9) years in the intervention group and 69.4 (SD 9.7) years in the control group, and the sample was primarily female (265/384, 69.0%). Patients in the intervention group showed significant improvements in systolic BP (SBP; mean 134.5 mm Hg, SD 15.5 mm Hg vs mean 140.7 mm Hg, SD 15.2 mm Hg; P=.001), medication adherence (mean 7.4, SD 1.2 vs mean 7.0, SD 1.3; P=.04), and knowledge about hypertension (mean 6.3, SD 0.9 vs mean 5.9, SD 1.2; P=.004) compared with those in the control group. In measures of diastolic BP (DBP), the two arms showed nonsignificant improvements (mean 78.2 mm Hg, SD 9.0 mm Hg vs mean 77.2 mm Hg, SD 10.3 mm Hg; P=.06). In total, 176 patients had controlled BP at the 3-month follow-up (98 patients in the intervention group vs 78 patients in the control group), but it was nonsignificant (P=.08). CONCLUSIONS: The use of SMS text messaging and consultation to manage SBP and improve medication adherence is effective, feasible, and acceptable among Chinese patients with hypertension, although a significant difference was not observed with regard to DBP. It is important to maximize the potential of SMS text messaging and consultation by increasing the feasibility and acceptance of mobile interventions and conduct a cost-effectiveness analysis on this method. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900026862; http://www.chictr.org.cn/showproj.aspx?proj=42717.

Review: New diagnostic and therapeutic avenues for mesothelioma.

Mesothelioma is a rare form of cancer affecting the mesothelium lining. It is usually caused by asbestos exposure or exposure to nanofibers. Median survival is less than one year in the mesothelioma patients. Due to its severity, there is a dire necessity to find out new diagnostic and therapeutic strategies. Some recent strategies could help us in fighting against mesothelioma. Diagnostic tools include a range of biomarkers or biotechnological procedure. Therapeutic tools include chemotherapeutic strategies along with immunotherapy, gene therapy and alternative therapy.

Perceptions Regarding Antimicrobial Resistance and Stewardship Programs among Healthcare Professionals.

BACKGROUND: Antimicrobial resistance is an important global problem resulting in an improper response of infections to antimicrobials and an increase in the duration and cost of treatment. Healthcare professionals play an important role in addressing Antimicrobial resistance and positive perception is important for involvement in antimicrobial stewardship policies. Hence the perception of key Healthcare professionals, including physicians, nurses, and hospital pharmacists, towards Antimicrobial resistance antimicrobial stewardship policies was studied. METHODS: A cross-sectional study was conducted in a tertiary care hospital at Lalitpur, from January to March 2021 using stratified random sampling. An online questionnaire was circulated to the selected Healthcare professionals. Median Antimicrobial resistance and antimicrobial stewardship policy scores were calculated and compared among different subgroups. Previous engagement with Antimicrobial resistance and antimicrobial stewardship policies programs was also noted. Descriptive statistics, Mann Whitney, and Kruskal Wallis tests were used for data analysis. RESULTS: The response rate was 89.3% (202/226). Antimicrobial resistance was regarded as a serious problem in the Nepali community by participants with work experience of 1-5 years, 87 (75.6%, p=0.029), and female participants, 62 (45.5%, p<0.001). Most physicians, females, and participants with working experience 1-5 years believed inappropriate use of antibiotics can harm patients and is professionally unethical. Physicians supported the availability of local antimicrobial guidelines and protocols. The median scores for Antimicrobial resistance (p<0.001) and Antimicrobial resistance eradication (p=0.048) differed according to age groups. CONCLUSIONS: Healthcare professionals believed Antimicrobial resistance was an important issue. Antibiotic guidelines developed should be strictly implemented. Healthcare professionals also believed inappropriate use of antibiotics can harm patients and is professionally unethical.

Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications.

Antimicrobial resistance (AMR) is a leading public health threat, which is exacerbated by the high and inappropriate use of antibiotics. Consequently, there is a need to evaluate knowledge regarding antibiotic use, AMR and the readiness to implement antimicrobial stewardship programs (ASPs) among final year medical, pharmacy and nursing students in Pakistan. This reflects the high and increasing rates of AMR in the country, and students as future healthcare professionals (HCPs). A cross-sectional study was conducted among 1251 final year students from 23 public and private educational institutions in Punjab. The majority of the surveyed participants possessed good knowledge of antibiotic use, AMR and the potential causes of AMR. The most common sources of the information on antibiotics were smartphones (69.9%), peers (35.9%) and medical textbooks (30.6%). However, most surveyed participants were not fully prepared to participate in ASPs. They knew, though, how to reduce AMR by educating HCPs about appropriate prescribing, implementing ASPs and improving laboratory facilities. There was a significant association between antibiotic knowledge and causes of AMR with sex, family income and student type (p < 0.05). Being a student at a public sector university (OR = 4.809; CI = 3.261−7.094; p < 0.001) and age (OR = 0.524, CI = 0.327−0.842; p < 0.008) were among the key factors impacting students' training on ASPs. Educational curricula must be improved to include more information about appropriate antibiotic use and ASPs, along with sufficient training, workshops and clinical rotations in the final year, to fully equip students by graduation.

A randomized controlled trial to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among TB patients.

Background: The study was designed to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among tuberculosis patients in Pakistan. Methods: A randomized, controlled prospective study was carried out in a Pakistan Institute of Medical Sciences hospital tuberculosis (TB) control center. Participants who visited the TB center between September 2020 and December 2021 were randomly assigned to two clusters, the usual care group (UC group) vs. the intervention group (pharmaceutical care group), in a 1:1 ratio by a simple envelope technique. In the intervention group, a patient received centered care that encompassed informed decision-making, which can increase the quality of care and monitoring of adverse drug events. However, the control group received routine TB treatment at the hospital. The EuroQol-5D-3L instrument was used to assess the health-related quality of life (HRQoL) at the baseline and in the third and sixth months of the treatment time period. Results: A total of 503 patients were eligible, of which only 426 patients were included in this study. At the end of the study, n = 205 of the patients in the intervention group and n = 185 of those in the control group were analyzed. In the intervention group, the EQ-5D-3L health utility score improved significantly (p < 0.001) (from the baseline mean ± SD, 0.40 ± 0.36, to 6 months of treatment, 0.89 ± 0.09, while in the control group from 0.42 ± 0.35 to 0.78 ± 0.27). In multivariate regression analysis, the variables that remained statistically associated (p < 0.001) with the HRQoL (unstandardized ß [95% confidence interval]) of the control group were as follows: gender, female vs. male (-0.039 [-0.076 to -0.003]); body weight, less than 40 kg vs. more than 40 kg (-0.109 [-0.195 to -0.024]); patients with any comorbidity vs. without comorbidity (-0.136 [-0.252 to -0.020]); and smokers vs. non-smokers (-0.204 [-0.291 to -0.118]). The study did not find any statistically significant associations between the intervention group's variables and the HRQoL. Conclusion: Patient-centered care interventions led by pharmacists as part of care coordination enhanced the HRQoL for TB patients significantly. According to this study, clinical pharmacists should be included in the interdisciplinary clinical staff for TB patient management.

Assessment of risk factors associated with potential drug-drug interactions among patients suffering from chronic disorders.

Patients suffering from chronic diseases are more likely to experience pDDIs due to older age, prolonged treatment, severe illness and greater number of prescribed drugs. The objective of the current study was to assess the prevalence of pDDIs and risk factors associated with occurrence of pDDIs in chronic disease patients attending outpatient clinics for regular check-ups. Patients suffering from diabetes, chronic obstructive pulmonary disease (COPD), stroke and osteoporosis were included in the study. This study was a cross sectional, observational, prospective study that included 337 patients from outpatient clinics of respiratory ward, cardiac ward and orthopedic ward of Nishter Hospital Multan, Pakistan. The mean number of interactions per patient was 1.68. A greater risk for occurrence of pDDI was associated with older age ≥ 60 years (OR = 1.95, 95% CI = 1.44-2.37, p<0.001); polypharmacy (≥ 5 drugs) (OR = 3.74, 95% CI 2.32-4.54, p<0.001); overburden (OR = 2.23, 95% CI = 1.64-3.16, p<0.01); CCI score (OR = 1.28, 95% CI = 1.04-1.84, p<0.001); multiple prescribers to one patient (OR = 1.18, 95% CI = 1.06-1.41, p<0.01); and trainee practitioner (OR = 1.09, 95% CI = 1.01-1.28, p<0.01). Old age, polypharmacy, overburden healthcare system, higher comorbidity index, multiple prescribers to one patient and trainee practitioner were associated with increased risk of occurrence of pDDIs in chronic disease patients.

Adherence to Infection Prevention and Control Measures Among Health-Care Workers Serving in COVID-19 Treatment Centers in Punjab, Pakistan.

OBJECTIVE: Infection prevention and control (IPC) measures are easily adoptable activities to prevent the spread of infection to patients as well as among health-care workers (HCWs). METHODS: This cross-sectional study evaluated the adherence to IPC measures among HCWs working at coronavirus disease 2019 (COVID-19) treatment centers in Punjab, Pakistan. HCWs were recruited by means of convenient sampling through Google Form® using the World Health Organization risk assessment tool. All data were analyzed using SPSS 20. RESULTS: A total of 414 HCWs completed the survey (response rate = 67.8%), and majority of them were males (56.3%). Most of the HCWs were nurses (39.6%) followed by medical doctors (27.3%). Approximately 53% reported insufficiency of personal protective equipment (PPE), 58.2% did not receive IPC training and 40.8% did not have functional IPC team at their health facilities. The majority of HCWs (90%) used disposable gloves and N95 facemasks while interacting with COVID-19 patients. Nearly 45% used protective face shields and gowns before providing care to their patients. Hand hygiene practices while touching, and performing any aseptic procedure was adopted by 70.5% and 74.1% of HCWs, respectively. CONCLUSIONS: In conclusion, the adherence to IPC measures among Pakistani HCWs working in COVID-19 treatment centers is good despite the limited availability of PPEs. Their practices can be optimized by establishing institutional IPC teams, periodic provision of IPC training, and necessary PPE.

Effect of a national antibiotic stewardship intervention in China targeting carbapenem overuse: An interrupted time-series analysis.

OBJECTIVES: To assess trends and patterns of carbapenem use and to evaluate the effects of a nationwide antibiotic stewardship policy to reduce carbapenem overuse. METHODS: In this quasi-experimental study, using longitudinal data from the national drug procurement database and interrupted time-series analyses with carbapenems as the intervention group and possible carbapenem substitutes as the comparison group, we evaluated the effects of a national stewardship policy on carbapenem consumption and expenditures, by region and types of healthcare institutions. RESULTS: The carbapenem procurement volume declined by -28.8% (95% CI -35.0 to -22.6) (-334.4 thousand defined daily doses [DDDs] per month), and carbapenem expenditures showed a relative reduction of -38.1% (-43.9 to -32.2). The gap between the use of carbapenems and each drug in the comparison group narrowed after the policy intervention, with an increase in tigecycline use (14.9 thousand DDDs [10.8-18.9]) and a slower decrease in use of certain third-generation cephalosporin combinations (-85.7 [-143.0 to -28.4]), penicillin combinations (-200.9 [-421.4-19.6]), and fourth-generation cephalosporins (-116.9 [-219.8 to -14.0]). Consumption was highest during the pre-policy period, and declines were largest following the intervention in the eastern region (-32.1%, -39.8 to -24.4) and among tertiary hospitals (-266.2 [-339.5 to -192.9] thousand DDDs per month). CONCLUSION: This population-level drug utilization research represents the first comprehensive evaluation of the effectiveness of China's nationwide carbapenem stewardship. The national policy targeting carbapenem prescribing has led to a sustained reduction in carbapenem use with limited substitution. Effects varied geographically and were concentrated in tertiary and secondary hospitals.

Evaluation of Willingness to Accept COVID-19 Vaccine and Willingness to Pay among Pakistani Parents for Their Children Aged 5 to 11 Years: Findings and Implications.

Vaccines are the most efficient and cost-effective tool to halt the transmission and prevention of COVID-19. The current study examined the willingness of parents to vaccinate their children against COVID-19. This was a cross-sectional study that used a questionnaire based on the Health Belief Model, previous history of COVID-19, willingness to accept, and willingness to pay for the COVID-19 vaccine. The questionnaire was administered among parents of children aged 5 to 11 years. Descriptive statistics, χ2 tests, and regression analysis were carried out for data analysis. A total of 474 respondents participated in this survey with a response rate of 67.7%. In our study, a majority of the respondents exhibited a willingness to accept the COVID-19 vaccine for their children (Definitely yes/Probably yes = 252, 53.2%); nevertheless, 229 (48.3%) respondents were unwilling to pay for it. More than three-quarters of the respondents were worried about the probability of COVID-19 infection in their children (n = 361, 76.2%) and were afraid of COVID-19-associated complications (n = 391, 82.5%). Likewise, most respondents showed their concerns regarding the effectiveness of the vaccine (n = 351, 74.1%), vaccine safety (n = 351, 74.1%), and the halal nature of the vaccine (n = 309, 65.2%). Respondents who were aged 40 to 50 years (odds ratio [OR]: 0.101, 95% CI: 0.38-0.268; P < 0.001), family income > 50,000 PKR (OR: 0.680, 95% CI: 0.321-1.442; P = 0.012), and location (OR: 0.324, 95% CI: 0.167-0.628; P = 0.001) were the factors that were likely to impact vaccine acceptance among parents. Education-based interventions are urgently required to improve COVID-19 vaccination acceptance among parents for their children.

The impact of diabetes mellitus on the emergence of multi-drug resistant tuberculosis and treatment failure in TB-diabetes comorbid patients: a systematic review and meta-analysis.

Background: The existence of Type 2 Diabetes Mellitus (DM) in tuberculosis (TB) patients is very dangerous for the health of patients. One of the major concerns is the emergence of MDR-TB in such patients. It is suspected that the development of MDR-TB further worsens the treatment outcomes of TB such as treatment failure and thus, causes disease progression. Aim: To investigate the impact of DM on the Emergence of MDR-TB and Treatment Failure in TB-DM comorbid patients. Methodology: The PubMed database was systematically searched until April 03, 2022 (date last searched). Thirty studies met the inclusion criteria and were included in this study after a proper selection process. Results: Tuberculosis-Diabetes Mellitus patients were at higher risk to develop MDR-TB as compared to TB-non-DM patients (HR 0.81, 95% CI: 0.60-0.96, p < 0.001). Heterogeneity observed among included studies was moderate (I2 = 38%). No significant change was observed in the results after sub-group analysis by study design (HR 0.81, 95% CI: 0.61-0.96, p < 0.000). In the case of treatment failure, TB-DM patients were at higher risk to experience treatment failure rates as compared to TB-non-DM patients (HR 0.46, 95% CI: 0.27-0.67, p < 0.001). Conclusion: The results showed that DM had a significant impact on the emergence of MDR-TB in TB-diabetes comorbid patients as compared to TB-non-DM patients. DM enhanced the risk of TB treatment failure rates in TB-diabetes patients as compared to TB-non-DM patients. Our study highlights the need for earlier screening of MDR-TB, thorough MDR-TB monitoring, and designing proper and effective treatment strategies to prevent disease progression.

Effectiveness of Community Pharmacy Diabetes and Hypertension Care Program: An Unexplored Opportunity for Community Pharmacists in Pakistan.

Background: The effective management of patients diagnosed with both Diabetes as well as Hypertension is linked with administration of efficacious pharmacological therapy as well as improvement in adherence through counseling and other strategies. Being a part of primary healthcare team, community pharmacists can effectively provide patient care for chronic disease management. The objective of the study was to evaluate the impact of pharmacist counseling on blood pressure and blood glucose control among patients having both hypertension and diabetes attending community pharmacies in Pakistan. Method: A randomized, controlled, single-blind, pre-post-intervention study design was used. The respondents included patients diagnosed with diabetes mellitus (Type I or II) and hypertension visiting community pharmacies to purchase their regular medicine. A simple random sampling technique using the lottery method was used to select community pharmacies in groups A (intervention, n = 4) and group B (control, n = 4). The total number of patients was 40 in each group, while estimating a dropout rate of 25%. The patients in the intervention group received special counseling. Blood pressure and blood glucose were checked after every 15 days for 6 months. Prevalidated tools such as the hypertension knowledge level scale, the diabetes knowledge questionnaire 24, and a brief medication questionnaire was used. Data were coded and analyzed using SPSS 21. Wilcoxon test (p < 0.05) was used to compare pre-post intervention knowledge regarding the disease, while the Mann-Whitney test (p < 0.05) was used to find differences in medication adherence among control and intervention groups. Results: A significant improvement in mean knowledge scores of patients with diabetes (16.02 ±2.93 vs. 19.97 ±2.66) and hypertension (15.60 ±3.33 vs. 18.35 ±2.31) in the intervention group receiving counseling for 6 months than control group (p < 0.05) was noted. Furthermore, the fasting blood glucose levels (8.25 ±1.45) and systolic BP (130.10 ±6.89) were significantly controlled after 6 months in the intervention group. Conclusion: The current study results concluded that community pharmacists' counselling has a positive impact on blood glucose and blood pressure management among patients suffering with both diabetes and hypertension.

Antibiotic use among hospitalized children with lower respiratory tract infections: a multicenter, retrospective study from Punjab, Pakistan.

BACKGROUND: Lower respiratory tract infection (LRTI) is one of the triggering factors toward death in children below the age of five years necessitating appropriate antibiotic selection. This study aimed to evaluate antibiotic use among hospitalized children (≤5 years age) with LRTIs. METHODS: A retrospective study was conducted in seven health facilities of the central region of Punjab province of Pakistan. The medical records of hospitalized children ≤5 years diagnosed with LRTI were thoroughly evaluated to get information on demographics, clinical characteristics, and details of prescribed antibiotics. The appropriateness of antibiotics was assessed according to guidelines of the British National Formulary due to a lack of indigenous standard treatment guidelines. RESULTS: The medical records of 5926 children were searched with the majority (70.9%) diagnosed with community-acquired pneumonia (CAP) followed by acute bronchitis (14.1%). Ceftriaxone plus ampicillin and ceftriaxone plus ampicillin plus amikacin were prescribed to 39% and 11.7% study population, respectively. One-fourth of children were prescribed the wrong dose, and more than half were encountered with the incorrect route of antibiotic administration. Alarmingly, 90.2% of antibiotic prescriptions were inappropriate in our findings. CONCLUSIONS: Current surveillance study revealed a worrying degree of antibiotic misuse among hospitalized LRTI children aged ≤5 years.

Assessment of Adverse Drug Events, Their Risk Factors, and Management Among Patients Treated for Multidrug-Resistant TB: A Prospective Cohort Study From Pakistan.

Background: Multidrug-resistant tuberculosis (MDR-TB) is a growing public health problem. Treatment regimens used against MDR-TB are costly, prolonged, and associated with more side effects as compared with the drug-susceptible tuberculosis. This study was framed to determine the incidence of adverse drug events, risk factors, and their management in MDR-TB patients. Methods: This prospective follow-up cohort study was conducted at the site of programmatic management of drug-resistant TB located at the Pakistan Institute of Medical Sciences, Islamabad. All patients, irrespective of their age, gender, and ethnicity, were included in the study. Adverse drug events were observed in patients at different time points during the study. Patients enrolled for the treatment from January 2018 were prospectively followed till December 2020 up to their end treatment outcomes. Results: Out of 126 MDR-TB patients enrolled for treatment, 116 met the inclusion criteria and were included in the final analysis. Most patients (50.9%) were between 18 and 45 years of age. A minimum of one adverse event was experienced by (50.9%) patients. Of all the adverse events, gastrointestinal disorders were more frequent (47.4%), followed by arthralgia (28.4%) and psychiatric disturbance (20.6%). Furthermore, multivariate analysis showed a significant association with the incidence of adverse events in patients with age group above 60 years (odds ratio (OR) 4.50; 95% CI 1.05-19.2), active smokers (OR 4.20; 95% CI 1.31-13.4), delayed reporting to the TB center (OR 4.03; 95% CI 1.34-12.1), and treatment without bedaquiline regime (OR 3.54; 95% CI 1.23-10.1). Most of the patients (94.6%), counseled by the pharmacist, were found to be satisfied with the information provided and looked for more pharmacist counseling opportunities in the management of MDR-TB. Conclusion: Current findings recommend that ADEs might be well managed by timely identification and reporting. Bedaquiline coupled with other active medications lowered the chance of ADEs in MDR-TB patients. Elderly patients, active smoking behavior, and those who have a delay in the treatment initiation are more prone to ADEs. Clinical pharmacist's contribution to TB control programs may help caregivers and patients concerning the rational use of medication, early detection, and management of ADEs.

Exploring Knowledge of Antibiotic Use, Resistance, and Stewardship Programs among Pharmacy Technicians Serving in Ambulatory Care Settings in Pakistan and the Implications.

Antimicrobial resistance (AMR) is a leading global health threat, increasing morbidity, mortality, and costs, with excessive and irrational use of antimicrobials contributing to the development of AMR. Consequently, the aims of this study were to evaluate the understanding of antibiotic use, AMR, and antimicrobial stewardship programs (ASPs) among pharmacy technicians serving in ambulatory healthcare settings in Pakistan. A cross-sectional survey was conducted among pharmacy technicians serving in 144 ambulatory care settings in seven districts of Punjab province using a validated questionnaire. Overall, 376 technicians completed the survey (85.8% response rate). The majority were men (89.1%), aged 25−35 years (45.1%), serving in emergency departments (43.9%) and filling 31−60 prescriptions per day (37.5%). Most (79.5%) knew that antibiotics were one of the most frequently prescribed drug classes, while 59.8% believed antibiotics for common colds did not speed up recovery. Inadequate duration (59.6%) and inadequate dosages (57.7%) of antibiotic therapy were reported as the leading causes of AMR. Terms including 'superbugs', 'multidrug resistance', and 'extensively drug resistance' were known to 42.0%, 25.3%, and 20.7% of participants, respectively; however, <10% knew about ASPs, including their core elements and purpose. Our study revealed that pharmacy technicians have adequate awareness of antibiotic use but are currently unaware of AMR and ASPs, which is a concern.

Assessment of Factors Associated with Unfavorable Outcomes among Drug-Resistant TB Patients: A 6-Year Retrospective Study from Pakistan.

The spread of drug-resistant tuberculosis (DR TB) poses significant challenges to the control and successful eradication of TB globally. The current retrospective study was designed to evaluate the treatment outcomes and identify the risk factors associated with unsuccessful outcomes among DR TB patients. A total of 277/308 eligible DR TB patients were enrolled for treatment at the programmatic management unit of DR TB at the Pakistan Institute of Medical Sciences, Islamabad between January 2014 and July 2019. Treatment outcomes were defined according to the WHO recommendations. Death, treatment failure, and lost to follow-up (LTFU) were collectively grouped as unsuccessful treatment outcomes, whereas cured and treatment completed were summed up together as successful treatment outcomes. Out of the total 277 patients, 265 (95.67%) were multidrug/rifampicin-resistant TB (MDR/RR-TB) cases, 8 (2.89%) were isoniazid resistant cases, and 4 (1.44%) were extensively drug-resistant ones. In the current cohort, a total of 177 (63.9%) achieved successful treatment outcomes. Among them, 153 (55.2%) were declared cured and 24 (8.7%) completed their treatment. Of the remaining 100 (36.1%) patients with unsuccessful outcomes, 60 (21.7%) died, 32 (11.5%) were LTFU, and 8 (2.9%) had failed treatment. The proportion of male patients was relatively higher (55.2%), within the age group of 21-40 years (47.3%) and lived in rural areas (66.8%). The multivariate analysis revealed that unsuccessful outcomes had a statistically significant association with being male (adjusted odds ratio, AOR: 1.92, 95% confidence interval (CI): 1.10-3.36), being in an age group above 60 years (AOR: 3.34, 95% CI: 1.09-10.1), suffering from any comorbidity (AOR: 2.69, 95% CI: 1.35-5.38), and the history of use of second-line drugs (AOR; 3.51, 95% CI 1.35-9.12). In conclusion, treatment outcomes among DR TB patients at the study site were poor and did not achieve the treatment success target (≥75%) set by the World Health Organization.