A Systematic Review of the Economic Burden of Diabetes in Eastern Mediterranean Region Countries.

Diabetes Mellitus (DM) is a highly prevalent non-communicable disease with high mortality and morbidity, which imposes a significant financial impact on individuals and the healthcare system. The identification of various cost components through cost of illness analysis could be helpful in health-care policymaking. The current systematic review aims to summarize the economic burden of DM in the Eastern Mediterranean Region (EMR) countries. The original studies published in the English language between January 2010 and June 2023 reported the cost of DM was identified by searching four different databases (Google Scholar, PubMed, Science Direct, and Cochrane Central). Two reviewers independently screened the search results and extracted the data according to a predefined format, whereas the third reviewer's opinion was sought to resolve any discrepancies. The costs of DM reported in the included studies were converted to USD dates reported in the studies. After the systematic search and screening process, only 10 articles from EMR countries met the eligibility criteria to be included in the study. There are substantial variations in the reported costs of DM and the methodologies used in the included studies. The mean annual cost per patient of DM (both direct and indirect cost) ranged from 555.20 USD to 1707.40 USD. The average annual direct cost ranged from 155.8 USD to 5200 USD and indirect cost ranged from 93.65 USD to 864.8 USD per patient. The studies included in the review obtained a median score of 8.65 (6.5 ─ 11.5) on the quality assessment tool based on Alison's checklist for evaluation of cost of illness studies. There is a significant economic burden associated with DM, which directly affects the patients and healthcare system. Future research should focus on refining cost estimation methodologies, improving the understanding of study findings, and making it easier to compare studies.

Demaghi, a polyherbal formulation, mitigates aluminum chloride-induced neurological impairment in mice: Insights from phytochemical analysis and behavioral assessment.

Herbal products have been very popular in Pakistan for their curative significance against various disorders. Demaghi (DEMG) is a widely used herbal product claimed to own natural substances having neuroprotective potential. The current study aims to scientifically validate the chemical composition as well as its neuroprotective claims of this widely used herbal tonic. The commercially available Demaghi product was chemically characterized for its phytocomposition. The mice were treated with two doses of Demaghi (DEMG 50 mg and 100 mg/kg/day), and the effects of its prolonged exposure on animal anxiety, memory, and depression were noted through a series of behavioral tests in the AlCl3-induced memory deficient mice model. Besides that, dissected brains were biochemically analyzed for oxidative stress markers and acetylcholinesterase activity, as well as histopathological changes. The study outcomes showed that DEMG (100 mg/kg/day) has prominent anti-anxiety effects, memory-enhancing properties, and anti-depressants effects observed in the AlCl3-induced memory-deficient mice model. Biochemical assays also showed a greater decrease in oxidative stress of tested animals treated with 100 mg/kg/day of DEMG. The histopathological analysis also revealed that administration of DEMG reduced the AlCl3-induced toxicity. UPLC-MS results revealed the presence of many phytoconstituents, which showed to support cholinergic signaling in in-silico studies. The current research validates the neurological benefits of Demaghi for memory-boosting properties. The phytocompounds present in Demaghi exert neuroprotective effects, possibly by enhancing the cholinergic neurotransmission and combating the neurotoxin-induced oxidative stress.

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.

Assessment of Health-Related Quality of Life, Medication Adherence, and Prevalence of Depression in Kidney Failure Patients.

BACKGROUND: Kidney failure is a global health problem with a worldwide mean prevalence rate of 13.4%. Kidney failure remains symptomless during most of the early stages until symptoms appear in the advanced stages. Kidney failure is associated with a decrease in health-related quality of life (HRQOL), deterioration in physical and mental health, and an increased risk of cardiovascular morbidity and mortality. This study aimed to evaluate the factors associated with decreased HRQOL and other factors affecting the overall health of patients. Another objective was to measure how medication adherence and depression could affect the overall HRQOL in patients with kidney failure. METHODOLOGY: The study used a prospective follow-up mix methodology approach with six-month follow-ups of patients. The participants included in the study population were those with chronic kidney disease grade 4 and kidney failure. Pre-validated and translated questionnaires (Kidney Disease Quality of Life-Short Form, Hamilton Depression Rating Scale Urdu Version, and Morisky Lewis Greens Adherence Scale) and assessment tools were used to collect data. RESULTS: This study recruited 314 patients after an initial assessment based on inclusion criteria. The mean age of the study population was 54.64 ± 15.33 years. There was a 47.6% male and a 52.4% female population. Hypertension and diabetes mellitus remained the most predominant comorbid condition, affecting 64.2% and 74.6% of the population, respectively. The study suggested a significant (p < 0.05) deterioration in the mental health composite score with worsening laboratory variables, particularly hematological and iron studies. Demographic variables significantly impact medication adherence. HRQOL was found to be deteriorating with a significant impact on mental health compared to physical health. CONCLUSIONS: Patients on maintenance dialysis for kidney failure have a significant burden of physical and mental symptoms, depression, and low HRQOL. Given the substantial and well-known declines in physical and psychological well-being among kidney failure patients receiving hemodialysis, the findings of this research imply that these areas related to health should receive special attention in the growing and expanding population of kidney failure patients.

Cost of Illness Analysis of Type 2 Diabetes Mellitus: The Findings from a Lower-Middle Income Country.

BACKGROUND: Diabetes is a major chronic illness that negatively influences individuals and society. Therefore, this research aimed to analyze and evaluate the cost associated with diabetes management, specific to the Pakistani Type 2 diabetes population. Research scheme and methods: A survey randomly collected information and data from diabetes patients throughout Pakistan out-patient clinics. Direct and indirect costs were evaluated, and data were analyzed with descriptive and inferential statistics. RESULTS: An overall of 1839 diabetes patients participated in the study. The results have shown that direct and indirect costs are positively associated with the participants' socio-demographic characteristics, except for household income and educational status. The annual total cost of diabetes care was USD 740.1, amongst which the share of the direct cost was USD 646.7, and the indirect cost was USD 93.65. Most direct costs comprised medicine (USD 274.5) and hospitalization (USD 319.7). In contrast, the productivity loss of the patients had the highest contribution to the indirect cost (USD 81.36). CONCLUSION: This study showed that direct costs significantly contributed to diabetes's overall cost in Pakistan and overall diabetes management estimated to be 1.67% (USD 24.42 billion) of the country's total gross domestic product. The expense of medications and hospitalization mostly drove the direct cost. Additionally, patients' loss of productivity contributed significantly to the indirect cost. It is high time for healthcare policymakers to address this huge healthcare burden. It is time to develop a thorough diabetes management plan to be implemented nationwide.

Assessment of health-related quality of life in hypertensive hemodialysis patients.

BACKGROUND AND OBJECTIVES: Globally, the prevalence of hypertension (HTN) with the coexistence of chronic kidney disease (CKD) is increasing, resulting in poor quality of life. The main objective of the study was to measure the health-related quality of life (HRQoL) of hypertensive hemodialysis patients. METHODS: A multicenter follow-up study was carried out in six public and two private dialysis centers in Pakistan. A total of 517 hypertensive hemodialysis patients responded by completing the questionnaire at baseline and two subsequent phases. The quality of life of these patients was assessed using the EQ-5D-5L questionnaire (a standardized instrument for measuring generic health status). Statistical analysis was done using a multivariate linear regression model, Friedman test and Kruskal Wallis test. RESULTS: The majority of patients (58.2%) had normal body mass index and about 60.5% of the patients were taking less salt due to HTN. Friedman test gave the statistically significant results (p ≤ 0.001) in systolic blood pressure (BP), diastolic BP and EQ-5D visual analogue scale (VAS) score between three phases (initial visit, first follow-up and second follow-up). A significant improvement was observed in self-care and usual activities from initial visit to first follow-up (p < 0.05). The most problematic dimension among the hypertensive patients with CKD was pain/discomfort (86.5%). CONCLUSIONS: HTN with coexisting CKD in hemodialysis patients severely affected HRQoL. Pain/discomfort was the most problematic dimension among the participants.

Assessment of immunization status and barriers to vaccination among the university students of Pakistan

A cross-sectional study was conducted to determine the vaccination status and barriers to vaccination among the university students by utilizing a simple random sampling technique in the largest public sector university of Southern Punjab, Pakistan. The participants comprised 380 university students. Data was collected by a self-designed questionnaire. Statistical Package for Social Sciences (SPSS) was used for data analysis. Chi-square Test and Fischer Exact test were applied to assess the impact of demographics on vaccination status, and barriers to vaccination. Out of 380 participants, 328 (86.31 pewrcent) were males and 52 (13.68) females. The immunization status of university students against various diseases was variable: 97.10 percent (n=369) were vaccinated against poliomyelitis, 58.68 percent (n=223) against BCG, 44.21 percent (n=168) against hepatitis B, 49.21 percent (n=187) against diphtheria, pertussis and tetanus and 55.26 percent (n=210) against measles vaccine. The barriers to vaccination were unwillingness 15.0 percent (n=57), inaccessibility 17.10 percent (n=65), financial issues 4.47 percent (n=17) and unawareness 63.42 percent (n=241). Moreover, 31 percent (n=118) of the participants considered that the use of vaccines is unsafe. The vaccination status of the university students in Southern Punjab, Pakistan is alarming as most of the students were unvaccinated. The unawareness and perception of the unsafety of vaccines were the biggest barriers to vaccination(AU)

Se realizó un estudio transversal para determinar el estado de vacunación y las barreras a la vacunación entre los estudiantes universitarios, mediante la utilización de una técnica de muestreo aleatorio simple, en la universidad más grande del sector público del sur de Punjab, Pakistán. Los participantes fueron 380 estudiantes universitarios. Los datos se recopilaron mediante un cuestionario de diseño propio. Se utilizó el Paquete Estadístico para Ciencias Sociales (SPSS) para el análisis de datos. Se aplicaron la prueba de chi-cuadrado y la prueba exacta de Fischer para evaluar el impacto de la demografía en el estado de vacunación y las barreras para la vacunación. De 380 participantes, 328 (86,31por ciento) fueron hombres y 52 (13,68 por ciento) mujeres. El estado de inmunización de los estudiantes universitarios frente a diversas enfermedades fue variable: 97,10 por ciento (n = 369) fueron vacunados contra poliomielitis, 58,68 por ciento (n = 223) contra BCG, 44,21por ciento (n = 168) contra hepatitis B, 49,21 por ciento (n = 187) contra la difteria, tos ferina y tétanos y 55,26 por ciento (n = 210) contra la vacuna contra el sarampión. Las barreras para la vacunación fueron la falta de voluntad 15,0 por ciento (n = 57); la inaccesibilidad 17,10 por ciento (n = 65); los problemas económicos 4,47 por ciento (n = 17) y el desconocimiento 63,42 por ciento (n = 241). Además, el 31por ciento (n = 118) de los participantes consideró que el uso de vacunas no es seguro. El estado de vacunación de los estudiantes universitarios en el sur de Punjab, Pakistán, es alarmante ya que la mayoría de los estudiantes no estaban vacunados. El desconocimiento y la percepción de la inseguridad de las vacunas fueron las mayores barreras para la vacunación(AU)

Humanistic and socioeconomic burden of COPD patients and their caregivers in Malaysia.

Chronic obstructive pulmonary disease (COPD) is associated with substantial humanistic and socioeconomic burden on patients and their caregivers. COPD is expected to be 7th leading cause of disease burden till 2030. The objective of the current study was to assess the humanistic and socioeconomic burden of COPD patients and their caregivers in Malaysia. The burden includes the cost of management of COPD, QOL of COPD patients and their caregivers, work productivity and activity impairment of COPD patients and their caregivers due to COPD. One hundred and fifty COPD patients and their caregivers from the chest clinic of Penang Hospital were included in the study from August 2018 to August 2019. Caregiving cost was estimated using the replacement cost approach, while humanistic and social burden was assessed with the help of health status questionnaires. Overall, 64.66% and 7.1% of COPD patients reported to depend on informal caregivers and professional caregivers respectively. COPD patients reported dyspnoea score as 2.31 (1.31), EQ-5D-5L utility index 0.57 (0.23), CCI 2.3 (1.4), SGRQ-C 49.23 (18.61), productivity loss 31.87% and activity impairment 17.42%. Caregivers reported dyspnoea score as 0.72 (0.14), EQ-5D-5L utility index 0.57 (0.23), productivity loss 7.19% and social activity limitation as 21.63% due to taking care of COPD patients. In addition to the huge direct cost of management, COPD is also associated with substantial burden on society in terms of compromised quality of life, reduced efficiency at the workplace, activity impairment and caregiver burden.

Assessment of risk factors responsible for rapid deterioration of lung function over a period of one year in patients with chronic obstructive pulmonary disease.

Compromised lung function is a common feature of COPD patients, but certain factors increase the rate of lung function decline in COPD patients. The objective of the current study was to investigate the effect of different clinically important factors responsible for rapid deterioration of lung function quantified as ≥ 60 ml decline in FEV1 over a period of one year. COPD patients recruited from the chest clinic of Penang hospital were followed-up for one year from August 2018 to August 2019. Rapid deterioration of lung function was defined as greater than 60 ml/year decline in force expiratory volume in one second. Among 367 included patients 73.84% were male, with mean age 65.26 (9.6) years and % predicted FEV1 51.07 (11.84). 30.27% patients showed mean decline of ≥ 60 ml in FEV1. The regression analysis showed that current smoking relative risk (RR) = 2.38 (1.78-3.07), p < 0.001); GOLD Stage III& IV RR = 1.43 (1.27-1.97), p < 0.001); mMRC score 3 to 4 RR = 2.03 (1.74-2.70), p < 0.01); SGRQ-C score ≥ 10 points difference RR = 2.01 (1.58-2.73), p < 0.01); SGRQ-C symptoms Score ≥ 10 points difference RR = 1.48 (1.23-2.29), p < 0.001); 6MWT < 350 m RR = 2.29 (1.87-3.34), p < 0.01); ≥ 3 exacerbation in study year RR = 2.28 (1.58-2.42, p < 0.001); 8 or more hospital admission days (RR = 3.62 (2.66-4.20), p < 0.001); Charlson comorbidity index ≥ 3 RR = 3.18 (2.23-3.76), p < 0.01) and emphysema RR = 1.31 (1.15-1.79), p < 0.01) were significant risk factors for the rapid deterioration of lung function (FEV1 decline ≥ 60 ml). Among different factors CCI score ≥ 3, abrupt decline in health status, exacerbation frequency ≥ 3, hospital admission days ≥ 8 and emphysema were reported as risk factors for rapid deterioration of lung function.

Chemical Profiling and Dose-Dependent Assessment of Fear Reducing and Memory-Enhancing Effects of Solanum virginianum in Rats.

The current study was planned to investigate the pharmacological basis of Solanum virginianum extract (SV.CR) pertaining to anxiolytic, antidepressant and memory-enhancing effects in rats. The SV.CR was analyzed in-vitro for phytoconstituents, antioxidant potential and anticholinesterase activity. The rats treated in a dose-dependent manner (25, 50 and 100 mg/kg of SV.CR) were subjected to behavioral tests for anxiety, depression and memory judgment followed by biochemical studies. A notable dose-dependent anxiolytic potential of SV.CR was observed in elevated plus maze and open field tests (P < 0.05). The decreased immobility time of the treated rats in the forced swim test (P < 0.01) unveiled the plant's potential to reduce depression. Moreover, SV.CR treatment also reversed scopolamine-impaired cognition (P < 0.05) in various deployed memory and learning tasks. Biochemical studies of brain homogenates of SV.CR treated animals demonstrated decreased anticholinesterase activity and lipid peroxidation levels whereas increased levels of superoxide dismutase and glutathione peroxidase (P < 0.05 vs scopolamine group) were noted. The scientific validation of the study supported the use of Solanum virginianum in reducing anxiety, depression and amnesia in experimental models. Phytoconstituents in SV.CR such as oleanolic acid and caffeic acid might have played a significant neuroprotective role via modulation of oxidative stress and neurochemical aspects.

Assessment of Undergraduate Pharmacy Students' Attitude Towards Pharmaceutical Care in Pakistan: Practice Implications.

BACKGROUND AND PURPOSE: Over the past few decades, the focus of pharmacy practice has been shifted from the classical role of drug dispenser to pharmacotherapy expert. Pharmacists now are more often involved in the patient care process by addressing the drug-related needs of the patients and this patient-centered approach is known as pharmaceutical care (PC). The present study was conducted to assess the attitude of pharmacy undergraduate students toward PC and various contributing factors that influence their preference towards it. METHOD AND INSTRUMENT: A descriptive cross-sectional study was conducted in 422 undergraduate pharmacy students by using a simple random sampling method. A pre-validated and self-reported Pharmaceutical Care Attitude Scale (PCAS) was used for assessing a student's attitude towards PC. RESULTS: Amongst the 422 undergraduate students, the majority were males (68.2%) and 70.4% were between the age group of 20 and 25 years. The students studying in third, fourth, and fifth year (final year) were 140 (33.2%), 142 (33.6%), and 140 (33.2%), respectively. Overall participant showed a positive attitude toward the PC. Professional year showed significant influence on professional duties (PD) (p<0.001) and age was significantly associated with return on efforts (ROE) (p<0.001) and professional benefits (PB) (p<0.001). CONCLUSION: Most of the participants showed a positive attitude toward PC and showed motivation to practice it. To promote PC practice in Pakistan, the government along with other professional bodies like Pakistan Pharmacists Association (PPA) should work together in collaboration with global health agencies to develop a well-structured advanced healthcare system in which there is a defined role of PC practice.

Burden of communicable diseases and cost of illness: Asia pacific region.

BACKGROUND: Communicable diseases such as AIDS/HIV, dengue fever, and malaria have a great burden and subsequent economic loss in the Asian region. The purpose of this article is to review the widespread burden of communicable diseases and related health-care burden for the patient in Asia and the Pacific. AREAS COVERED: In Central Asia, the number of new AIDS cases increased by 29%. It is more endemic in the poor population with variations in the cost of illness. Dengue is prevalent in more than 100 countries, including the Asia-Pacific region. In Southeast Asia, the annual economic burden of dengue fever was between $ 610 and $ 1,384 million, with a per capita cost of $ 1.06 to $ 2.41. Globally, 2.9 billion people are at risk of developing malaria, 90% of whom are residents of the Asia and Pacific region. The annual per capita cost of malaria control ranged from $ 0.11 to $ 39.06 and for elimination from $ 0.18 to $ 27. EXPERT OPINION: The cost of AIDS, dengue, and malaria varies from country to country due to different health-care systems. The literature review has shown that the cost of dengue disease and malaria is poorly documented.