Occupancy Prediction in IoT-Enabled Smart Buildings: Technologies, Methods, and Future Directions.

In today's world, a significant amount of global energy is used in buildings. Unfortunately, a lot of this energy is wasted, because electrical appliances are not used properly or efficiently. One way to reduce this waste is by detecting, learning, and predicting when people are present in buildings. To do this, buildings need to become "smart" and "cognitive" and use modern technologies to sense when and how people are occupying the buildings. By leveraging this information, buildings can make smart decisions based on recently developed methods. In this paper, we provide a comprehensive overview of recent advancements in Internet of Things (IoT) technologies that have been designed and used for the monitoring of indoor environmental conditions within buildings. Using these technologies is crucial to gathering data about the indoor environment and determining the number and presence of occupants. Furthermore, this paper critically examines both the strengths and limitations of each technology in predicting occupant behavior. In addition, it explores different methods for processing these data and making future occupancy predictions. Moreover, we highlight some challenges, such as determining the optimal number and location of sensors and radars, and provide a detailed explanation and insights into these challenges. Furthermore, the paper explores possible future directions, including the security of occupants' data and the promotion of energy-efficient practices such as localizing occupants and monitoring their activities within a building. With respect to other survey works on similar topics, our work aims to both cover recent sensory approaches and review methods used in the literature for estimating occupancy.

Comparison of cystatin C and creatinine-based estimated glomerular filtration rate equations among elderly chronic kidney disease patients attending a tertiary care hospital: A prospective cross-sectional study
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BACKGROUND: Serum creatinine has been solely used in clinical practice to identify chronic kidney disease (CKD) staging in the elderly population. Serum cystatin C is believed to more accurately define the CKD staging and is also ratified as an endogenous biomarker by Kidney Disease Improving Global Outcomes (KDIGO) guidelines. MATERIAL AND METHODS: A total of 300 elderly Malay participants (age ≥ 65 years) with CKD, attending the Hospital University Sains Malaysia were included in the study. Demographic data and history were also recorded. Serum creatinine was assayed by Chemistry Analyzer Model Architect-C8000 (Jaffe method). While serum cystatin C was examined by Human cystatin C ELISA kit (Sigma-Aldrich) using Thermo Scientific Varioskan Flash ELISA reader. RESULTS: Out of 300 study participants, 169 (56.3%) were females. Mean age of patients was 67.6 ± 6.7 years. 64 male (64.6%) and 35 female (35.4%) patients were between 70 and 79 years. When estimated by MDRD equation, the prevalence of CKD stage 3 (defined as eGFR = 30 - 59 mL/min/1.73m2) was 27.7%, while based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, it was 28%, 36.3%, and 36.3%, respectively. The prevalence of CKD stage 4 (defined as eGFR = 15 - 29 mL/min/1.73m2) when estimated by MDRD was 37.6%, whereas based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, it was 36.3%, 46.4%, and 46.4%, respectively. CKD stage 5 (defined as eGFR < 15 mL/min/1.73m2) when estimated by the MDRD equation was 34.7%. While based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, the prevalence of CKD stage 5 was 35.7%, 17.3%, and 17.3%, respectively. CONCLUSION: The staging of CKD is different between the creatinine- and cystatin C-based equations. Creatinine-based equations classify patients as having CKD stage 5 twice as often as cystatin C-based equations.

Development and validation of the General Rehabilitation Adherence Scale (GRAS) in patients attending physical therapy clinics for musculoskeletal disorders.

BACKGROUND: Non-adherence to physical therapy ranges from 14 to 70%. This could adversely affect physical functioning and requires careful monitoring. Studies that describe designing and validation of adherence measuring scales are scant. There is a growing need to formulate adherence measures for this population. The aim was to develop and validate a novel tool named as the General Rehabilitation Adherence Scale (GRAS) to measure adherence to physical therapy treatment in Pakistani patients attending rehabilitation clinics for musculoskeletal disorders. METHODS: A month-long study was conducted in patients attending physical therapy sessions at clinics in two tertiary care hospitals in Karachi, Pakistan. It was done using block randomization technique. Sample size was calculated based on item-to-respondent ratio of 1:20. The GRAS was developed and validated using content validity, factor analyses, known group validity, and sensitivity analysis. Receiver operator curve analysis was used to determine cut-off value. Reliability and internal consistency were measured using test-retest method. Data was analyzed through IBM SPSS version 23. The study was ethically approved (IRB-NOV:15). RESULTS: A total of 300 responses were gathered. The response rate was 92%. The final version of GRAS contained 8 items and had a content validity index of 0.89. Sampling adequacy was satisfactory, (KMO 0.7, Bartlett's test p-value< 0.01). Exploratory factor analysis revealed a 3-factor model that was fixed and confirmed at a 2-factor model. Incremental fit indices, i.e., normed fit index, comparative fit index and Tucker Lewis index, were reported > 0.95 while absolute fit index of root mean square of error of approximation was < 0.03. These values indicated a good model fit. The value for Cronbach (α) was 0.63 while it was 0.77 for McDonald's (ω), i.e., acceptable. Test-retest reliability coefficient was 0.88, p < 0.01. Education level was observed to affect adherence (p < 0.01). A cut-off value of 12 was identified. The sensitivity and accuracy of the scale was 95%, and its specificity was 91%. CONCLUSION: The scale was validated in this study with satisfactory results. The availability of this tool would enhance monitoring for adherence as well as help clinicians and therapists address potential areas that may act as determinants of non-adherence.

Assessment of Antiviral combination therapy with Cephalosporin antibiotic for prevention of severe Influenza-A (H1N1)pdm09 infection associated secondary bacterial infection and other complications.

Secondary bacterial infection is considered as a major complication associated with severe Influenza-A (H1N1)pdm09 infection responsible for the mortalities and morbidities worldwide. Use of antibiotics in viral Influenza infection is still debatable. All the confirmed diagnosed hospitalized Influenza-A (H1N1)pdm09 infection patients fulfilling inclusion/exclusion criteria during the study period were divided into two groups based on drug therapy for initial 72 hours. Group-1 included those patients who received oral oseltamivir alone while Group-2 included patients who were initiated on oseltamivir in combination with empiric cephalosporin antibiotic within 6-8 hours after hospitalization. The patients of both groups were assessed for incidences of various complication associated with Influenza-A (H1N1)pdm09 infection. A total of 227 and 116 patients were enrolled for Group-1 and Group-2 respectively. The incidences of secondary bacterial infections were significantly less (P<0.05). Moreover, length of stay in hospitalization, need of ICU admission, multiple organ failure and need of respiratory support were also significantly less (P<0.05) for Group-2 patients. Majority of patients that suffered complications were unvaccinated and aged more than 50 years with multiple comorbidities. Among cephalosporins, cefuroxime was found to be least effective in prevention of Influenza associated complications. Early initiation of empiric antibiotic therapy in combination with oseltamivir can prevent complications associated with Influenza-A (H1N1)pdm09 infection especially in elderly and unvaccinated high risk patients. Different combinations of antibiotics and antiviral medications need to be analysed for the prevention of severe Influenza infection complications.

Assessment of antiviral and antibiotic combination treatment in influenza-A H1N1 induced acute kidney injury among hospitalized patients.

The aim of the study is to assess and compare the impact of antiviral drug alone and in combination with antibiotic for prevention of Influenza-A H1N1 induced acute kidney injury (AKI) in hospitalized patients. Hospitalized admitted patients with confirmed diagnosis of Influenza-A H1N1 infection were divided into two groups: group 1, which received antiviral (oseltamivir) drug alone and group 2, which received antiviral (oseltamivir) in combination with empirically prescribed antibiotic. Patients of both groups were assessed for incidences of AKI by two criteria i.e Acute Kidney Injury Network (AKIN) and RIFLE. A total of 329 patients (176 for group 1 and 153 for group 2) were enrolled. According to RIFLE criteria, 23(13%) of group 1 and 9(6%) patients of groups 2 were suffered from AKI with statistically significant difference (P<0.05). Also as per AKIN criteria, the incidence of AKI is statistically significantly difference (P<0.05) between both groups with 18(10%) patients and 6(4%) patients of group 1 and 2 respectively. Length of hospitalization was statistically less (P<0.05) in group 2 patients. The incidences of AKI in Influenza-A H1N1 treated with antiviral and antibiotic combination was statistically less as compared to patients who were given antiviral alone for treatment of influenza infection.

Development and bioevaluation of 99mTc(CO)3-labeled (1-azido-1-deoxy-ß-D-glucopyranoside) complex as a potential tumor-seeking agent.

The 1,2,3-triazole-containing (1-azido-1-deoxy-ß-D-glucopyranoside) complex was synthesized using click chemistry approach and evaluated its potential as a tumor-seeking agent. In the present study, (99m)Tc-tricarbonyl labeled (1-azido-1-deoxy-ß-D-glucopyranoside) radiotracer [(99m)Tc(CO)(3)-BM], (where BM stands for biomolecule, e.g., (1-azido-1-deoxy-ß-D- glucopyranoside)) was synthesized via click chemistry approach and then labeled with technetium-99m through isolink kit. Radio labeled drug was tested for radiochemical purity and in vitro stability by chromatographic techniques. Normal distribution and tumoral uptake were studied in Swiss Webster mice. Radiochemical purity results show 97.9 ±1.5% labeling and its in vitro stability were studied at room temperature up to 5h. The radio labeled drug exhibited 73.6±1.1% binding with blood proteins. Normal distribution of drug shows prominent uptake in brain while in case of tumor-bearing mice, the uptake was maximum in tumor tissue and negligible amount was shown in brain. The biodistribution was further compared with 2-fluoro-2-deoxy glucose ((18)F-FDG), which was used as a positive control. The data indicate that (99m)Tc-tricarbonyl labeled (1-azido-1-deoxy-ß-D- glucopyranoside) radiotracer might be a feasible candidate with reasonable potential for tumor diagnosis.

Prevalence of undiagnosed metabolic syndrome using three different definitions and identifying associated risk factors among apparently healthy adults in Karachi, Pakistan: a cross-sectional survey in the year 2022.

OBJECTIVE: To determine the prevalence and associated risk factors of undiagnosed metabolic syndrome (MetS) using three different definitions among apparently healthy adults of Karachi, Pakistan. METHODS: This community-based cross-sectional survey was conducted in Karachi, Pakistan, from January 2022 to August 2022. A total of 1065 healthy individuals aged 25-80 years of any gender were consecutively included. MetS was assessed using the National Cholesterol Education Program for Adult Treatment Panel (NCEP-ATP) III guidelines, International Diabetes Federation (IDF), and modified NCEP-ATP III. RESULTS: The prevalence of MetS was highest with the modified NCEP-ATP III definition at 33.9% (95% CI: 31-36), followed by the IDF definition at 32.2% (95% CI: 29-35). In contrast, the prevalence was lower at 22.4% (95% CI: 19-25) when using the NCEP ATP III definition. The risk of MetS significantly increases with higher BMI, as defined by the IDF criteria (adjusted OR [ORadj] 1.13, 95% CI 1.09-2.43), NCEP-ATP III criteria (ORadj 1.15, 95% CI 1.11-1.19), and modified NCEP-ATP III criteria (ORadj 1.16, 95% CI 1.12-1.20). Current smokers had significantly higher odds of MetS according to the IDF (ORadj 2.72, 95% CI 1.84-4.03), NCEP-ATP III (ORadj 3.93, 95% CI 2.55-6.06), and modified NCEP-ATP III (ORadj 0.62, 95% CI 0.43-0.88). Areca nut use was associated with higher odds of MetS according to both IDF (ORadj 1.71, 95% CI 1.19-2.47) and modified NCEP-ATP III criteria (ORadj 1.58, 95% CI 1.10-2.72). Furthermore, low physical activity had significantly higher odds of MetS according to the NCEP-ATP III (ORadj 1.36, 95% CI 1.01-1.84) and modified NCEP-ATP III criteria (ORadj 1.56, 95% CI 1.08-2.26). CONCLUSION: One-third of the healthy individuals were diagnosed with MetS based on IDF, NCEP-ATP III, and modified NCEP-ATP III criteria. A higher BMI, current smoking, areca nut use, and low physical activity were significant factors.

Development of 99mTc-5-fluorouracil as a potential tumor diagnostic agent.

5-Fluorouracil is a well know drug for chemotherapy of various types of cancer. In the present study, we radiolabeled 5-fluorouracil with (99m)Tc for a diagnostic study of cancer. After successful labeling of the drug we performed an animal study to evaluate the potential of this radiopharmaceutical as a tumor diagnostic agent. The results showed 98.1 ± 1.2% labeling efficacy of 5-fluorouracil with (99m)Tc. The in vitro stability of the radiolabeled drug at room temperature at 4 hr of post-labeling was >96.5 ± 0.4%. The binding of the radiolabeled drug with plasma proteins was 66.6 ± 3%. Partition coefficient results showed that this drug is hydrophilic in nature. Biodistribution study in rabbit models displayed faint uptake in liver. Both kidney and bladder were prominent as excretory route of the labeled drug. Bioevaluation was performed in Swiss Webster mice having naturally developed tumor. Mice were dissected, uptake of drug in various organs was studied and results showed prominent uptake in liver and tumor. Tumor was further investigated by histopathological study.

In house development of (99m)Tc-Rhenium sulfide colloidal nanoparticles for sentinel lymph node detection.

In this study, rhenium sulfide colloidal nanoparticles were developed as radiopharmaceutical for sentinel lymph node detection. We directly used rhenium sulfide as a starting material for the preparation of colloidal nanoparticles. UV-visible spectrophotometry was used for characterization of in house developed colloidal particles. The size distribution of radioactive particles was studied by using membrane filtration method. The percentage of radiolabeled colloidal nanoparticles was determined by paper chromatography (PC). The study also includes in vitro stability, protein binding in human blood and bioevaluation in a rabbit model. The results indicate that 77.27 ± 3.26 % particles of size less than 20nm (suitable for lymphoscintigraphy) were radiolabeled. (99m)Tc labeled rhenium sulfide labeling efficacy with the radiometal is 98.5 ± 0.5%, which remains considerably stable beyond 5h at room temperature. Furthermore, it was observed that 70.2 ± 1.3% radiolabeled colloid complex showed binding with the blood protein. Bioevaluation results show the remarkable achievement of our radiopharmaceutical. The in house prepared (99m)Tc labeled rhenium sulfide colloidal nanoparticles reached the sentinel node within 15 min of post injection. These results indicate that (99m)Tc labeled rhenium sulfide colloid nanoparticles kit produced by a novel procedure seems of significant potential as a feasible candidate for further development to be used in clinical practice.

Synthesis, characterization and bioevaluation of technetium-99m labeled N-(2-Hydroxybenzyl)-2-amino-2-deoxy-D-glucose as a tumor imaging agent.

N-(2-Hydroxybenzyl)-2-amino-2-deoxy-D-glucose (NHADG) was synthesized by conjugation of salicylaldehyde to glucosamine. The obtained compound was well characterized via different analytical techniques. Labeling of the synthesized compound with technetium-99m ((99m)Tc) in pertechnetate form ((99m)Tc O4-) was carried out via chelation reaction in the presence of stannous chloride dihydrate. Maximum radiochemical yield of (99m)Tc-NHADG complex (99%) was obtained by using 1 mg NHADG, 200 µg SnCl2.2H2O, at pH 9.5 and reaction time of 15 min. The radiochemical purity of the (99m)Tc-NHADG complex was measured by instant thin layer chromatography (ITLC) and paper chromatography (PC), without any notable decomposition at room temperature over a period of 4h. The biological evaluation results show that the (99m)Tc labeled NHADG conjugate is able to specifically target mammary carcinoma in mice models, thus highlighting its potential as an effective (99m)Tc labeled glucose-derived agent for tumor imaging.

A distribution-free newsvendor model considering environmental impact and shortages with price-dependent stochastic demand.

In today's competitive and volatile market, demand prediction for seasonal items is a challenging task. The variation in demand is so quick that the retailer cannot face the risk of understocking or overstocking. Unsold items need to discarded, which has environmental implications. It is often difficult to calculate the effects of lost sales on a firm's monetary values, and environmental impact is not a concern to most businesses. These issues concerned with the environmental impact and the shortages are considered in this paper. A single-period inventory mathematical model is formulated to maximize expected profit in a stochastic scenario while calculating the optimal price and order quantity. The demand considered in this model is price-dependent, with several emergency backordering options to overcome the shortages. The demand probability distribution is unknown to the newsvendor problem. The only available demand data are the mean and standard deviation. In this model, the distribution-free method is applied. A numerical example is provided to demonstrate the model's applicability. To prove that this model is robust, sensitivity analysis is performed.

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.

Synthesis, characterization and biodistribution of novel amine thiophene 99mTc labeled complex.

(99m)Tc-labeled amine thiophene ligand might be a potential candidate for brain imaging. The purpose was to investigate the uptake of a radiolabeled drug in the brain. In this study, a tetradentate amine-thiophene-dione ligand was synthesized by the reaction of thiophene-2-carboxaldehyde with ethane-1,2-diamine and reducing with NaBH(4). The ligand system was characterized by elemental analysis, FTIR and 1H NMR. Radiolabeling of the complex with (99m)Tc was performed by reducing with stannous ions. The radiochemical purity of the radiolabeled drug was determined by paper chromatography (PC) and instant thin layer chromatography (ITLC). Bioevaluation of the (99m)Tc complex was studied in rabbits. The yield of the final product was 4.42 g (60%) and the characterization data confirmed the synthesis of the final product. The efficacy of radiolabeling was >98%. A significant uptake was observed in the brain which retained significantly upto 4h. The data indicate that the proposed system may be suitable for brain imaging in future clinical applications.

Comparative efficacy assessment of antiviral alone and antiviral-antibiotic combination in prevention of influenza-B infection associated complications.

OBJECTIVE: The study aimed to compare the efficacy of antiviral drug alone and antiviral-antibiotic combination therapy in prevention of complications associated with influenza B hospitalized patients. METHOD: Laboratory confirmed influenza B hospitalized patients presented in emergency room after 48 hours of symptoms onset were identified and divided into two groups; Group-1 patients were initiated on Antiviral drug (oseltamivir) alone while Group-2 patients were initiated on Antiviral drug (oseltamivir) in combination with Antibiotic for at least 3 days. Patients were evaluated for different clinical outcomes among both treatment group. RESULTS: A total of 153 and 131 patients were identified for Group-1 and Group-2, respectively. Clinical outcomes such as secondary bacterial infections (20.9%-vs-9.1%; P = 0.031), need of respiratory support (28.7%-vs-12.9%; P = 0.002), length of hospitalization stay (6.57-vs-4.95 days; P = <0.001), incidences of ICU admission (15.7%-vs-7.6%; P = 0.036), early clinical failure (32.6%-vs-16.1%; P = 0.01), and time to clinical stability (4.83-vs-4.1 days; P = 0.001) were found to be statistically less significant (P-value <0.05) for Group-2 patients. CONCLUSION: Early initiation of antibiotic therapy in combination with oseltamivir was found to be more efficacious than oseltamivir alone in prevention of influenza B-associated complications especially in high-risk influenza patients.

The Association between Chronic Heroin Smoking and Chronic Obstructive Pulmonary Disease.

INTRODUCTION: Little is known about the correlation between chronic obstructive pulmonary disease (COPD) and heroin smoking. Heroin smoking is a recent underinvestigated problem. The goal of this study is to study the impact of heroin smoking among COPD patients. METHODS: This is a descriptive clinical study. A combination of self-reporting questionnaires and data extraction tools were used to collect information during baseline tests, interviews, and follow-ups. Patients' medical, clinical, and socioeconomic history were recorded. Participants were recruited using random sampling from multiple centers. RESULTS: Out of 1034 COPD patients, heroin smokers represented the vast majority of addiction cases (n = 133). Heroin smokers were leaner than non-addicts (19.78 ± 4.07 and 24.01 ± 5.6, respectively). The most common type of comorbidities among heroin smokers was emphysema (27%). Both the forced expiratory volume (FEV1)/forced vital capacity ratio and FEV1% predicted were lower among heroin smokers than non-addicts (52.79 ± 12.71 and 48.54 ± 14.38, respectively). The majority of heroin smokers (55%) had advanced COPD, and at least 15% of heroin smokers suffered from frequent respiratory failure. The mean ± SD for COPD onset age among heroin smokers was 44.23 ± 5.72, and it showed a statistically significant correlation (P < 0.001). CONCLUSION: Heroin smoking might be linked to the onset of COPD. Heroin smokers showed a significantrespiratory impairment compared to tobacco smokers of the same age group.

Efficacy comparison of oseltamivir alone and oseltamivir-antibiotic combination for early resolution of symptoms of severe influenza-A and influenza-B hospitalized patients.

OBJECTIVES: To assess the comparative efficacy of oseltamivir alone and oseltamivir-antibiotic therapy for early relief of symptoms associated with severe influenza-A (non-H1N1) and influenza-B infection hospitalized patients. METHODS: In this retrospective multicenter study conducted from 2016-2019, enrolled patients were divided into 2 treatment groups. Group 1 patients were started on Antiviral drug (oseltamivir) alone therapy. Group 2 patients were initiated on Antiviral drug (oseltamivir) in combination with Antibiotic therapy. Using acute respiratory illness scoring, symptom severity score was assessed daily for 8 symptoms namely, fever, fatigue, headache, cough, sore throat, wheezing, muscle ache and nasal congestion. For each symptom the severity was scored from scale 0-3. Results: Overall mean ARI severity score was statistically significantly lower (p less than 0.05) on day 2 (14.65-vs-13.68), day 3 (12.95-vs-11.67) and day 4 (10.31-vs-9.12 ) for influenza-A (non-H1N1) while day 3 (12.52-vs-11.87) and day 4 (11.21-vs-10.18) for influenza-B patients for patients who were initiated on oseltamivir-antibiotic combination therapy. Fever, cough and nasal congestion showed statistically significant improvement within 4 days of initiation of combination treatment. Fatigue, sore throat and muscle ache improvement pattern was same for both treatment protocols. CONCLUSION: Oseltamivir-antibiotic combination treatment showed early resolution of some symptoms with cumulatively reduced mean symptom severity score in severe influenza infection hospitalized patients.

Estimation of direct cost of managing rheumatoid arthritis treatment to Pakistani patients using real-world follow-up data.

OBJECTIVE: This study aimed to estimate annual direct cost attributed to rheumatoid arthritis (RA) treatment from a patient's perspective using real-world patient follow-up data from hospitals' electronic database. METHODS: A prospective 1-year study was conducted in rheumatology clinics of tertiary care hospitals of Karachi, Pakistan. Cost-of-illness methodology was used and all patient data related to costs of rheumatologist visits, physical therapy sessions, medications, assistive devices and laboratory investigations were obtained directly in printed hardcopies from patient electronic databases using their medical record numbers. Transportation cost was calculated from patient-reported log books. Data were analyzed through IBM SPSS version 23. Patients were asked to sign a written consent and the study was ethically approved. RESULTS: The mean age of patients (N = 358) was 48 years. Most patients (73.7%) were female, married (86%) and had basic education (71.8%). Average cost of rheumatologist visits was PKR 11 510.61 (USD: 72.05) while it was PKR 66 947.37 (USD: 419.07) for physical therapy sessions. On average, medicines and medical devices costs were estimated at PKR 10 104.23 (USD: 63.25) and PKR 7848.48 (USD: 49.13) respectively. Cost attributed to diagnostic and laboratory charges was PKR 1962.12 (USD: 12.28) and travel expense was PKR 6541 (USD: 40.95). The direct expenditure associated with managing RA was PKR 37 558 (USD: 235.1). All costs were reported per annum. CONCLUSION: Patient with RA in Pakistan pay a considerable amount of their income for managing their condition. Most patients have no provision for insurance which is a need considering the nature of the disease and associated productivity loss that would significantly lower income as the disease progresses.

Assessment of efficacy of Oseltamivir-Azithromycin combination therapy in prevention of Influenza-A (H1N1)pdm09 infection complications and rapidity of symptoms relief.

Objectives: This study aimed to assess the efficacy of oseltamivir-Azithromycin combination therapy for prevention of Influenza-A (H1N1)pdm09 infection associated complications and early relief of influenza symptoms.Methods: In a retrospective observational cohort study, Influenza-A (H1N1)pdm09 infection hospitalized patients were identified and divided into two groups based on the initial therapy. Group-AV patients were initiated on Oseltamivir without any antibiotic in treatment regimen while Group-AV+AZ patients were initiated on Oseltamivir and Azithromycin combination therapy for at least 3-5 days. Patients were evaluated for different clinical outcomes.Results: A total of 227 and 102 patients were identified for Group-AV and Group-AV+AZ respectively. Multivariate regression analysis showed that incidences of secondary bacterial infections were significantly less frequent (23.4% vs 10.4%; P-value = 0.019) in Group-AV+AZ patients. Group-AV+AZ patients were associated with shorter length of hospitalization (6.58 vs 5.09 days; P-value = <0.0001) and less frequent incidences of respiratory support (38.3% vs 17.6%; P-value = 0.016). Overall influenza symptom severity score was statistically significant less for Group-AV+AZ patients on Day-5 (10.68 ± 2.09; P-value = 0.001) of hospitalization.Conclusion: Oseltamivir-Azithromycin combination therapy was found to be more efficacious as compared to oseltamivir alone in rapid recovery and prevention of Influenza associated complications especially in high risk patients.

Risk Factors Associated With Medication Errors Among Patients Suffering From Chronic Disorders.

Introduction: Medication error is unintentional and can be reduced by reducing the risk factors. Patients suffering from chronic diseases are at an increased risk of medication errors. Objective: This work aims to assess the risk factors associated with medication errors among patients suffering from chronic disorders in hospitals of South Punjab, Pakistan. Methodology: Multiple logistic regression analysis was used to assess the impact of different risk factors on the prevalence of medication errors in patients suffering from chronic diseases. Results: A greater risk for the occurrence of medication errors was associated with age ≥60 years (odds ratio, OR = 1.9; 95% CI = 1.3-3.1; p = 0.001), overburdened healthcare system (OR = 2.2; 95% CI = 1.64-3.56; p < 0.000), number of prescribed drugs ≥5 (OR = 1.74; 95% CI = 1.02-2.64; p < 0.000), comorbidities (OR = 2.6; 95% CI = 1.72-3.6; p = 0.003), Charlson comorbidity index (OR = 1.31; 95% CI = 0.49-1.84; p = 0.004), and multiple prescribers to one patient (OR = 1.12; 95% CI = 0.64-1.76; p = 0.001). Conclusion: Older age, overburdened healthcare system, number of prescribed drugs, comorbidities, Charlson comorbidity index, and multiple prescribers to one patient are significant risk factors for the occurrence of medication errors.

Validation of the General Medication Adherence Scale in Pakistani Patients With Rheumatoid Arthritis.

OBJECTIVE: The aim was to validate the Urdu version of General Medication Adherence Scale (GMAS) in patients with rheumatoid arthritis disease. METHODS: A 2-month (March-April 2019) cross-sectional study was conducted in randomly selected out-patients with rheumatoid arthritis. The sample size was calculated using item-subject ratio of 1:20. The scale was evaluated for factorial, concrete, concurrent, and known group validities. Concrete validity was established by correlating scores of EQ-5D quality of life scale and GMAS adherence score. Concurrent validity was established by correlating the GMAS adherence score with pill count. Analyses for sensitivity were also conducted. Cut-off value was determined through receiver operator curve (ROC), and test-retest method was used to analyze internal consistency and reliability. Data were analyzed through IBM SPSS, IBM AMOS, and MedCalc software. The Urdu version of EQ-5D quality of life questionnaire was used with permission from developers (#ID20884). The study was approved by an ethics committee (#NOV:15). RESULTS: A total of 351 responses were analyzed. The response rate was 98%. Reliability was in acceptable range, i.e., Cronbach α = 0.797. Factorial validity was established by calculation of satisfactory fit indices. Correlation coefficients for concrete and concurrent validities were ρ = 0.687, p < 0.01 and ρ = 0.779, p < 0.01, respectively. Known group validity was established as significant association of adherence score with insurance and illness duration (p < 0.05) that were reported. Sensitivity of the scale was 94%. Most patients had high adherence (N = 159, 45.3%). CONCLUSION: The Urdu version of GMAS demonstrated adequate internal consistency and was validated. These results indicate that it is an appropriate tool to measure medication adherence in Pakistani patients with rheumatoid arthritis.