Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan.

BACKGROUND: The current study is aimed to assess menstruation-related knowledge and practices of adolescent females visiting a public health care institute of Quetta city, Pakistan. METHODS: A questionnaire-based cross-sectional survey was conducted. Nine hundred and twenty three female adolescents attending general out-patient departments of Mohtarma Shaheed Benazir Bhutto Hospital Quetta, Balochistan, was approached for data collection. Based on the objectives of the study, descriptive analysis was conducted and SPSS v. 21.0 was used for the data analysis. RESULTS: Demographic characteristics revealed that the mean age of the respondents was 15 years. Mothers' (67%) were the main source of menstruation-related information. Majority (77.7%) of our respondents never had a class or session regarding menstruation-related education in their schools. About (44%) knew that menstruation is a physiological phenomenon while 60.2% knew that menstrual blood comes from the vagina. Nearly 40% of our study respondents missed their schools because of menarche. The use of absorbent material was frequent (90%) among the adolescent females and (68.7%) used commercially available sanitary napkins/pads. Although majority of the respondents (58.2%) were not taking baths during menstruation, 80.5% do cleaned their genitalia with water during menstruation. CONCLUSION: Female adolescents of our study had certain misconception regarding menstruation because of poor access to health-related education. Education can be provided at healthcare facilities, residential area as well as religious centers. Adolescent reproductive health should be included in the school curriculum; this will influence general reproductive health of females.

Medication Management Program: Adherence, Disease-related Knowledge, Health-related Quality of Life, and Glycemic Control for Type 2 Diabetes Mellitus.

CONTEXT: Escalation in rates of diabetes in Pakistan is posing threats to the economy and to the people's quality of life due to poor glycemic control and very high rates of complications. Cost of care is very high, and many barriers to quality care exist. Most often patients are unable to afford the high cost of treatment. Patients' knowledge about diabetes is associated with better medication adherence and better glycemic control. OBJECTIVE: The current study intended to evaluate the effects of an educational intervention in a pharmacist led, medication management program (MTM) tailored for patients with type 2 diabetes (T2DM). DESIGN: The research team conducted a nonclinical, randomized controlled trial. SETTING: The study took place at District Headquarters and Teaching Hospital, a public-sector hospital (Sargodha, Pakistan). PARTICIPANTS: Participants were 392 individuals with T2DM. INTERVENTION: Participants were randomly assigned to one of 2 groups-intervention and control-with 196 patients in each. The intervention group, instead of receiving standard care, received pharmaceutical care through the Medication Therapy Management program, whereas the control group received standard care. OUTCOME MEASURES: At baseline and 3 mo post ntervention, the study assessed participants' diabetes-related knowledge, medication adherence, and health-related quality of life (HRQoL) using the 14-item Michigan Diabetes Knowledge Test, the 8-item Morisky Medication Adherence Scale, and the European Quality of Life scales, respectively. To determine glycemic control, participants' baseline HbA1c levels were taken from their medical records, and the final HbA1c result was obtained postintervention. RESULTS: For the intervention and control groups at baseline, diabetes-related knowledge was average, at 7.99 ± 2.65 and 8.03 ± 2.49, respectively; medication adherence was low, at 4.54 ± 1.69 and 4.41 ± 1.84, respectively; and glycemic control was poor, at 9.47 ± 1.57 and 9.41 ± 1.57, respectively. After the educational intervention, the intervention group had increased its diabetes-related knowledge, medication adherence, and HRQoL scores, with the results being 10.55 ± 2.56, 5.24 ± 1.48, and 0.6115 ± 0.286, respectively. The group's glycemic control has also improved to 8.97 ± 1.362. A statistically significant difference between the groups had occurred, with P < .001. The control group's scores had remained approximately the same for medication adherence, HRQoL, and glycemic control, and little difference had occurred as compared with the group's baseline analysis. CONCLUSION: The study found that the educational program increased the intervention group's level of diabetes-related knowledge, and improved its adherence to medication and its glycemic control, all due to its improved HRQoL. Patients' beliefs about the effects of long-term use of medicines were also addressed by the MTM program. The program was successful because it decreased participants' HbA1c values, which is a positive indicator of successful T2DM therapy.

Religious Cliché and Stigma: A Brief Response to Overlooked Barriers in COVID-19 Management.

For decades, religion has provided explanations and answers to existential questions and queries that can emerge during a pandemic. This characteristic of religion has helped communities in finding answers and meanings to their confusions. During a pandemic, healthcare professionals are often unprepared in answering the patients' religious beliefs regarding the diseases. Moreover, patients are faced with religious clichés and stigma that results because of religious beliefs and practices. To overcome the religious stigma, a deeper understanding of religious beliefs and values is required so that a perception or practice change can take place. Therefore, the inclusion and collaboration of spiritual leaders with healthcare professionals are needed to ensure a holistic understanding and overcome the stigma that can shape as a barrier for reaching an optimal therapeutic outcome.

Formulation and stability evaluation of immediate release antioxidant tablet.

Oxidative stress plays an important part in the development of human diseases. Pharmaceutical strategies are required to be work out in order to fight against such oxidative damages. Designing of new formulations that can protect human beings from the undesirable effects, consequence of oxidative stress, the crucial cellular and molecular processes, along with recurring oxidative damage and diseases is to be expedited. The main objective of present work was to design a rapidly releasing synthetic antioxidant tablet dosage form comprising of vitamin A, vitamin C, vitamin E and zinc in combination with lecithin (a phospho-lipid) that can fulfill human health and nutritional requirement and to perform stability studies. Beside active ingredients, the excipients used in present formulation were; Avicel pH 102, starch pregelatinized, silicon dioxide colloidal and polyethylene glycol 8000 milled magnesium stearate, acid stearic fine powder and aq.opa dry coating material. The immediate release formulation of antioxidant was prepared by wet granulation method. Three different trials were developed. Vitamin C was selected as tracer for detection and evaluation of tablet dosage form. When the resulting formulation was evaluated by USP 24 / NF 19, 2000 guidelines and later by stability studies, it was found that their quality can be maintained over a storage period of 24 months.

Characterization and biological studies of bis- and tera-acetyl derivatives of hydrocarbon-bridged diamines-I.

A systematic study of the pharmaceutically important, double ended, chelating agents of the types CH(3)CONH(CH(2))nNHCOCH(3) and (CH(3)CO)(2)N(CH(2))n N(COCH(3))(2), where n= 2, 3, 4, 5 and 6, prepared by the bis- and tetra-acetylation of the corresponding diamino-polymethylenes, have been carried out. Bis- and tertra-acetyl derivatives have been characterized by their elemental analysis and the FTIR spectra, Mass spectra and H-NMR spectra of these compounds have been reported to establish their structures. In the present work, FTIR spectra have been found an excellent means for distinguishing the bis-acetyl derivatives from their tetra-acetyl counterparts. The structures of these bis- and tetra-acetyl compounds have further been established by their H-NMR and Mass Spectra. The selective pharmacological screening of the derivatives was carried out according to the standard procedures. The compounds were screened for their antibacterial and antifungal activities and it was found that majority of these compounds did not possess any remarkable activity. Only the compound BA1,2-DAE, showed significant antifungal activity against Microsporum canis (80%).

Physico-chemical comparison of famotidine tablets prepared via dry granulation and direct compression techniques.

Famotidine is generally employed for the treatment of gastric ulcer. The present study was conducted to fabricate famotidine tablets using various diluents. The binder was incorporated to the formulations in different proportions. Both the dry granulation and direct compression techniques were employed to develop the tablets. Physical evaluation of tablets i.e. tablets hardness, friability, weight variation, thickness and diameter was determined. In vitro dissolution studies of the prepared tablets were carried out for 60 min using the USP apparatus II and 900 ml 0.1 M HCl stirred at 37 ± 0.5°C with a speed of 50 rpm. Physical analysis of tablets prepared via direct compression showed satisfactory results regarding the weight variation, hardness and friability, since their respective values were within the BP limits. All the prepared famotidine tablets exhibited diffusion based mode of drug release. 100% release of drug occurred in less than 60 min. The drug release from all the formulated tablets has elaborated the involvement of diffusion (Higuchian drug release). This comparative study exhibited that physical parameters of tablets are affected by the technique of tabletting.

Frequency, types and predictors of drug therapy problems among non-dialysis chronic kidney disease patients at a tertiary care hospital in Pakistan.

BACKGROUND: Drug therapy problems (DTPs) are common among patients suffering from chronic kidney disease (CKD). However, there is a lack of information about DTPs and its predictors among CKD patients from Pakistan. OBJECTIVES: To evaluate the frequency, type and predictors of various types of DTPs among CKD patients at a tertiary-care hospital in Pakistan. METHODOLOGY: This was a cross-sectional study carried out at Sandeman Provincial Hospital, Quetta between 1-11-2020 and 31-1-2021. It included 303 non-dialysis ambulatory patients of CKD-stage 3 and above. Cipolle et al., criterion was used for classifying the DTPs and a clinician at the study site checked the identified DTPs for accuracy. Data were analyzed by SPSS 23. Multivariate analysis was conducted to find the predictors of individual types of DTPs. A p-value <0.05 was considered statistically significant. RESULTS: The patients received a total of 2265 drugs with a median of eight drugs per patient (range: 3-15 drugs). A total of 576 DTPs were identified among 86.1% patients with a median of two DTPs (interquartile range 1-3) per patient. Dosage too high (53.5%) was the most common DTP followed by adverse drug reactions (ADRs) (50.5%) and need of additional drug therapy (37.6%). In multivariate analysis, patients' age of >40 years emerged as a predictor of unnecessary drug therapy and dosage too high. The odds of needing a different drug product was significantly high in patients with cardiovascular diseases (CVD) and diabetes mellitus (DM). The dosage too low had significant association with CVD. The risk of ADRs was significantly high in elderly patients (>60 years) and those with CVD. The presence of hypertension, DM and CKD stage-5 emerged as predictors of dosage too high. CONCLUSION: This study revealed a high prevalence of DTPs among CKD patients. Targeted interventions in high risk patients may reduce the frequency of DTPs at the study site.

Exploring Nurses' Perception of Antibiotic Use and Resistance: A Qualitative Inquiry.

PURPOSE: Quality use of antibiotics and the development of antibiotic resistance is a global catastrophe. In the conceptual context, the phenomenon is correlated with the healthcare practitioners' understanding of antibiotic use and resistance. Therefore, the study aimed to highlight nurses' perception of antibiotic use and resistance at a public healthcare institute in Quetta City, Pakistan. RESPONDENTS AND METHODS: By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Nurses practicing at the surgical and medical units of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. RESULTS: Although the saturation was reached after the 13th interview, an additional two were interviewed for absolute validation. Content analysis revealed five major themes: (1) defining antibiotics and antibiotic resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. Even though the understanding of nurses regarding antibiotic use and resistance was promising, certain apprehensions were also observed. The respondents were aware of the critical situation and provided valuable insights that can offer significant input while promoting the quality use of antibiotics in a developing country. CONCLUSION: While the perception towards antibiotics appeared positive, potential areas of concern and contributing factors regarding antibiotic resistance were also identified. Importantly, nurses too highlighted possible solutions to address the issue of irrational antibiotic use and the development of antibiotic resistance.

Determination of thiram and aminocarb pesticides in natural water samples using flow injection with tris(2,2'-bipyridyl)ruthenium(II)-diperiodatoargentate(III) chemiluminescence detection.

A simple and sensitive flow-injection (FI) method is reported for the determination of thiram and aminocarb pesticides in natural water samples based on the strong enhancing effects of these pesticides on the tris(2,2'-bipyridyl)ruthenium(II)-diperiodatoargentate(III) (Ru(bipy)3(2+)-DPA) chemiluminescence (CL) system. Under the optimum experimental conditions, the CL intensity was linear over the range of 1.0 - 1000 and 1.0 - 10000 ng mL(-1) (R(2) = 0.9998 (n = 7) and 0.9994 (n = 11)) for thiram and aminocarb, respectively, with relative standard deviations (RSDs; n = 3) in the range 1.0 - 2.6%. The limits of detection (S/N = 3) were 0.1 ng mL(-1) for both pesticides with injection throughputs of 150 h(-1). The key chemical and physical variables (reagent concentrations, flow rates, sample volume, PMT voltage) were optimized and potential interferences investigated. The method was successfully applied to natural water samples and the results obtained were not significantly different (95% confidence interval) from results obtained by the previously reported FI-CL and HPLC methods. Thiram could be determined in the presence of aminocarb using Triton X-100. The possible CL reaction mechanism is also discussed briefly.