Antibiotic Stewardship: A Handshaking Strategy Among Physicians and Pharmacists to Improve therapeutic Outcomes in Hematology-Oncology.

Background: Infections are highly susceptible in patients with hematological malignancies due to immune suppression, immunosuppressive therapies and disease progression. Rational use of antibiotics following Antimicrobial Stewardship (AMS) guidelines in early detection and response to infection is significant to improve patient care. Objectives: The present study was conducted to determine the impact of clinical pharmacists' interventions (PIs) on antibiotics usage in hematology-oncology set up in Karachi, Pakistan. Methodology: An observational prospective study was conducted for a period of 4 months in a well-known 75-bed teaching hospital, specializing in bone marrow transplantation in Karachi, Pakistan without a structured Antimicrobial stewardship programs (ASPs). The information was gathered from patient medical histories, laboratory, and microbiological records. Results: A total of 876 PIs (1 to 5 per patient) were implemented. Dose modifications or interval changes accounted for the major interventions (n = 190, 21.6%). The majority of all recommendations were related to antipseudomonal ß-lactams, aminoglycosides, sulfamethoxazole-trimethoprim and vancomycin. Overall, 94.3% (n = 876) of the 928 PIs were accepted. Conclusion: The PIs and the high physician acceptance rate may be useful for improving the safe use of antibiotics, lowering their toxicity, lowering the need for special-vigilance medications and potentially improving patient care.

Post-COVID-19 Outbreak of Severe Kawasaki-like Multisystem Inflammatory Syndrome in Children.

With the continuation of the second wave of a novel coronavirus disease (COVID-19), which is likely to be even more devastating, there are several associated health problems. COVID-19 is usually mild and non-fatal in children. However, in rare cases, children could severely be affected, and clinical manifestations may differ from adults. A multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication associated with COVID-19, initiated by an overactive immune response in kids that usually hits weeks after exposure to the COVID-19. MIS-C is a disorder in which inflammation could occur in different parts of the body. The disease puts pressure on the heart, as blood vessels leading towards the heart get inflamed and incapable of carrying adequate blood, hence producing cardiac complications in children hospitalised with MIS-C. The problem seems to be associated with COVID-19 in children; however, the association between MIS-C and COVID-19 is still unidentified. There is very little understanding of what triggers the MIS-C, which necessitates a rigorous mapping of the disease and associated risk elements for better disease management and navigating through this crisis.

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.

Health and Economic Impact of COVID-19: Mapping the Consequences of a Pandemic in Malaysia.

The World Health Organization (WHO) has termed the novel coronavirus infection a pandemic based on number of confirmed cases in more than 195 countries and with risk of further spread. The infection has had drastic impact on global trade and stock markets. The Malaysian authorities realised the need to ensure availability of health resources and facilities in the country so that the healthcare professionals could treat serious cases on priority basis. Steps have been taken to ensure that health facilities are not overwhelmed with cases and do not become the source of virus spread to other healthcare staff and patients.

Evaluation of in vitro antioxidant capacity and reducing potential of polyherbal Coded capsules Arthitec 1 and Arthitec 2.

Free radicals are partially reduced form of metabolites of Nitrogen and Oxygen. These are highly reactive and potentially toxic compounds which are contributing factors in different chronic disease. The present study was aimed to determine antioxidant capability and reducing ability of coded polyherbal capsules (Arthitec 1 & Arthitec 2). DPPH (2,2'-diphenyl-1-picryl hydrazyl) assay is most commonly used method for gauging antioxidant capability of natural compounds. In this assay DPPH act as stable free radical which react with an antioxidant. For measuring reducing ability suspected antioxidant react with ferric tripyridyltriazine (Fe3± TPTZ) complex and convert ferric into ferrous. Results are evident that both capsule formulations Arthitec 1 & Arthitec 2 have promising antioxidant activity and reducing potential. Antioxidant potential of both coded capsules with varied concentrations (10, 50 and 100 µg/ml) were compared and in both cases scavenging activity and as well as reducing ability raised in a dose dependent manner just like standard Butylated hydroxyanisole (BHA).

Simultaneous determination of ACE inhibitors and dexibuprofen in active pharmaceutical ingredient, formulations and human serum by RP-HPLC.

The contemporary work describes a rapid and cost effective reversed phase High Performance Liquid Chromatography (RP-HPLC) method for the quantification of Captopril, Lisinopril and Dexibuprofen (DXP) simultaneously in dosage formulations, active pharmaceutical ingredients and human serum. The chromatographic system included LC-20A pump, Sil-20A auto sampler and SPD-20A UV/visible detector. The estimation was carried out by using a C18 (5µm, 250 ×4.6 mm) column with mobile phase methanol: water (80:20 v/v, pH 3.0) at 230 nm with a flow rate of 1.0 ml•min-1. The retention time of Dexibuprofen was 5.4 min while that of Captopril and Lisinopril were found to be 3.2 and 1.8 minutes respectively. There was no considerable variation exists in between the tested drug spiked in serum and the extent recovered, without interference of serum in concurrent approximation. The method developed was found to be precise, selective and validated for precision, linearity, specificity, accuracy, limit of detection and limit of quantitation. There is no such method reported earlier for the determination of ACE Inhibitors and DXP simultaneously. The present study helps in assessing the co-administration of both drugs in treatment and can be employed for quality control analysis and drug-drug interaction studies.

Efficacy and safety of Entoban for the treatment of chronic diarrhea.

The current randomized clinical trial was conducted to assess the safety and effectiveness of Entoban for treating patients of chronic diarrhea. The study enrolled 150 patients fulfilling the inclusion criteria, among them 95 were males and 55 were females. Written informed consent was obtained from all study participants. Metronidazole tablets (400 mg) were used in a control group for 7-10 days. The test group received Entoban capsule 400mg every 8 hours for five days. Primary outcome of the study was daily bowel frequency evaluation; the secondary outcome was evaluation of clinical symptoms including abdominal pain, distention, stool consistency and sensation of incomplete evacuation. The study is registered at (https://register.clinicaltrials.gov) having registration number NCT02642250. In an intention-to-treat (ITT) analysis, it has been observed that 39(84.78%) in test group and 37(78.72%) in control group showed complete improvement. Participants in the test group exhibited a marked reduction in symptoms; the symptom score was decreased from 3 (maximum) to 1 (minimum) or 0 (absent) in most of participants. Major difference was observed regarding side effects reported between two treatment groups (p value <0.0001). Entoban possesses considerable therapeutic efficacy for the treatment of chronic diarrhea analogous with the conventional Metronidazole therapy.

In vitro antioxidant and reducing capability of weight loss tablet formulation.

Antioxidants are used as an influential counteractive measure in opposing the generation of reactive oxygen species. The current study was carried out to investigate antioxidant potential and reducing capability of developed weight reducing tablet formulation. When tablets were evaluated at concentrations of 50, 100 and 500µ/ml, antioxidant activity improved in a dose depending way just similar to standard Butylated hydroxyl anisol (BHA). For evaluation of reducing ability the formulation under test evaluated at concentrations of 50, 100 and 500µ/ml and it was observed that formulation contain good reducing capability and possess considerable activity to scavenge super oxide radicals. In-vitro analysis of weight reducing tablets formulation showed considerable antioxidant and reducing capacity that will be supportive in averting the development of a variety of oxidative stress-related diseases.

Evaluation of in vitro urease and lipoxygenase inhibition activity of weight reducing tablets.

Enzyme inhibition is a significant part of research in pharmaceutical field in view of the fact that these studies have directed to the innovations of drugs having remarkable performance in diverse physiological conditions. The present study was aimed to assess urease and lipoxygenase inhibitory activity of weight reducing tablets. For evaluating the urease activity indophenol method was employed using Thiourea as the model urease inhibitor. The lipoxygenase inhibition was evaluated by measuring the hydroperoxides produced in lipoxygenation reaction using a purified lipoxygenase with lionoleic acid as substrate. When formulation of the weight reducing tablets was compared at various concentrations (50, 100 and 500µg/ml). The antiurease activity and lipoxygenase inhibition activity increased in a dose dependent manner. The formulations under test have an excellent antiurease and lipoxygenase inhibition potential and prospective to be used in the cure of a variety of complications associated with the production of urease and lipoxygenase enzymes.

Determination of Cefadroxil in Tablet/Capsule formulations by a validated Reverse Phase High Performance Liquid Chromatographic method.

An innovative, selective and rapid reversed phase High Performance Liquid Chromatographic (RP-HPLC) method for the analysis of cefadroxil in bulk material and oral solid dosage forms has been developed and validated. The chromatographic system consisted of Sil-20A auto sampler, LC-20A pump and SPD-20A UV/visible detector. The separation was achieved by C18 column at ambient temperature with a mobile phase consisting of methanol: Phosphate buffer (10: 90) at a flow rate of 1.5 ml/min. The method is reproducible, repeatable (%RSD for intra-day and inter-day ranged between 1.75-5.33% and 0.58-2.69%) and linear (R2=0.9935). The LOD and LOQ of the method were 0.5 and 1.0 µg/ml, respectively. The present RP-HPLC method was found to be sensitive, accurate, precise, rapid and cost effective that can be efficiently used in QC/QA laboratories for routine analysis of the raw materials as well as oral dosage formulations of cefadroxil.

Disintegrants combination: development and optimization of a cefadroxil fast disintegrating tablet.

Fast Disintegrating Tablets (FDTs) is a rapidly growing dosage form preferred for special population (pediatric, geriatric and psychotic patients). It is also developed with the aim of improving bioavailability and patient compliance. During the present study, cefadroxil fast disintegrating tablets formulations (n=9) were designed and optimized by central composite design with two independent variables (croscarmellose and crospovidone) using design expert® software. The effects of independent variables on formulation properties such as friability, hardness, in vitro dispersion and disintegration were assessed by drawing response surface graphs with design expert® software. Tablets were assessed for pharmacopeial and non-pharmacopeial parameters to ensure the quality of compressed tablets. Among all formulations, F3, F8 and F9 have shown better results. The formulation F9 containing 15mg croscarmellose and 33.075mg crospovidone showed good pharmacotechnical attributes as well as shelf life. F 9 showed improved dissolution with t90% of> 2 min and will lead to better bioavailability.

Translation and validation of the Sindhi version of the general medication adherence scale in patients with chronic diseases.

Background: There is no medication adherence scale available in Sindhi language currently. Hence, the Sindhi speaking population will either use a translator or provide their medical history in another language for documentation of medical conditions. This poses a challenge in monitoring and evaluating adherence to medications within this linguistic community. Aim: The aim of this study was to translate and validate the Sindhi version of the General Medication Adherence Scale (GMAS-S) in patients with chronic diseases. Methods: This was a cross-sectional study of 4 months duration and was conducted in out-patient department of a university affiliated hospital in Karachi, Pakistan. All adults with chronic diseases, who were on long-term medications, and able to read and understand Sindhi language were invited. Convenience sampling was employed and a questionnaire consisting of demographic questions and the Sindhi version of GMAS was used. The translation of the scale was carried out. Confirmatory factor analysis (CFA) was conducted, and a structural equation model (SEM) was developed. Fit indices, namely, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were reported. Reliability was assessed using Cronbach's alpha (α), intraclass correlation coefficient (ICC), corrected item-to-total correlation (ITC) and item deletion. Data were analysed through IBM SPSS version 23 and IBM AMOS version 25. The study obtained ethical clearance. Results: A total of 150 responses were analysed. The reliability of the Sindhi version of GMAS was (α) = 0.696. The intraclass correlation coefficient (ICC) was reported at 0.696 (95% CI: 0.618-0.763). The values for the fit indices were as follows: χ2/df = 1.84, GFI = 0.918, TLI = 0.920, CFI = 0.942, AGFI = 0.864, and RMSEA = 0.075. All values except AGFI were in the acceptable ranges and indicated good fitness. Most participants (80.7%) appeared non-adherent to their medications. Conclusion: The results of the study demonstrate that the Sindhi version of the GMAS is a valid and reliable scale to measure adherence in Sindhi speaking persons with chronic diseases.

The Association of Research Quantitative Measures With Faculty Ranks of Australian and New Zealand Dental Schools.

INTRODUCTION: The scholarly productivity of a faculty member can be measured through several indicators including annual appraisals, feedback, and the number of publications per year. The present study aims to assess the association of quantitative research measures and academic ranks in Australian and New Zealand dental schools. METHODS: It was an analytical observational cross-sectional study. Full-time faculty members working in Australia and New Zealand's dental schools were discovered on official websites. Various bibliometric parameters including h-index, total number of citations, total number of publications, and maximum number of sources of a single publication were analyzed. Spearman rank correlation was used to determine the correlation between bibliometric variables and academic ranks (lecturer, assistant professor, professor). The Mann-Whitney U test was used to compare bibliometric parameters among departments (Basic and Clinical) and gender (male and female). RESULTS: Through the present search strategy, 207 full-time faculty members were identified, of which 12 were from New Zealand, and 195 were from Australia. Among them, 130 (62.8%) were male and 70 (33.8%) were female faculty members. There was a positive correlation of all bibliometric parameters with academic ranks (p = 0.001). There was no statistical difference between the two countries for academic parameters (p > 0.05). Male faculty members showed significantly higher academic productivity than female members in Australian dental schools (p = 0.001). CONCLUSION: These bibliometric parameters and other educational parameters can be considered for determining faculty promotions. These bibliometric parameters appear to be suitable metrics for assessing research productivity, impact, and visibility.

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.

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.

From text to e-text: perceptions of medical, dental and allied students about e-learning.

Objective: More than a year ago, Pakistan like the rest of the word, was hit by a global pandemic, due to which students of higher education had to accept the new era and adapt to the electronic learning environment for the very first time. This study aims to analyze the perceptions of medical, dental, and allied health students about e-learning in Pakistan. Methods: A descriptive, cross-sectional study was conducted throughout the country. A pre-validated, anonymous online questionnaire regarding demographics, past-experience of e-learning, advantages disadvantages of e-learning, and general perception of students towards e-learning was distributed. Descriptive statistics were computed for all demographics. Chi-square test was used to compare the differences of perceptions between pre-clinical year and clinical years students. Chi-square was used to compare overall category-wise positive and negative responses of students. The association between participant demographics and their perception towards e-learning was also calculated using chi square. Results: A total of 1200 students participated in the study of which 797 (66.4%) were from pre-clinical years and 403 (33.6%) were from clinical years. The major advantage identified by all students was the 'comfortable environment' (70%) and 'technical problems with IT equipment' was listed as the biggest disadvantage (89%) of e-learning. For preclinical year students, 'anxiety due to social isolation' was selected as the biggest issue (p < 0.05) whereas, for clinical year students, it was 'lack of patient interaction' (p < 0.05). Overall, 72% of students had a negative perception of e-learning. Conclusion: After more than a year of online studying, medical and allied students of Pakistan have expressed dissatisfaction towards e-learning. Student-teacher training, student counselling sessions, and innovative techniques need to be introduced to enhance student engagement and reduce pandemic stress.

Prompt Identification of Sepsis on Hospital Floors: Are Healthcare Professionals Ready for the Implementation of the Hour-1 Bundle?

Early intervention in sepsis management with recognized therapeutic targets may be effective in lowering sepsis-related morbidity and mortality, although this necessitates timely identification of sepsis by healthcare professionals. The present study aimed to assess knowledge levels, attitudes, and agreement among physicians regarding the Surviving Sepsis Campaign (SSC) guidelines (more specifically, the Hour-1 bundle). A quantitative, descriptive, cross-sectional study was conducted among physicians working in different clinical settings in Karachi, Pakistan, using a self-administered questionnaire. The mean cumulative knowledge score of the respondents towards SSC was 6.8 ± 2.1 (out of 10), where a total of n = 127 respondents (51.62%) had a strong understanding of the SSC guidelines, compared to n = 78 (31.7%) and n = 41 (16.7%) respondents with fair and inadequate knowledge, respectively. The majorly known bundle elements by the respondents were to administer broad-spectrum antibiotics (89.8%, n = 221), the need for taking blood cultures before administering antibiotics (87.8%, n = 216), and measurement of blood lactate levels (75.6%, n = 186). Experienced physicians were more likely to use norepinephrine as the first-choice vasopressor (p < 0.001). Female respondents were more likely to consider the duration of antibiotic therapy to be determined according to the site of infection, the microbiological etiology, the patient's response to treatment, and the likelihood of achieving adequate source control (p = 0.001). The current study concluded that respondents had an optimistic approach and frequently practice in accordance with the SSC guidelines, while some respondents were not up to date with the most recent guidelines. There is a need for further interventions and continuous medical education to encourage physicians towards appropriate use of the recommended guiding principles for improving treatment outcomes in sepsis patients.

Healthcare Professionals' Compliance with the Standard Management Guidelines towards the Use of Biological Disease-Modifying Anti-Rheumatic Drugs in Rheumatoid Arthritis Patients.

Treatment of rheumatoid arthritis (RA) is complicated, with numerous aspects influencing decision-making, including disease severity, comorbidities, and patient preferences. The present study aimed to evaluate healthcare professionals' (HCPs) knowledge of biological disease-modifying anti-rheumatic drugs (bDMARDs) and their compliance with the standard management guidelines for assuring optimal RA therapy. The cross-sectional, survey-based study was performed in various healthcare and academic settings in Karachi, Pakistan to probe HCPs' knowledge of bDMARDs and their compliance with the European League against Rheumatism (EULAR) recommendations for the management of RA patients. Overall, n = 413 questionnaires were included in our study (response rate: 82.6%). The physicians were further well-informed about the indications (n = 276, 91.3%, p = 0.001) and monitoring requirements (n = 258, 85.4%, p = 0.004). The pharmacists were more knowledgeable about the drug targets (n = 96, 86.4%, p = 0.029) and their mechanisms of action (n = 80, 72.0%, p = 0.013). Male respondents as compared with females (41.3% vs. 35.6%, p = 0.04), and physicians as compared with pharmacists (40.7% vs. 37.8%, p = 0.012), were more confident in using bDMARDs than conventional treatment in RA patients. Our findings show that the respondents were familiar with the attributes of bDMARDs and the standard management guidelines for RA care. Our results may be relevant in creating new methods, guidelines, and treatments to enhance RA treatment adherence, satisfaction, and health outcomes.

Healthcare Professionals' Practice of HIV Post-Exposure Prophylaxis in Clinical Settings in Karachi, Pakistan.

The human immunodeficiency virus (HIV) is an important public health concern that has become more prevalent in Pakistan in recent decades. Healthcare professionals (HCPs) are frequently exposed to many HIV-infected patients; as a result, they are more vulnerable to HIV infection due to occupational exposure. Hence, the current study was executed to evaluate HCPs' knowledge, attitude and practice in terms of post-exposure prophylaxis (PEP) for HIV. This cross-sectional study was carried out in several clinical and laboratory settings of Karachi and the HCPs involved in treating patients were surveyed using a structured questionnaire. The Shapiro-Wilk test was performed to establish the normality of the variables. Pearson correlation was employed to identify the relationship between the independent variables considering p-values < 0.05 as statistically significant. A total of 578 filled forms were incorporated in the study with a response rate of 72.2%. Physicians and medical students (OR = 1.68; 95% CI = 1.16-2.24; p = 0.001) belonging to private work settings (OR = 1.84; 95% CI = 1.33-2.35; p < 0.003) indicated better knowledge. The majority, 407 (70.4%), of the respondents reported having been exposed to risky occupational circumstances during their professional life; however, 65.7% took PEP for HIV after exposure and only 56.8% completed the entire course. A statistically significant association was observed between experience (p = 0.004, CI = 0.14-0.72), job category (p = 0.0001, CI = 0.16-0.62) and frequency of exposure (p = 0.003, CI = 0.42-11.31) and reporting of occupational exposure. More than half (53.8%) of respondents stated that their institute has a policy for the management of HIV exposures; however, their response was significantly associated with their organization (p = 0.004). The current study shows adequate knowledge revealing a positive attitude among respondents; however, there was a gap between the knowledge and its practical application. Even though many of the HCPs had experienced risky HIV exposure, a lack of reporting was noted in the study.

Assessment of Knowledge, Attitude, and Practice of Obstetricians and Gynecologists Toward Off-Label Medicine Use in Female Reproductive Health Issues.

Background: Off-label medication usage (OLMU) is prevalent in the treatment of various diseases, including female reproductive health issues (FRHIs). However, there is a paucity of literature on the perspective of health professionals on this subject. The purpose of the current study was to assess gynecologists/obstetricians' knowledge, attitude and practice toward OLMU in the treatment of FRHIs. Methods: The current cross-sectional study was conducted in September and October 2021, at five tertiary care hospitals (two public and three private sector), different clinics and maternity homes in a metropolitan city of Karachi, Pakistan. The target population was gynecologists, obstetricians and physicians/residents working in the ob/gyn department in various hospitals and clinical settings of Karachi. Results: The overall response rate was 77.1%. The mean age of the study respondents was 36.1 ± 7.7 years; n = 85 (55.9%) respondents were working in primary patient care. The majorly reported OLMU by the respondents were clomiphene citrate in unexplained infertility (n = 66; 43.4%), metformin to improve cycle regularity in females with polycystic ovary syndrome (PCOS) (n = 59; 38.8%) and letrozole to induce ovulation (n = 31; 20.4%). The majorly stated categories of OLMU were at a different dose (n = 95; 62.5%) and at different indications than approved to treat (n = 89; 58.5%). It was reported by the majority of the respondents (n = 95; 62.5%) that they do not follow any guidelines or regulations for OLMU in their work setting; however, the response was statistically varied with the working organization (CI 2.14-2.93; p = 0.037) and practice area (CI 2.85-4.32; p = 0.0001) of respondents. Conclusions: The present study revealed that the respondents were well-familiar with the practice of OLMU in the treatment of FRHIs. They expressed their concerns about decreasing such practices by being involved in collective decision-making procedures, and they were inclined to accept initiatives aimed at ensuring drug safety in patients.