Awareness of Chronic Kidney Disease, Medication, and Laboratory Investigation among Nephrology and Urology Patients of Quetta, Pakistan.

Patients' awareness is critical in medical care, as it can serve as an input into the adjustment of interventions. The aim of study was to explore the level of awareness regarding chronic kidney disease (CKD), its medications, and laboratory investigations among nephrology and urology patients of Quetta. The cross-sectional study was used by adopting and culturally modifying a questionnaire. By convenient sampling technique, a total of 500 questionnaires were self-administered to inpatients, outpatients, and dialysis patients, and 468 responses (response rate 93.6%) were analyzed. Descriptive statistics, inferential statistics, and reliability analysis were performed on SPSS v25. A majority, 50.3% (n = 235), was unaware of symptoms that will develop due to worsening of disease, while 56.2% (n = 263) were unaware of what aggravates their kidney function. Almost half of the affected individuals, 47.4% (n = 222), have no understanding about the long-term prognosis of the disease. The majority of the respondents, 51.5% (n = 248), do not know about the names and usage of medications, and 62.4% (n = 292) were unaware of the medicines that may impair kidney function; more than half, 66.7% (n = 312), were unaware about the necessary laboratory investigations. A strong association between awareness and patient education level was found (p < 0.001). Awareness regarding disease condition, medications, and laboratory investigations of CKD among nephrology and urology patients of Quetta was found out to be low, which needs immediate educational intervention.

Evaluation of cardio protective, anti-inflammatory, analgesic and CNS depressant activity of Grewia asiatica L. fruit extract.

Grewia asiatica L. is a potential medicinal plant used for various diseases in traditional medicine. Current study was aimed to evaluate the cardio protective, anti-inflammatory, analgesic and CNS depressant activities of Grewia asiatica L. fruit extract. In cardio protective activity myocardial injury was produced by injection of Isoproterenol (200 mg/kg, s.c), G. asiatica 250 and 500mg/kg treated groups significantly (p<0.05) decreased the level of serum AST, ALT, LDH and CKMB, hence produced cardio protective effect. In analgesic activities G. asiatica produced significant (p<0.05) analgesic effects in acetic acid induced writhing, formalin, paw pressure and tail immersion test. G. asiatica at 250 and 500mg/kg oral dose, significantly (p<0.05) reduced the rat paw edema in carrageen an induced rat paw edema test. G. asiatica extract also produced significant CNS depressant effects in open field, hole board and thiopental sodium induced sleeping time. Findings of the current study suggest that G. asiatica fruit extract showed potential pharmacological effects and can be utilized in alternative medicine.

Formulation and evaluation of an ointment from Pinus gerardiana extracts indigenous to Balochistan.

In skin disorders such as microbial and fungal infections, plants and their parts are used. However, there have been very few scientific reports of herbal extracts of the plant Pinus gerardiana to be administered transdermally. The antifungal activity was assessed using poisoned food method against the strains of three pathogenic fungi, namely Alternaria alternata, Curvularia lunata and Bipolaris specifera. Ointment was prepared according to British pharmacopeia and physiochemical evaluation tests were performed. The GCMS was used to determine the chemical composition of the essential oil of Pinus gerardiana. 27 components were obtained. Monoterpenes= 89.97%, Oxygenated monoterpenes = 8.75%, Sesquiterpenes = 2.21% out of 100% of the total composition. The extract of pinus gerardiana showed a zone of inhibition on organism Bipolaris specifera 2.98±0.1µg/ml, Alternaria alternate 3.48±0.21µ/ml and Curvularia lunata 5.04±0.24µg/ml. Ointment was prepared with pH 5.9, conductivity 0.1, viscosity 22.24 and tested for stability. Franz cells were used in vitro and release was determined from 30 minutes to 12 hours.

Association of clinical features of typhoid fever with socioeconomic status in Pakistan.

BACKGROUND: Typhoid fever is spread by ingestion of contaminated food or water, which is linked to infrastructure; specifically, sewage and sanitation. In developing countries, infrastructure varies according to socioeconomic status (SES). Balochistan is the least developed province of Pakistan. AIMS: To analyse the association between the clinical features of typhoid fever and socioeconomic status. METHODS: A quantitative, cross-sectional study was conducted in Quetta, Balochistan, Pakistan. Between May and October 2017, 143 patients presented to tertiary care hospitals and private clinics with a complaint of fever lasting ~3 days, along with a clinical history of headache, malaise, diarrhoea or constipation, abdominal pain, dry cough, and anorexia. All patients had a positive blood culture for Salmonella enterica serotype Typhi. Eighteen patients dropped out of the study, leaving 125. RESULTS: Seventy (56%) participants had low socioeconomic status (SES), 40 (32%) middle SES and 15 (12%) high SES. The strongest predictors of presenting with typhoid fever were patients' clinical condition when presenting to health facilities, followed by SES. Most respondents had a treatment duration of 1-2 weeks. SES had a high impact on source of drinking water supply. CONCLUSION: The strongest predictor of reporting typhoid fever was the current clinical condition of the patients, followed closely by SES. The incidence of typhoid fever in the low SES patients was almost the same as in the middle and high SES patients. Patients with low SES were more susceptible to contracting typhoid fever due to poor health status and facilities.

Profile and predictors of health related quality of life among type II diabetes mellitus patients in Quetta city, Pakistan.

BACKGROUND: This study aims to assess the profile and predictors of Health-Related Quality of Life (HRQoL) in Type II Diabetes Mellitus (T2DM) patients in Quetta, Pakistan. METHODS: The study was designed as a questionnaire based, cross sectional analysis. 300 Type II diabetic patients attending public and private hospitals were targeted for data collection. In addition to demographic and disease related information, Euroqol Quality of Life was used to measure HRQoL. Moreover, Drug Attitude Inventory and Michigan Diabetes Knowledge Test were used to assess medication adherence and diabetes related knowledge respectively. Treatment satisfaction was assessed by patient's experience towards health care professionals and available facilities. Descriptive statistics were used to elaborate patients' demographic and disease related characteristics. Binary logistic regression was used to predict factors independently associated with HRQoL. SPSS v. 20 was used for data analysis and p < 0.05 was taken as significant. RESULTS: Patients in the current study reported poor HRQoL with a mean score of 0.48 ± 0.36. Age, duration of disease, number of prescribed drugs, medication adherence and treatment satisfaction were significantly associated (p < 0.05) with HRQoL in the cross tabulation analysis. The significant variables were entered into the model that showed significant goodness of fit with highly significant Omnibus Test of Model Coefficient (Chi-square = 12.983, p = 0.030, df = 4). Medication adherence was reported as a significant predictor of HRQoL with an increase of one adherence score was associated with improvement of HRQoL by a factor of 1.75 provided other variables remain constant. CONCLUSION: The study presents a model that is associated with HRQoL with patient with T2DM, where medication adherence shaped as a predictor of HRQoL. Healthcare professionals should pay special attention on patients' medication taking behavior and should put their efforts in explaining the benefits of the medication adherence to the patients.

Pharmacist intervention in improving hypertension-related knowledge, treatment medication adherence and health-related quality of life: a non-clinical randomized controlled trial.

OBJECTIVE: The study evaluated whether a pharmaceutical care intervention can result in better understanding about hypertension, increase medication adherence to antihypertensive therapy and improve overall health-related quality of life. METHODS: A non-clinical randomized control trial was conducted whereby participants received an educational intervention through hospital pharmacists. Hypertension knowledge, medication adherence and health-related quality of life were measured by means of self-administered questionnaires. Descriptive statistics were used to describe the demographic and disease characteristics of the patients. Inferential statistics were used for inter- and intragroup comparisons. SPSS 17 was used for data analysis. RESULTS: Three hundred and eighty-five hypertensive patients were randomly assigned (192 in the control group and 193 in the intervention group) to the study. No significant differences were observed in either group for age, gender, income, locality, education, occupation or duration of disease. There was, however, a significant increase in the participants' levels of knowledge about hypertension and medication adherence among the interventional group after completing the intervention. Significantly lower systolic and diastolic blood pressure levels were also observed among the interventional group after completion of the intervention. The interventional group, however, reported decreased yet significant health-related quality of life at the end of the interventional programme. CONCLUSION: Pharmacist intervention can significantly increase disease-related knowledge, blood pressure control and medication adherence in patients with hypertension. However, further research is needed to address the decreased health-related quality of life after completion of the study.

Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia.

BACKGROUND: Patient satisfaction is considered an essential component of healthcare services evaluation and an additional indicator of the quality of healthcare. Moreover, patient satisfaction may also predict health-related behaviours of patients such as adherence to treatment and recommendations. AIMS: The study aimed to assess patients' level of satisfaction with public healthcare services and to explore the association between socio-demographic and other study variables and patient satisfaction level. METHOD: A cross-sectional study was conducted using selfadministered questionnaires distributed to a convenience sample of the general public in Kedah, Malaysia. RESULTS: A total of 435 out of 500 people invited to participate in the study agreed to take part, giving a response rate of 87 per cent. In this study, only approximately half of the participants (n=198, 45.5 per cent) were fully satisfied with the current healthcare services. The majority of the participants agreed that doctors had given enough information about their state of health (n=222, 51 per cent) and were competent and sympathetic (n=231, 53.1 per cent). Almost half of the participants (n=215, 49.5 per cent) agreed that the doctors took their problems seriously. Only 174 (40 per cent) participants agreed that doctors had spent enough time on their consultation session. Some respondents (n=266, 61.2 per cent) agreed that healthcare professionals in the public health sector were highly skilled. The majority of the respondents described amenities, accessibility and facilities available in the public healthcare sector as good or better. In this study, waiting time was significantly associated with patient satisfaction as the results showed that those who waited longer than two hours were less satisfied with the services than those who waited under two hours. CONCLUSION: The study findings showed that approximately half of the respondents were fully satisfied with current healthcare services. In this study, waiting time was the main factor that affected patient satisfaction level. Other factors that influenced satisfaction level included the length of consultation sessions and the process of patient registration. Hence, improvement in the health services that leads to a shorter waiting time may increase the satisfaction level of patients.

Cross Sectional Assessment of Health Related Quality of Life (HRQoL) among patients with cancer in Malaysia.

BACKGROUND: Health Related Quality of Life (HRQoL) is an important aspect in identifying cancer patients' perceptions of being diagnosed with cancer and the assessment of treatment outcomes. The present study aimedto assess the profile and predicators of HRQoL of Malaysian oncology patients. MATERIALS AND METHODS: A cross sectional study adopting the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was conducted. All cancer patients attending Penang General Hospital between August-November 2011 were approached. Descriptive statistics were used to assess demographic and disease related characteristics of the patients. All analyses were performed using SPSS v 16.0. RESULTS: Three hundred and ninety three cancer patients met the inclusion criteria and were enrolled in the study. The mean age was 53.9 (SD±13) years. The cohort was dominated by females (n=260, 66.2%). Nearly half (n=190, 48.3%) of the participants were of Malay ethnicity, practicing Islam as their religion (n=194, 49.4%). Two hundred and ninety six (n=296, 75.3%) had beene diagnosed with cancer within six months to 3 years previously. The most common primary cancer site was breast (n=143, 36.4%). The mean Global Health Status (GHS) score was 60.7 (SD=21.3). Females (mean GHS score of 62.3, p=0.035) with Malay ethnicity (mean GHS score of 63.8, p=0.047), practicing Islam as their religion (mean GHS score of 63.0, p=0.011) had better GHS scores. Patients having medical insurance had good scores (mean 65.6, p=0.021). Marital status was significantly associated with GHS scores (p=0.022). Bone cancer patientshad the lowest mean GHS score of 49.2 (p=0.044). Patients at very advanced stages of cancer featured a low GHS mean score of 52.2 (p<0.001). CONCLUSIONS: The present study identified many demographic and disease related factors which may contribute to the HRQoL of cancer patients, pointing to the necessity for improved management of disease symptoms and provision of psychological and financial support.

A cross-sectional assessment of knowledge, attitude and practice among Hepatitis-B patients in Quetta, Pakistan.

BACKGROUND: Hepatitis-B is a life threatening infection resulting in 0.6 million deaths annually. The prevalence of Hepatitis-B is rising in Pakistan and furthermore, there is paucity of information about Knowledge, Attitude and Practice among Hepatitis-B patients. Better disease related knowledge is important to have positive attitude and that will bring the good practices which will prevent the further spread of infection. This study aimed to evaluate knowledge, attitude and practice of Hepatitis-B Patients in Quetta city, Pakistan. METHODS: A cross-sectional, descriptive study was undertaken with 390 Hepatitis-B patients attending two public hospitals in Quetta city, Pakistan. Knowledge, attitude and practice regarding Hepatitis-B were assessed using a pre-validated questionnaire containing 20, 7 and 8 questions for knowledge, attitude and practice, respectively. Descriptive statistics were used for elaborating patients' demographic characteristics and mean scores for knowledge, attitude and practice of Hepatitis-B patients. Inferential statistics (Mann-Whitney U test and Kruskal Wallis tests, p < 0.05) were used to establish association between study variables. Spearman's rho correlation was used to identify the association between the knowledge, attitude and practice scores. RESULTS: Out of 390 patients, 223 (57.2%) were males, with the majority (136, 34.9%) in the age group of 38-47 years. Mean age of the study cohort was 32.6 ± 9.5 years. One hundred and four (26.7%) had primary level education, with 110 (28.2%) working in the private sector. The mean scores for knowledge, attitude and practice were 8.48 ± 2.7, 3.87 ± 1.2 and 2.37 ± 1.0, respectively. Education, locality and occupation were significantly associated with knowledge, attitude and practice scores. Significant positive linear correlations between knowledge-attitude (r = 0.466, p < 0.01) knowledge-practice (r = 0.221, p < 0.01) and attitude-practice (r = 0.224, p < 0.01) were also observed from the study results. CONCLUSION: The findings of this study indicate that Hepatitis-B patients lack a basic understanding of infection control and management. This can result in the further spread of Hepatitis-B infection. Extensive health education campaigns should be provided to the patients in the hospital as well as in community settings for rational control and management of the disease.

Disease related knowledge and quality of life: a descriptive study focusing on hypertensive population in Pakistan.

OBJECTIVE: This study aims to evaluate association between Health related quality of lifeand disease state knowledge among hypertensive population of Pakistan. METHODS: A cross sectional descriptive study was undertaken with a representative cohort of hypertension patients. Using prevalence based sampling technique, a total of 385 hypertensive patients were selected from two public hospitals of Quetta city, Pakistan. Hypertension Fact Questionnaire (HFQ) and European Quality of Life scale (EQ-5D) were used for data collection. Statistical Package for the Social Sciences 16.0 was used to compute descriptive analysis of patients' demographic and disease related information. Categorical variables were described as percentages while continuous variables were expressed as mean ± standard deviation (SD). Spearman's rho correlation was used to identify the association between study variables. RESULTS: The mean (SD) age of the patients was 39.02 (6.59), with 68.8% males (n=265). The mean (SD) duration of hypertension was 3.01 (0.93) years. Forty percent (n=154) had bachelor degree with 34.8% (n=134) working in private sector. Almost forty one percent (n=140) had monthly income of more than 15000 Pakistan rupees per month with 75.1% (n=289) having urban residency. The mean EQ-5D descriptive score (0.46±0.28) and EQ-VAS score (63.97±6.62) indicated lower HRQoL in our study participants. Mean knowledge score was 8.03 ± 0.42. Correlation coefficient between HRQoL and knowledge was 0.208 (p< 0.001), indicating a week positive association. CONCLUSION: Results of this study highlight hypertension knowledge to be weakly associated with HRQoL suggesting that imparting knowledge to patients do not necessarily improve HRQoL. More attention should be given to identify individualized factors affecting HRQoL.

A cross sectional assessment of health related quality of life among patients with Hepatitis-B in Pakistan.

OBJECTIVE: The study aims to assess Health Related Quality of Life (HRQoL) among Hepatitis B (HB) patients and to identify significant predictors of the HRQoL in HB patients of Quetta, Pakistan. METHODS: A cross sectional study by adopting European Quality of Life scale (EQ-5D) for the assessment of HRQoL was conducted. All registered HB patients attending two public hospitals in Quetta, Pakistan were approached for study. Descriptive statistics were used to describe demographic and disease related characteristics of the patients. HRQoL was scored using values adapted from the United Kingdom general population survey. EQ-5D scale scores were compared with Mann-Whitney and Kruskal-Wallis test. Standard multiple regression analysis was performed to identify predictors of HRQoL. All analyses were performed using SPSS v 16.0. RESULTS: Three hundred and ninety HB patients were enrolled in the study. Majority of the participants (n = 126, 32.3%) were categorized in the age group of 18-27 years (36.07 ± 9.23). HRQoL was measured as poor in the current study patients (0.3498 ± 0.31785). The multivariate analysis revealed a significant model (F(10, 380) = 40.04, P < 0.001, adjusted r(2) = 0.401). Educational level (ß = 0.399, p = 0.025) emerged as a positive predictor of HRQoL. Age, gender, occupation, income and locality were not predictive of better quality of life in HB patients. CONCLUSIONS: Hepatitis B has an adverse affect on patients' well-being and over all HRQoL. The study findings implicate the need of health promotion among HB patients. Improving the educational status and imparting disease related information for the local population can results in better control and management of HB.

A cross sectional assessment of knowledge, attitude and practice towards Hepatitis B among healthy population of Quetta, Pakistan.

BACKGROUND: Hepatitis B (HB) is a serious global public health problem. This study aims to evaluate Knowledge, Attitude and Practice (KAP) towards Hepatitis B (HB) among healthy population of Quetta city, Pakistan. METHODS: A cross sectional, descriptive study was undertaken. One thousand healthy individuals (aged 18 years and above) were approached for the study. KAP towards HB was assessed by using a pre validated questionnaire. Descriptive statistics were used for elaborating patients' demographic characteristics. Inferential statistics (Mann-Whitney U test and Kruskal Wallis test) were used for comparison while Spearman's rho correlation was used to identify association between the study variables. All analyses were performed using SPSS 16.0. RESULTS: Out of 1000 distributed questionnaires, 780 were returned with a response rate of 78.0%. Four hundred and twenty (53.8%) respondents were male with mean age of 32.76 ± 9.40 year. Two hundred and eight (26.7%) had intermediate level of education and 354 (45.4%) were unemployed. Mean scores for knowledge, attitude and practice were 8.74 ± 2.7, 3.72 ± 1.2 and 2.76 ± 1.1 respectively. Significant and positive linear correlations between knowledge-attitude (r = 0.296, p < 0.01) knowledge-practice (r = 0.324, p < 0.01) and attitude-practice (r = 0.331, p < 0.01) were observed. Area of residence (locality) was the only variables significantly associated with mean KAP of the study respondents. CONCLUSION: Results from the current study heighted poor KAP of healthy population towards HB. The positive linear correlations reaffirms that better knowledge can lead to positive attitude and subsequently in good practices. This will further help in prevention and management of HB. Therefore, extensive health educational campaign should be provided to general population and especially to the residents of rural areas.

Does treatment adherence correlates with health related quality of life? Findings from a cross sectional study.

BACKGROUND: Although medication adherence and health-related quality of life (HRQoL) are two different outcome measures, it is believed that adherence to medication leads to an improvement in overall HRQoL. The study aimed to evaluate the association between medication adherence and HRQoL. METHODS: A questionnaire-based cross-sectional study design was undertaken with hypertension patients attending public hospitals in Quetta city, Pakistan. HRQoL was measured by Euroqol EQ-5D. Medication adherence was assessed by the Drug Attitude Inventory. Descriptive statistics was used to tabulate demographic and disease-related information. Spearmans correlation was used to assess the association between the study variables. All analysis was performed using SPSS 17.0. RESULTS: Among 385 study patients, the mean age (SD) was 39.02 (6.59), with 68.8% of males dominating the entire cohort. The mean (SD) duration of hypertension was 3.010.939years. Forty percent (n=154) had a bachelors degree level of education with 34.8% (n=134) working in the private sector. A negative and weak correlation (0.77) between medication adherence and EQ-5D was reported. In addition, a negative weak correlation (0.120) was observed among medication adherence and EQ-VAS. CONCLUSIONS: Correlations among the study variables were negligible and negative. Hence, there is no apparent relationship between the variables.