SARS-CoV-2 infection pattern, transmission and treatment: Multi-center study in low to middle-income districts hospitals in Punjab, Pakistan.

Pakistan has reported a substantial number of COVID-19 cases since 2020. A multicenter observational study was conducted to identify the pattern of SARS-CoV-2 infection, transmission, and treatment in patients admitted to seven low to middle-income district hospitals in the Province of Punjab, Pakistan from March to June 2020. A total of 102 patients were recruited. 57 patients tested positive and 45 developed moderate-severe COVID-19 disease. About 67% of the patients in March-April and 93% in May-June have contracted the disease from the local transmission. The mean number of symptoms in SARS-CoV-2 positive patients was significantly higher than suspected patients (6.46 vs 5.04, p=0.003). The number of deaths was low (n=8) with 86% recovery rate. Mild COVID patients received acetaminophen (n=102), azithromycin (n=8), and hydroxychloroquine (n=4) in addition to standard medical care. The treatment provided to moderate-severe cases included acetaminophen (45/45), azithromycin (45/45), Ivermectin (14/45) and corticosteroids (13/45). The mean number of antimicrobials was significantly higher in moderate-severe patients than mild cases (1.80 vs 1.12, p=0.001). Low number of deaths with a high recovery rate was reported. Diabetes was the most common comorbid condition followed by hypertension. Many antimicrobials were prescribed in both mild and moderate-severe cases that require careful review.

Serious Inadequacies in High Alert Medication-Related Knowledge Among Pakistani Nurses: Findings of a Large, Multicenter, Cross-sectional Survey.

INTRODUCTION: Deaths-related to medications errors are common in Pakistan but these are not accurately reported. Recently, the death of a 9 months old baby due to abrupt administration of 15% potassium chloride injection sparked the issue of high alert medications (HAMs) related errors in the country. Since drug administration is the prime responsibility of the nurses, it is pivotal that they possess good knowledge of HAMs. Since there is no published data regarding the knowledge of HAMs among Pakistani nurses, we aimed to assess knowledge of HAMs among registered nurses of Pakistan. METHODS: A cross-sectional study was conducted among registered nurses, recruited using a convenient sampling technique, from 29 hospitals all over the Punjab Province. Data were collected using a validated self-administered instrument. All data were entered and analyzed using SPSS version 22. RESULTS: The study sample was comprised of 2,363 registered nurses (staff nurses = 94.8%, head nurses = 5.2%). Around 63% were working in tertiary hospitals whereas almost 25 and 12% were from district headquarter hospitals and tehsil headquarter hospitals, respectively. Around 84% of the study participants achieved scores <70%, indicating majority of Pakistani nurses having poor knowledge of HAMs administration as well as regulation. There was no significant difference of overall knowledge among age, hospitals, departments, training, designations, qualification, and experience categories. Major obstacles encountered during HAMs administration were "getting uncertain answers from colleagues" (72.9%), "unavailability of suitable person to consult" (61.1%) and "receiving verbal orders" (55.6%). CONCLUSION: Our study revealed the serious inadequacies in HAMs knowledge among Pakistani nurses which may lead to adverse patient outcomes. Nurses should receive comprehensive pharmacology knowledge not only during in-school nursing education but also as hospital-based continuing education. Moreover, it is of immense importance to bridge the gaps between physicians, clinical pharmacists, and nurses through effective communication as this will help reduce medication errors and improve patient care.

Assessment of antibiotics use for children upper respiratory tract infections: a retrospective, cross-sectional study from Pakistan.

Background: Since drug utilization evaluation is essential to assess the appropriate use of medications, the present study was carried out to evaluate antibiotics use for children upper respiratory tract infections (URTIs).Methods: A retrospective, cross-sectional study was conducted in the six health care settings of central Punjab, Pakistan. Medical records of children ≤ 12 years who were admitted in the study settings from 1st Jan-28th Feb 2019 were reviewed. Patterns of antibiotic use were assessed in the light of the WHO prescribing indicators and appropriateness of antibiotics treatment was assessed from British National Formulary for children.Results: A total of 1843 cases of URTI were analyzed, containing 6635 total medications. All of the patients were given antibiotics (mean 1.94 ± 0.63 antibiotics). Cephalosporin was the most commonly used antibiotics class (37.8%) followed by penicillins. Injections were given to all the patients. Only 11% of the cases received appropriate therapy according to the indication. Of these (n = 204), around 93% received right dose whereas right frequency and duration were found in 96.5% and 95.5% of the cases, respectively.Conclusion: Our study revealed alarmingly high utilization of antibiotics among Pakistani children with URTIs. A great emphasis should be placed on implementing antimicrobial stewardship strategies for the rational use of antimicrobials in Pakistan and pharmacists should be in the front and centre to lead antimicrobial stewardship.