Prescribing trend of treating malaria patients by public and private healthcare facilities in Lahore

Malaria is an infectious disease caused by parasites of the Plasmodium genus. It is one of the major causes of morbidity and mortality worldwide. The World Health Organization (WHO) has recommended artemisinin combination therapy (ACT) to manage malaria among children and adults. However, chloroquine as monotherapy and ACT are commonly prescribed in treating malaria in Pakistan's healthcare delivery system. Therefore, this study assessed the prescribing trends for treating malaria patients in public and private healthcare facilities. Moreover, the study also determined the number of drugs prescribed per prescription by physicians and consultants. This descriptive study was conducted for six months in Lahore's major public and private healthcare facilities. A purposive sampling technique was employed to review 300 malaria patients' prescriptions accessed from the hospital records. Descriptive statistics and the chi-square test were used to achieve the study's objectives. The study showed that most malaria prescriptions were from both public (64.67%) and private healthcare facilities (42.67%) and comprised a dual-drug regimen involving antimalarials, antibiotics, antipyretics, or their combinations. There was a significant difference (p = 0.002) in the prescription trend between public and private healthcare facilities regarding the number of drugs prescribed for treating malaria. Moreover, prescriptions from private healthcare facilities mainly contained antimalarial drugs (58.59%) and antibiotics (17.60%), while most prescriptions from public healthcare facilities contained antipyretics and other drugs (60.67%) (p = 0.001). Most of the consultants prescribed two (66.67%) or three drugs (33.33%), while the prescribing trends of physicians ranged between one and four, which was also statistically significantly different (p = 0.001). In addition, most prescriptions from public healthcare facilities were rationally prescribed (68%). On the other hand, most prescriptions from private healthcare facilities were rational (54%) and semirational (42%). The rationality of prescriptions by public and private healthcare facilities was also significantly different (p = 0.001). Public healthcare facilities were found to exhibit more rational prescribing trends for managing malaria compared to private healthcare facilities, with a focus on prescribing an optimal number of drugs per prescription and a lower usage of antimalarial and antibiotic medications

Predictors of evidence-based pressure ulcer prevention behaviors among recently graduated nurses in tertiary care hospitals in Lahore

Pressure ulcers (PUs) remain a critical and preventable challenge in hospital care, especially in resource-constrained settings. Despite formal training, early-career nurses often experience gaps in applying evidence-based PU prevention practices. This study identified the behavioral and contextual predictors of evidence-based PU prevention behaviors among recently graduated nurses in tertiary care hospitals in Lahore, Pakistan, by assessing their level of knowledge, attitudes, and self-efficacy, as well as the impact of clinical exposure, internship training, and perceived barriers to their preventive practices. A cross-sectional design involving 135 BSN graduates who had completed their clinical internships within the past six months were recruited for the study using a purposive sampling method. Data were collected via a structured, self-administered questionnaire composed of validated tools, including the Pressure Ulcer Knowledge Assessment Tool 2.0, the Attitude towards Pressure Ulcer Prevention (APuP) scale, and as well as constructs derived from the Theory of Planned Behavior framework. Descriptive statistics, Pearson correlations, one-way ANOVA, and multiple linear regression were used for analysis. While participants showed moderately positive attitudes and self-efficacy, only knowledge of PU prevention emerged as a statistically significant predictor of evidence-based behavior (p = 0.003). Other factors, such as attitudes, perceived barriers, and clinical decision-making ability, did not significantly influence behavior. Despite high exposure to PU cases, most participants reported limited workshop participation and demonstrated low decision-making accuracy. This study highlights that factual knowledge, rather than attitudinal or perceptual factors, plays a pivotal role in shaping evidence-based PU prevention behavior among newly graduated nurses. This finding emphasizes the need for knowledge-intensive interventions and scenario-based training in early clinical practice. Further longitudinal studies are recommended to evaluate the impact of mentorship and institutional support on sustained preventive behaviors

Screening and donor awareness of hepatitis B, hepatitis C, and HIV in Khyber Pakhtunkhwa

Globally, blood donations carry the risk of transmitting infectious diseases if not properly screened, necessitating rigorous protocols to detect transfusion-transmitted infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV. Our study focused on assessing the frequencies of HBV, HCV, and HIV, as well as donor awareness of these infections in Khyber Pakhtunkhwa, Pakistan. This observational study, which was conducted over two months at Nowshera Medical College, involved 100 volunteer blood donors and used a close-ended questionnaire to gather data on both diagnostic results and awareness. The results indicated that HBV was present in 4% of the donors, HCV was present in 2%, and no HIV was detected. Awareness levels varied, with 52% of donors aware of HBV transmission through blood transfusions, 54% recognizing the lack of a vaccine for HCV, and 74% having a greater awareness of HIV affecting the immune system. This study highlights significant gaps in donor knowledge, especially regarding transmission and prevention. These findings underscore the need for enhanced screening and donor education to reduce the risk of infections from blood transfusions. Improved public health strategies and policies are necessary to ensure the safety of the blood supply, ultimately improving health outcomes in the region. This study advocates for targeted interventions that can significantly mitigate transfusion-related risks and foster a safer blood donation environment

Surgical outcomes of patients with corrosive ingestion: a retrospective analysis

Corrosive ingestion can cause severe complications, including perforation, stricture, and fistula, which often require surgical intervention to prevent further damage. This retrospective observational study analyzed surgical outcomes and gender differences in ingestion types (accidental vs. suicidal) and causative substances (acid, alkali, ammonia, detergent, or mixed) among 99 patients at a tertiary care hospital in Rawalpindi from January 2002 to January 2024. The average age of the patients was 30.36 ± 10.18 years, with 61.62% female patients and 38.38% male patients. Accidental ingestion was more common in males (94.74%), whereas suicidal ingestion was more common in females (21.31%, p = 0.026). Mixed substances were the most common substances ingested, particularly among females (60.66%, p = 0.048). All patients underwent upper gastrointestinal endoscopy, and diagnostic laparoscopy or feeding jejunostomy was the most common surgical procedure (57.58%). The esophagus (68.69%) was the most affected site. Surgical site infections (16.16%) and strictures (11.11%) were the most frequent complications, with a mortality rate of 4.04%. Our study concluded that timely surgical management could reduce the risk of complications and enhance patient outcomes. Corrosive ingestion often affects multiple areas of the gastrointestinal tract that require several surgical interventions. In certain cases, complex procedures, such as colon interposition and total laryngopharyngoesophagectomy (TLPO), which require skilled surgeons as well as advanced management centers, are performed to manage corrosive injuries. Therefore, improving these patients’ outcomes via interventions focused on training in complex surgical procedures is crucial. However, more research is needed to identify the most effective approaches for the surgical management of corrosive ingestion

A comparative analysis of antihypertensive drugs for hypertension and gestational hypertension among women in tertiary care hospitals in Lahore, Pakistan

Hypertension, characterized by persistently elevated blood pressure, poses severe risks, such as heart damage, artery hardening, and reduced blood and oxygen flow to the heart, which can also lead to kidney damage and stroke. Antihypertensive therapy for pregnant women differs from that for nonpregnant women because most antihypertensive medications used for nonpregnant hypertensive women are contraindicated for pregnant hypertensive patients. This study aimed to compare therapeutic regimens for treating hypertension between pregnant and nonpregnant women in various healthcare facilities. This cross-sectional study was conducted at several tertiary care hospitals in Lahore, Pakistan, recruiting 500 pregnant or nonpregnant female patients aged 18-55 years with hypertension. The data were collected through structured interviews and medical records reviews. Descriptive statistics and chi-square tests were used to analyze the data, with significance set at p < 0.05. A significant difference in area of residence was observed, with 83.2% of nonpregnant women residing in urban areas compared to 52.4% of pregnant women residing in urban areas. A systolic blood pressure between 120 and 139 mmHg was observed in 82.8% of pregnant women, compared to 51.2% of nonpregnant women (p < 0.001). Diastolic blood pressure between 80-99 mmHg was observed in 84.4% of pregnant women and 76.8% of nonpregnant women (p < 0.001). CVDs were more prevalent among nonpregnant women (38.8%), while anemia was more common in pregnant women (25.6%). Pregnant women were primarily prescribed methyldopa (58%), labetalol (56%), and amlodipine (40.4%), whereas nonpregnant women were more frequently prescribed valsartan (39.2%), metoprolol (28.8%), nebivolol (28%), and a combination of furosemide and spironolactone (24%). This study highlighted significant differences in comorbid conditions and antihypertensive treatment regimens between pregnant and nonpregnant women, emphasizing the need for tailored hypertension management approaches. Moreover, safer antihypertensive agents were prescribed to both groups, considering the Food and Drug Administration (FDA) drug categories and the observed comorbid conditions

Outcomes of the butler neural mobilization technique and manual therapy for chronic low back pain in patients with lumbar radiculopathy: a cross-sectional comparative study

Surgeries were considered the only effective treatment method for patients suffering from chronic low back pain with lumbar radiculopathy for a while. However, in the contemporary world, it is not regarded as the primary treatment method until other conventional pharmacological and physical therapy interventions have not proven effective. Therefore, this study compares the outcomes in terms of pain relief and perceived level of mobility in patients with chronic low back pain with lumbar radiculopathy, regardless of whether the butler neural mobilization technique or manual therapy is used. This comparative cross-sectional study was conducted in Lahore, recruiting 100 patients by rendering a purposive sampling technique undergoing any treatment method mentioned above. Observations were recorded pre- and postintervention with a follow-up of 7 days to assess the response to both techniques using a questionnaire. Face-to-face interviews were conducted to assess pain levels using the Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Questionnaire (MODQ). Descriptive statistics, chi-square test, Mann‒Whitney U test, independent t test, and the Wilcoxon signed-rank test were used to analyze the data. The medical characteristics of patients who had opted for manual therapy and butler neural mobilization were not different (p > 0.05), except for the quality of pain (p < 0.05). However, pre- and postintervention NPRS scores, pain intensity during the last 24 hours using NPRS scores, and MODQ scores were significantly different among the groups, indicating postintervention pain reduction for both groups comprising patients who had opted for manual therapy (p = 0.001) and butler neural mobilization technique (p = 0.001). Moreover, patients who had opted for either technique had improved their disability levels compared with the preintervention disability levels (p = 0.001). The study concluded that both techniques significantly reduce pain and disability levels, including butler neural mobilization and manual therapy, among patients suffering from chronic low back pain with lumbar radiculopathy

Diagnostic delay in breast cancer diagnosis: the role of health practitioners

Breast cancer is a significant health concern for women in Pakistan, with one in nine women facing a high lifetime risk of being diagnosed with the disease. Accessing timely and appropriate healthcare services for breast cancer patients can be challenging in Pakistan, and understanding the role of different health practitioners is essential to understand the functioning of the informal referral system. Therefore, this study aimed to explore the different aspects of patients' consultations with various health practitioners for diagnosing breast cancer symptoms. Data were collected from 168 breast cancer patients who had consulted local health practitioners before being diagnosed with breast cancer. Descriptive statistics, the Kruskal‒Wallis H test, and post hoc tests were used to analyze the data. The study found that most patients consulted general practitioners (59.52%) and pir (56.55%) for their health-related concerns. Consultants referred most patients to diagnostic centers, while pir and hakim referred no patients. Patients visited pir and general practitioners the most, but the average number of visits to pir and hakim was higher than that to other health practitioners (p < 0.05). Moreover, pir (130 days) and hakim (120 days) had longer treatment periods than other health practitioners, with hakim charging the highest consultation fees [i.e., Pakistani rupees (PKR) 18,000] and patients incurring the highest travel expenses to visit pir (p < 0.05). Our study highlights the challenges faced by breast cancer patients in seeking timely and effective healthcare services. The absence of a formal referral system resulted in prolonged diagnosis times, extensive travel, and financial burdens on the patients. The findings suggest the need to improve general public awareness regarding breast cancer symptoms and establish an active cancer referral system to achieve early diagnosis, timely treatment, and improved quality of life for breast cancer patients, especially those with a lower socioeconomic status

Evaluating the pharmacokinetic parameters of a single dose of oral disintegrating tablets in elderly patients with hypertension and hyperlipidemia

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, particularly in underprivileged areas such as Pakistan. Hypertension and hyperlipidemia are major risk factors for CVDs and often require medication for effective management. This study aimed to develop and validate a high-performance liquid chromatography (HPLC) method to assess the bioavailability of orally disintegrating tablets (ODTs) of atenolol and atorvastatin in elderly volunteers with high blood pressure and cholesterol levels by comparing the pharmacokinetic parameters of these ODTs with those of conventional tablet formulations. The study was conducted in Sargodha, Punjab Province, Pakistan, by recruiting 30 male and female elderly volunteers aged 45-65 years and weighing 60-90 kilograms. Each participant was administered a single dose of atenolol (25 mg), atorvastatin (10 mg), or an ODT containing both drugs. Blood samples were collected at specific intervals up to 48 hours postadministration. The concentrations of atenolol, atorvastatin, and the ODTs were measured using HPLC, and various pharmacokinetic parameters, including the area under the curve (AUC), maximum plasma concentration (Cmax), and elimination half-life (t½), were analyzed. The maximum concentration (Cmax) of 10 mg atorvastatin occurred at 4 hours (9.50 ng/mL), while for 25 mg atenolol, it peaked at 4 hours (150.00 ng/mL). The ODTs showed comparable pharmacokinetic profiles, with the Cmax values for atorvastatin and atenolol at 4 hours being 4.00 ng/mL and 165.00 ng/mL, respectively. The elimination half-life (t½) for the ODTs was 4.62 hours for atorvastatin and 4.95 hours for atenolol. The pharmacokinetic analysis indicated that the AUC and Cmax of the ODTs met the bioequivalence criteria, demonstrating absorption and elimination properties similar to those of conventional tablet formulations. The study concluded that the pharmacokinetic parameters of the ODT formulations atenolol and atorvastatin are comparable to those of conventional tablets. ODTs offer a viable and effective alternative for delivering these medications, particularly for patients who have difficulty swallowing pills, thereby potentially improving patient compliance

Mental health and stigmata: childhood learning and strabismus

Strabismus (crossed eyes/squint) is a common eye condition among children. Approximately 5 in every 100 children aged five years are likely to suffer from a squint. The stigmatization of a child's psychology by strabismus is significant, as it affects their lives socially and professionally. Children with strabismus may face marginalization and social exclusion due to their physical appearance and may also experience difficulties in learning and socializing. It has become increasingly necessary to fully understand the emotional and psychological impacts of strabismus in children and to address the challenges faced by them

Pharmacokinetics and dosage regimen of roxithromycin in adult healthy female subjects

Macrolides are a group of antibiotics produced by Streptomyces bacteria commonly used to treat bacterial infections, including gum infections, gingivitis, and stomach and intestinal ulcers. Roxithromycin is a macrolide antibiotic that effectively targets bacterial cells and inhibits their growth, promoting symptom relief and recovery. Despite this, there is limited research on roxithromycin pharmacokinetics and dosing regimens, particularly in healthy female volunteers from the local population. Thus, this study aimed to investigate roxithromycin's pharmacokinetic parameters and dose regimen in ten healthy female volunteers aged 18 to 30 years. Participants received an oral dose of 300 milligrams of roxithromycin, and blood samples were collected at various intervals for 48 hours. Pharmacokinetic parameters were assessed using two open compartmental models and high-performance liquid chromatography (HPLC). The results showed that the Cmax of roxithromycin was 10.13 ± 0.43 µg/mL, attained at a time to reach tmax of 2.42 ± 0.34 hours. Moreover, the drug exhibited a volume of distribution of 1.38 ± 0.55 L/kg, an elimination half-life of 34.95 ± 22.51 hours, and a total body clearance of 0.04 ± 0.01 L/hr/kg. In accordance with these results, the calculated dosage regimen for 24-hour intervals was 975 milligrams as a priming dose and 372 milligrams as a maintenance dose. In conclusion, this study found that the elimination half-life (t1/2 β) of roxithromycin was higher than literature values, leading to less clearance and ultimately increased Cmax, tmax, and area under the curve (AUC) values of the orally administered drug, indicating the need for dose adjustment in patients