Assessment of Self-medication Practices During COVID-19 Pandemic in Hyderabad and Karachi, Pakistan

Background: Lack of appropriate treatment for COVID-19 infection led the general population of Pakistan toward self-medication and symptomatic treatment; almost 80% of the population collected medications for future use during pandemic. Thus, the current study aimed to assess the use of medication as symptomatic treatment preventive strategy. Methods: This descriptive cross–sectional study was conducted on a local population of Hyderabad and Karachi, Sindh, Pakistan. The study duration was six months (April– September 2020). A total of 698 responders were selected via random sampling method. The number of participants were recruited based on 95% confidence interval with 5% margin error. Data were transferred into analysis sheet descriptively. Results: Most participants responded to the use of different over-the-counter (OTC) products for headache. The use of antibiotics with prescription due to allergic conditions, cough, respiratory tract infections including sore throat, and urinary tract infections was also found among the majority. Few respondents had self-medication practice with sedatives due to difficulty in falling asleep, and 9.5% had self-medication practice due to pain. About 20.8% of the population agreed that lockdown was a contributing factor in the self-medication practice. Conclusion: Pharmacists and healthcare professionals are advised to counsel the general public regarding the use of medication. A close collaboration is required at this stage to fight against COVID-19 and preventing the situation from worsening. Keywords: self-medication, covid-19, Hyderabad, Karachi, Pakista

Interventional Study on Adherence to Pharmacotherapy and Drug Pattern in Elderly Patients at Civil Hospital of Badin, Pakistan

Background: To assess the contributing factors to adherence of pharmacotherapy and perception of elderly patients. Methods: This prospective cross-sectional study was conducted in the outpatient clinic of Civil Hospital Badin, Pakistan from January to June 2019. A total of 300 samples were selected to analyze the results. A self-designed proforma (prescribing indicator form) was used for collecting data including patient demographics, diagnosis, and the current medications prescribed for each patient. Results: Of the 300 selected participants, 221(73.7%) were male, while 79 (26.3%) were female. Majority of the subjects in the age group of 60–69 (52%) and 70–79 years (27%) followed by those aged >79 (21%). Antibiotics were prescribed to 17.2% and vitamins to 14.7%. Patients’ responses related to nonadherence factor were 92.7% for the cost, 32.7% for the long treatment duration, and 24% for the lack of knowledge. Out of the total patients, 28% were forgetful, 26.7% complained about complex therapy, 26.3% blamed financial problems, 19.7% patients had side effects, and 14.3% were negligent in taking the medication. Conclusion: Patient conformity can be enhanced by dropping polypharmacy and simplifying complex management, use of extended formulations, rate of medications, and by creating awareness among elderly patients. Keywords: elderly, polypharmacy, pharmacotherapy, adherenc

Assessment of Knowledge, Qualification, Experience, and Medication Dispensing Practices in South Karachi, Pakistan

Background: Drug stores in Pakistan are run by dispensers with varied knowledge, qualification, and experience. The current study was sought to explore the knowledge, qualification, experience, and dispensing practices among dispensers working in drugstores in South Karachi, Pakistan. Methods: A cross-sectional survey was carried out using a structured questionnaire. Data were collected from medical stores in South Karachi which were then categorized, coded, and analyzed using SPSS version 23. Relationship among different study variables with pharmacist’s availability and personal experience was assessed using statistical non-parametric Chi-square test. A total of 385 samples obtained using a simple random sampling method were included in the study. However, only 210 responses on questionnaire were complete which were then selected for study analysis between October and December 2018. Results: Of the 210 surveyed drugstores, 9% of their staff had studied only till primary school, 5.7% till the eighth grade, 25.2% up to secondary school level, 26.7% till higher secondary school level, 15.7% had non-professional education, and 8.1% were professional graduate. Only 9% of them had a degree in Pharm. D or B. Pharm, while 0.5% had a post-graduation qualification. Furthermore, 44.8% of pharmacies had a valid pharmacy license but the pharmacist was physically absent in 91% of the drugstores. Majority of pharmacies did not maintain appropriate temperature (refrigerator and/or room temperature). Majority of dispensers did not review prescription particulars before dispensing medications and also dispensed medications on older prescriptions as well as without prescription. Conclusion: In conclusion, the overall knowledge and practices of dispensers working in drugstores was poor. However, the presence of pharmacist was associated with good dispensing practices to a certain extent

Pathophysiological Correlation between Diabetes Mellitus Type-II and Chronic Obstructive Pulmonary Diseases

INTRODUCTION: Diabetes Mellitus, a chronic disease is usually associated and linked to many other conditions and complications. Chronic Obstructive Pulmonary Disease (COPD); a life threatening progressive inflammatory lung disease associated with chronic bronchitis and emphysema; when associated with Diabetes Mellitus generates a huge burden on patients quality of life as well as on health care systems. OBJECTIVE: Although link between DM and COPD is not scientifically established or confirmed yet, however evidence suggest a pathophysiological correlation between both conditions might be present. This study focuses upon impact of DM on the onset of COPD and to find if there is any evidence of the suggested pathophysiological correlation. METHODOLOGY: We retrospectively analyzed 120 cases of Chronic Obstructive Pulmonary Disease (COPD), data collected from General Medical Units and Pulmonary Ward of Liaquat University Teaching Hospital, Jamshoro / Hyderabad from January till June, 2016. RESULTS: The majority of cases with COPD were male representing 81.6% of the sample population, almost 90% of patients were smokers or ex-smokers, 42.50% of COPD patients were suffering from DM and 76.47% were either non-compliant or had a very poor control over their blood glucose level. Blood glucose levels of most of the patients was from 140 mg/dl to 500 mg/dl and 19.60% of patients reached diabetic ketoacidosis (DKA) once at least. CONCLUSION: DM increases the risk for occurrence of COPD and cause rapid decline in clinical state of the patient. Unlike cardiovascular complication of diabetes in case of diabetic patients with COPD the lower the BMI the higher the risk of mortality

Assessment of Self-medication Practices During COVID-19 Pandemic in Hyderabad and Karachi, Pakistan

Background: Lack of appropriate treatment for COVID-19 infection led the general population of Pakistan toward self-medication and symptomatic treatment; almost 80% of the population collected medications for future use during pandemic. Thus, the current study aimed to assess the use of medication as symptomatic treatment preventive strategy. Methods: This descriptive cross–sectional study was conducted on a local population of Hyderabad and Karachi, Sindh, Pakistan. The study duration was six months (April– September 2020). A total of 698 responders were selected via random sampling method. The number of participants were recruited based on 95% confidence interval with 5% margin error. Data were transferred into analysis sheet descriptively. Results: Most participants responded to the use of different over-the-counter (OTC) products for headache. The use of antibiotics with prescription due to allergic conditions, cough, respiratory tract infections including sore throat, and urinary tract infections was also found among the majority. Few respondents had self-medication practice with sedatives due to difficulty in falling asleep, and 9.5% had self-medication practice due to pain. About 20.8% of the population agreed that lockdown was a contributing factor in the self-medication practice. Conclusion: Pharmacists and healthcare professionals are advised to counsel the general public regarding the use of medication. A close collaboration is required at this stage to fight against COVID-19 and preventing the situation from worsening

Interventional Study on Adherence to Pharmacotherapy and Drug Pattern in Elderly Patients at Civil Hospital of Ba

Background: To assess the contributing factors to adherence of pharmacotherapy and perception of elderly patients.Methods: This prospective cross-sectional study was conducted in the outpatient clinic of Civil Hospital Badin, Pakistan from January to June 2019. A total of 300 samples were selected to analyze the results. A self-designed proforma (prescribing indicator form) was used for collecting data including patient demographics, diagnosis, and the current medications prescribed for each patient.Results: Of the 300 selected participants, 221(73.7%) were male, while 79 (26.3%) were female. Majority of the subjects in the age group of 60–69 (52%) and 70–79 years (27%) followed by those aged >79 (21%). Antibiotics were prescribed to 17.2% and vitamins to 14.7%. Patients’ responses related to nonadherence factor were 92.7% for the cost, 32.7% for the long treatment duration, and 24% for the lack of knowledge. Out of the total patients, 28% were forgetful, 26.7% complained about complex therapy, 26.3% blamed financial problems, 19.7% patients had side effects, and 14.3% were negligent in taking the medication.Conclusion: Patient conformity can be enhanced by dropping polypharmacy and simplifying complex  management, use of extended formulations, rate of medications, and by creating awareness among elderly patients

Analysis of treatment cost and persistence among migraineurs: A two-year retrospective cohort study in Pakistan.

ObjectivesThe persistence pattern of anti-migraine drugs' use among migraineurs is very low in the United States and different European countries. However, the cost and persistence of antimigraine drugs in Asian countries have not been well-studied. Hence, the present study aimed to evaluate the treatment cost and persistence among migraineurs in Pakistan.MethodsData from prescriptions collected from migraineurs who visited the Outpatient Department (OPD) of different public and private sector tertiary-care hospitals of Karachi, Pakistan were used to conduct this retrospective cohort study from 2017 to 2019. The minimum follow up period for each migraineur was about 12 months for persistence analysis while dropped-out patients data were also included in survival analysis as right censored data. Pairwise comparisons from Cox regression/hazards ratio were used to assess the predictors of persistence with the reference category of non-binary variables i.e. hazard ratio = 1 for low frequency migraineurs and NSAIDs users. Persistence with anti-migraine drugs was estimated using the Kaplan-Meier curve along with the Log Rank test.ResultsA total of 1597 patients were included in this study, 729 (45.6%) were male and 868 (54.3%) were female. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most prescribed class of drug initially for all classes of migraineurs (26.1%). Of them, 57.3% of migraineurs discontinued their treatment, 28.5% continued while 14.8% were switched to other treatment approaches. Persistence with initial treatment was more profound in female (58.8%) patients compared to males while the median age of continuers was 31 years. The total cost of migraine treatment in the entire study cohort was 297532.5 Pakistani Rupees ($1901.1). By estimating the hazard ratios (HR) using the Cox regression analysis, it can be observed that patients with high frequency (HR, 1.628; 95%CI, 1.221-2.179; pConclusionSimilar to western countries, the majority of migraineurs exhibited poor persistence to migraine treatments. Various factors of improved persistence were identified in this study