Behind the counter: pharmacies and dispensing patterns of pharmacy attendants in Karachi.

BACKGROUND: There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries. OBJECTIVE: This study obtained background information on pharmacies assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi. METHODOLOGY: This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants. RESULTS: Of the 219 pharmacies surveyed, 62% reported more than 50 customers daily and 20% also sold items of general provision. Mean operating hours were 13. Only 24 (11%) had a visible license. On an average 3 attendants were employed per pharmacy. We interviewed one in each. Amongst the 219 interviewed, 77 (35%) were intermediate qualified and only 26 (12%) pharmacologically trained. Correct frequency of ORS administration was not known by 167 (76%) and 21% incorrectly suggested an anti-diarrhoeal preparation for viral diarrhoea in children. The knowledge of those with pharmacological training was significantly better. For respiratory tract infection in children approximately 60% did not know the correct dose of Paracetamol and Amoxicillin. Only 13 (6%) knew that Propanalol was contraindicated in hypertensive asthamatics. For Cotrimoxazole, metronidazole and lomotil only 40%, 21% and 15% respectively, were aware that these could not be dispensed without prescription. CONCLUSION: In the absence of trained pharmacists existing pharmacy attendants should be trained to improve drug-dispensing patterns

THE NEXUS between TRADE LIBERALIZATION and POVERTY: A DISAGGREGATED ANALYSIS

Decades after trade liberalization, poverty among the developing countries has continued to rise as their economies adjust to fierce and increasing external competition. This study investigates the impact of the 1988 trade reforms on poverty in Pakistan using micro-level data from 1990 to 2005. Using the feasible generalized least squares (FGLS) model in panel setting to address the problem of heteroskedasticity, we explored the impact of trade liberalization on the poverty level in Pakistan. The findings reveal that reductions in import tariffs have increased Pakistan s level of poverty. Our findings are robust and impervious to different poverty measures (i.e., headcount ratio, poverty gap, and squared poverty gap). Also, it was observed that lagged trade policies are associated with poverty in Pakistan. The rise in poverty may be attributed to the lower participation of the poor in external markets. It is recommended that policymakers enact policies that will encourage poor people to participate in external markets if they wish to benefit from trade liberalization. © 2022 AESS Publications. All Rights Reserved

An occasional diagnosis of myasthenia gravis - a focus on thymus during cardiac surgery: a case report

<p>Abstract</p> <p>Background</p> <p>Myasthenia gravis, an uncommon autoimmune syndrome, is commonly associated with thymus abnormalities. Thymomatous myasthenia gravis is considered to have worst prognosis and thymectomy can reverse symptoms if precociously performed.</p> <p>Case report</p> <p>We describe a case of a patient who underwent mitral valve repair and was found to have an occasional thymomatous mass during the surgery. A total thymectomy was performed concomitantly to the mitral valve repair.</p> <p>Conclusion</p> <p>The diagnosis of thymomatous myasthenia gravis was confirmed postoperatively. Following the surgery this patient was strictly monitored and at 1-year follow-up a complete stable remission had been successfully achieved.</p

The Relative Importance of Clinical, Economic, Patient Values and Feasibility Criteria in Cancer Drug Reimbursement in Canada:A Revealed Preferences Analysis of Recommendations of the Pan-Canadian Oncology Drug Review 2011–2017

Background: Most Canadian provinces and territories rely on the pan-Canadian Oncology Drug Review (pCODR) to provide recommendations regarding public reimbursement of cancer drugs. The pCODR review process considers four dimensions of value—clinical benefit, economic evaluation, patient-based values and adoption feasibility—but they do not define weights for individual decision criteria or an acceptable threshold for any of the criteria. Given this implicit review process, it is of interest to understand which factors appear to carry the most weight in pCODR recommendations using a revealed preferences approach. Methods: Using publicly available decision summaries (n = 91) describing submissions and resulting recommendations 2011–2017, we extracted ten attributes that characterized each submission. Using logistic regression, we identified statistically significant attributes and estimated their relative impact in final recommendations. Results: Clinical aspects appear to carry the greatest weight in the decision to reject or not reject, along with aspects of patient value (treatments with no alternatives were less likely to be rejected). Cost effectiveness does not appear to play a role in the initial decision to reject or not reject but is critical in full versus conditional approvals. There is evidence of a maximum acceptable threshold of around $Can140,000 per quality-adjusted life-year (QALY) gained. Conclusion: A set of factors driving pCODR recommendations is identifiable, supporting the consistency of the review process. However, the implicit nature of the review process and the difficulty of extracting and interpreting some of the attribute levels used in the analysis suggests that the process may still lack full transparency

A global view on star formation: The GLOSTAR Galactic plane survey. VII. Supernova remnants in the Galactic longitude range 28∘<l<36∘28^\circ<l<36^\circ

Context. While over 1000 supernova remnants (SNRs) are estimated to exist in the Milky Way, only less than 400 have been found to date. In the context of this apparent deficiency, more than 150 SNR candidates were recently identified in the D-configuration Very Large Array (VLA-D) continuum images of the 4--8 GHz global view on star formation (GLOSTAR) survey, in the Galactic longitude range $-2^\circ<l<60^\circ$. Aims. We attempt to find evidence of nonthermal synchrotron emission from 35 SNR candidates in the region of Galactic longitude range $28^\circ<l<36^\circ$, and also to study the radio continuum emission from the previously confirmed SNRs in this region. Methods. Using the short-spacing corrected GLOSTAR VLA-D+Effelsberg images, we measure ${\sim}6$ GHz total and linearly polarized flux densities of the SNR candidates and the SNRs that were previously confirmed. We also attempt to determine the spectral indices by measuring flux densities from complementary Galactic plane surveys and from the temperature-temperature plots of the GLOSTAR-Effelsberg images. Results. We provide evidence of nonthermal emission from four candidates that have spectral indices and polarization consistent with a SNR origin, and, considering their morphology, we are confident that three of these (G28.36+0.21, G28.78-0.44, and G29.38+0.10) are indeed SNRs. However, about $25\%$ of the candidates have spectral index measurements that indicate thermal emission, and the rest of them are too faint to have a good constraint on the spectral index yet. Conclusions. Additional observations at longer wavelengths and higher sensitivities will shed more light on the nature of these candidates. A simple Monte-Carlo simulation reiterates the view that future studies must persist with the current strategy of searching for SNRs with small angular size to solve the problem of the Milky Way's missing SNRs.Comment: To be published in A&A. 21 pages, 15 figure

A global view on star formation: The GLOSTAR Galactic plane survey VIII. Formaldehyde absorption in Cygnus~X

Cygnus X is one of the closest and most active high-mass star-forming regions in our Galaxy, making it one of the best laboratories for studying massive star formation. As part of the GLOSTAR Galactic plane survey, we performed large scale simultaneous H$_{2}$CO (1$_{1,0}$-1$_{1,1}$) spectral line and radio continuum imaging observations toward Cygnus X at $\lambda\sim$6 cm with the Karl G. Jansky Very Large Array and the Effelsberg-100 m radio telescope. Our Effelsberg observations reveal widespread H$_{2}$CO (1$_{1,0}$-1$_{1,1}$) absorption with a spatial extent of $\gtrsim$50 pc in Cygnus~X for the first time. On large scales of 4.4 pc, the relative orientation between local velocity gradient and magnetic field tends to be more parallel at H$_{2}$ column densities of $\gtrsim$1.8$\times 10^{22}$~cm$^{-2}$. On the smaller scale of 0.17 pc, our VLA+Effelsberg combined data reveal H$_{2}$CO absorption only toward three bright H{\scriptsize II} regions. Our observations demonstrate that H$_{2}$CO (1$_{1,0}$-1$_{1,1}$) is commonly optically thin. Kinematic analysis supports the assertion that molecular clouds generally exhibit supersonic motions on scales of 0.17-4.4 pc. We show a non-negligible contribution of the cosmic microwave background radiation in producing extended absorption features in Cygnus X. Our observations suggest that H$_{2}$CO ($1_{1,0}-1_{1,1}$) can trace molecular gas with H$_{2}$ column densities of $\gtrsim 5 \times 10^{21}$ cm$^{-2}$. The ortho-H$_{2}$CO fractional abundance with respect to H$_{2}$ has a mean value of 7.0$\times 10^{-10}$. A comparison of velocity dispersions on different linear scales suggests that the dominant $-3$ km s$^{-1}$ velocity component in the prominent DR21 region has nearly identical velocity dispersions on scales of 0.17-4.4 pc, which deviates from the expected behavior of classic turbulence.Comment: 27 pages, 23 figures, accepted for publication in A&

Efficacy and patient satisfaction with autoadjusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial

Expiratory pressure relief (C-Flex) technology monitors the patient’s airflow during expiration and reduces the pressure in response to the patient. Increased comfort levels associated with C-Flex therapy have potential to improve patient adherence to therapy. The purpose of this study was to assess the combination of autoadjusting CPAP (APAP) and C-Flex in terms of (1) treatment efficacy, and (2) patient preference when compared to standard CPAP. Fifteen patients who had previously undergone formal CPAP titration polysomnography were treated with either one night of the APAP with C-Flex or one night of conventional CPAP, in a crossover trial. Patient satisfaction levels were recorded using visual analog scales (VAS) on the morning after the study. Mean patient age was 50 ± 12 years, body mass index (BMI) was 36 ± 6 kg/m(2), baseline AHI was 53 ± 31 events/h, and CPAP Pressure was 11 ± 2 cm/H(2)O. APAP with C-Flex was as effective as CPAP, with no differences detected in sleep latency (17 ± 5 vs 12.3 ± 3 min, p = 0.4), or respiratory indices (AHI of 4.2 ± 2 vs 2.4 ± 0.7 events/h, p = 0.1). VAS scores (scale 0–10) indicated a trend towards increased patient satisfaction while using APAP with C-Flex (7.9 vs 7.2, p = 0.07). 10 patients expressed a preference for APAP with C-Flex (VAS, 0 to10) over standard CPAP (total positive score of 68, mean score of 4.8 ± 4.3). One patient expressed no preference. Four patients expressed a preference for CPAP (total positive score of 13, mean score of 0.9 ± 1.9) (APAP with C-Flex vs standard CPAP, p < 0.01 paired t test). APAP with C-Flex eliminates sleep disordered breathing as effectively as standard CPAP. Patients indicated a preference for APAP with C-Flex suggesting a possible advantage in terms of patient adherence for this mode of treatment