Epidemiological And Clinical Outcomes Of Tuberculosis With Its Co-Morbidities In General Population And In Prisons In Malaysia

The threat of tuberculosis (TB) seemed to have become increasingly looming with the fatal combination of co-morbid conditions like human immunodeficiency virus (HIV)-acquired immune deficiency syndrome (AIDS), diabetes mellitus (DM) and hepatitis. Ancaman penyakit tuberkulosis (TB) menunjukkan peningkatan yang ketara dengan ancaman kematian kepada kombinasi TB dengan status komobiditi seperti Virus Kurang Daya Tahan Penyakit (HIV)-Sindrom Daya Kurang Tahan Penyakit (AIDS), diabetes mellitus (DM) dan penyakit hepatitis

Doctors’ Knowledge of Hypertension Guidelines Recommendations Reflected in Their Practice

Aim. To evaluate doctors’ knowledge, attitude, and practices and predictors of adherence to Malaysian hypertension guidelines (CPG 2008). Methods. Twenty-six doctors involved in hypertension management at Penang General Hospital were enrolled in a cross-sectional study. Doctors’ knowledge and attitudes towards guidelines were evaluated through a self-administered questionnaire. Their practices were evaluated by noting their prescriptions written to 520 established hypertensive outpatients (20 prescriptions/doctor). SPSS 17 was used for data analysis. Results. Nineteen doctors (73.07%) had adequate knowledge of guidelines. Specialists and consultants had significantly better knowledge about guidelines’ recommendations. Doctors were positive towards guidelines with mean attitude score of 23.15±1.34 points on a 30-point scale. The median number of guidelines compliant prescriptions was 13 (range 5–20). Statistically significant correlation (rs = 0.635, P<0.001) was observed between doctors’ knowledge and practice scores. A total of 349 (67.1%) prescriptions written were guidelines compliant. In multivariate analysis hypertension clinic (OR = 0.398, P=0.008), left ventricular hypertrophy (OR = 0.091, P=0.001) and heart failure (OR = 1.923, P=0.039) were significantly associated with guidelines adherence. Conclusion. Doctors’ knowledge of guidelines is reflected in their practice. The gap between guidelines recommendations and practice was seen in the pharmacotherapy of uncomplicated hypertension and hypertension with left ventricular hypertrophy, renal disease, and diabetes mellitus

Commentary: Outbreak of Chikungunya in Pakistan

Rauf et al. in their recent correspondence in “Lancet Infectious Diseases” reported the first chikungunya outbreak in Karachi, Pakistan with 30,000 suspected and 4,000 confirmed cases (1). However, these estimates have been denied in a subsequent report by the National Institute of Health (NIH) indicating 818 suspected and 82 laboratory-confirmed cases of chikungunya (2). Rauf and colleagues have highlighted warm climate and wretched sanitary conditions as contributing factors of current outbreak and urge national and international health-organizations to address these momentous issues (1). We agree that climatic features and sanitation issues potentially lead to vector proliferation and the importance of these concerns cannot be disregarded. However, we felt inclined to share our point of view about the recent outbreak of chikungunya in Pakistan. We believe that there are some more important factors that should be considered as causes of this outbreak and must be addressed by the Government of Pakistan in haste to quell the further disease spillover. One of these factors is unchecked cross-border movements between Pakistan and India

Psychometric Properties of the Urdu Version of Diabetes Knowledge Questionnaire

Objective: Patient education is a key element in the treatment of diabetes. Assessment of diabetes knowledge is important for optimum treatment. For the assessment of diabetes knowledge, validated tool is essential. None of such validated tool is available in Urdu language. Therefore, the aim of this study was to translate and examine the psychometric properties of the 24-item Urdu version of Diabetes Knowledge Questionnaire (DKQ) among type 2 diabetes patients. Methods: Standard “forward–backward” process was used to translate DKQ into Urdu language. Later, it was validated on a convenience sample of 130 patients with type 2 diabetes, between July and September 2016. Internal consistency was assessed by reliability analysis, one-way analysis of variance was applied for known group validity and multivariate linear logistic regression was applied for identifying significant predictors for patients’ DKQ score. results: Good internal consistency was observed for DKQ (Cronbach’s α = 0.702). The mean HbA1c of the patients was 8.55% (±1.91). DKQ scores of patients’ with “good glycemic control” (14.22 ± 2.4) were observed significantly higher (P < 0.05) than patients with “poor glycemic control” (12.56 ± 2.75). Multiple linear regression revealed that patients’ HbA1c (OR −0.17, CI −1.111, −0.023) and patients’ education (OR 0.17, CI −0.032, 0.758) were significant predictors for DKQ sum score. conclusion: Urdu version of the DKQ is a valid and reliable instrument for adequate estimation of disease knowledge and its association with glycemic control in type 2 diabetes patients in Pakistan

Acute Ischemic Stroke and Acute on Chronic Kidney Disease

Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity. Here wer present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden onset of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus(un controlled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and carefull selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating conditio

Effect of Calcium Channel Blockers on Lower Urinary Tract Symptoms: A Systematic Review

Background. Numerous medications are known to be associated with the development of lower urinary tract symptoms (LUTS). One such medication group is calcium channel blockers (CCB). Objective. To critically examine the literature regarding the involvement of CCB in manifestation of LUTS in humans. Methods. A systematic literature search was conducted on PubMed, SciELO, Scopus, and OpenGrey databases to find all potentially relevant research studies before August 2016. Results. Five studies met the inclusion criteria and were included in this review. Three out of five studies stated that CCB were involved in either precipitation or exacerbation of LUTS. As for the remaining two studies, one study found out that only the monotherapy of CCB was associated with increased prevalence of nocturia and voiding symptoms in young females, whereas the other study reported an inverse association of CCB with LUTS. The methodological quality of studies was considered high for four studies and low for one study. Conclusion. Healthcare providers should make efforts for an earlier identification of the individuals at risk of LUTS prior to the commencement of CCB therapy. Moreover, patients should be counselled to notify their healthcare provider if they notice urinary symptoms after the initiation of CCB

Rational Use of Antibiotics and Requisition of Pharmacist

ABSTRACT Background: Direct consequence of microbes developing resistance against antibiotics is prolonged hospitalization, increased treatment cost and duration. Increased duration of hospitalization causes prolonged use antibiotics which results towards side effects. Primary Study Objective: The purpose of antibiotics use is either to kill the microbes (bactericidal) or slows down their growth (bacteriostatic). Irrational use of antibiotics makes them do their exact opposite. Instead of killing microbes or slowing down their growth, it allows microbes to develop resistance against antibiotics. Methods/Design: An observational concurrent study was performed in which data was collected. Individuals were interviewed using structured questionnaire. Percentage of rationality and irrationality of antibiotics use was observed. Additionally percentage of prescribed class of antibiotics was also observed in patients. Setting: Health care system includes: Quaid e Azam International Hospital Islamabad, Benazir Hospital Rawalpindi, CMH Rawalakot AJK, Amna Hospital Rawalakot AJK, DHQ Kotli AJK Pakistan. Participants: This study was conducted on 100 patients of different health care systems, to whom antibiotics were prescribed. Most patients interviewed were female with UTI aged above 30 and adults male with RTI or chest infection. Intervention: Different patients were interviewed in different hospital settings to evaluate the rational use of antibiotics Primary Outcome Measures: Rational use of antibiotics is using antibiotics according to the guidelines provided by WHO. Major guidelines include:&nbsp; patient receives medication according to their clinical needs, dosage appropriate to the individual requirements and for specific duration of time with low cost. Results: 47 percent of these patients were using antibiotics rationally and 53 percent were taking antibiotics medication irrationally. The most prevalent form of irrational use was patients without counseling about the antibiotics use. Patients with poor knowledge about the use of antibiotics were 84 among the 100. Irrational use of antibiotics in the form of pre-mature discontinuation was reported 56 patients among the 100. Patient who irrationally use antibiotics as OTC or Self medications were 38 among the 100. Conclusion: Major form of irrationality found in the study was no proper counseling provided to the patients by specialist physician or Pharmacists. The reason we critically observed for this is the burden of patients on physicians due to which they are not able to properly guide patients. The community on which this study was conducted has a major absence of pharmacist. Dispensers and pharmacy technicians are performing pharmacist’s tasks. Absence of pharmacist leads to dosage dispensing errors, lack of professional medical counseling, and no drug utilization revie

Awareness and knowledge of Chikungunya infection following its outbreak in Pakistan among health care students and professionals: a nationwide survey

Background The World Health Organization (WHO) declares Chikungunya (CHIK) infection to be endemic in South Asia. Despite its first outbreak in Pakistan, no documented evidence exists which reveals the knowledge or awareness of healthcare students and workers (HCSW) regarding CHIK, its spread, symptoms, treatment and prevention. Since CHIK is an emergent infection in Pakistan, poor disease knowledge may result in a significant delay in diagnosis and treatment. The current study was aimed to evaluate the awareness and knowledge of CHIK among HCSW. Methods A cross-sectional study was conducted among HCSW from teaching institutes and hospitals in seven provinces of Pakistan. We collected information on socio-demographic characteristics of the participants and their knowledge by using a 30-item questionnaire. The cumulative knowledge score (CKS) was calculated by correct answers with maximum score of 22. The relationship between demographics and knowledge score was evaluated by using appropriate statistical methods. Results There were 563 respondents; mean age 25.2 ± 5.9 years with female preponderance (62.5%). Of these, 319 (56.7%) were aware of CHIK infection before administering the survey. The average knowledge score was 12.8 ± 4.1 (% knowledge score: 58.2%). Only 31% respondents had good disease knowledge while others had fair (36.4%) and poor (32.6%) knowledge. Out of five knowledge domains, domain III (vector, disease spread and transmission) and V (prevention and treatment) scored lowest among all i.e. percent score 44.5% and 54.1%, respectively. We found that socio-demographic characteristics had no influence on knowledge score of the study participants. Conclusion Approximately one-half of participants were not aware of CHIK infection and those who were aware had insufficient disease knowledge. Findings of the current study underscore the dire need of educational interventions not only for health care workers but also for students, irrespective to the discipline of study

Resistance patterns, prevalence, and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients

AbstractBackgroundFluoroquinolones are the backbone of multidrug resistant tuberculosis treatment regimens. Despite the high burden of multidrug resistant tuberculosis in the country, little is known about drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance among multidrug resistant tuberculosis patients from Pakistan.ObjectiveTo evaluate drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients.MethodsThis was a cross-sectional study conducted at a programmatic management unit of drug resistant tuberculosis, Lady Reading Hospital Peshawar, Pakistan. Two hundred and forty-three newly diagnosed multidrug resistant tuberculosis patients consecutively enrolled for treatment at study site from January 1, 2012 to July 28, 2013 were included in the study. A standardized data collection form was used to collect patients’ socio-demographic, microbiological, and clinical data. SPSS 16 was used for data analysis.ResultsHigh degree of drug resistance (median 5 drugs, range 2–8) was observed. High proportion of patients was resistant to all five first-line anti-tuberculosis drugs (62.6%), and more than half were resistant to second line drugs (55.1%). The majority of the patients were ofloxacin resistant (52.7%). Upon multivariate analysis previous tuberculosis treatment at private (OR=1.953, p=0.034) and public private mix (OR=2.824, p=0.046) sectors were predictors of ofloxacin resistance.ConclusionThe high degree of drug resistance observed, particularly to fluoroquinolones, is alarming. We recommend the adoption of more restrictive policies to control non-prescription sale of fluoroquinolones, its rational use by physicians, and training doctors in both private and public–private mix sectors to prevent further increase in fluoroquinolones resistant Mycobacterium tuberculosis strains

Effect of Fruit/Vegetable-Drug Interactions on CYP450, OATP and p-Glycoprotein: A Systematic Review

Purpose: To review the concomitant use of certain drugs with fruit/vegetable juices that may lead to drug-juice interactions resulting in medication-related problems.Method: In this systematic review, online databases (PubMed, Google Scholar and Science Direct) were searched for information on juices derived from fruits and vegetables that are reported to have inhibitory effects on cytochrome P450, p-glycoprotein and organic anion transporting polypeptides (OATPs).Results: Fruits can inhibit CYP1A1, CYP1A2, CYP1A4, CYP3A1, CYP3A4, CYP2C6, CYP2C9,CYP2E1 and drug transporters (P-glycoprotein, OATP). On the other hand CYP1A1, CYP1A2, CYP2A2, CYP3A1, CYP1B1, CYP2B1, CYP2B2, CYP2C1, CYP2C6, CYP2E1 can be inhibited by some vegetables. Antihypertensives, antidiabetics, statins, analgesics and antipsychotics were the most common drugs interacting with fruits and vegetables. The inhibition of their metabolism by fruits and vegetables can cause serious toxic effects, e.g., hypertension, poor glycemic control, rhabdomyolosis and drug overdose-related toxic effects. Overall, active components of fruits and vegetables can interact with many drugs leading to adverse effects.Conclusion: Screening of fruits/vegetables for possible risk of interaction, and patient counseling are some effective strategies for preventing such interactions for optimal patient care.Keywords: Fruits and vegetables, Cytochrome P450, Drug interactions, p-Glycoprotein, Organic anion transporting polypeptide