A study to evaluate prescribing pattern and cost minimization analysis of antihistamines among patients of allergy

Background: Allergy is a hypersensitivity disorder of the immune system of the human body. In this study we selected CMA, It evaluates the cost differences between two or more medication from one group and with a similar clinical effect and then determines the least costly alternative. This helps in making best possible decision ensuring the maximum available benefits from every penny spent to achieve reasonable value for money.Methods: This prospective observational study was conducted to assess the prescribing pattern and cost minimization of antihistamines in patients of allergy in a tertiary care teaching hospital. 210 outpatient and inpatient prescriptions of patients coming to tertiary hospital during the period July 2015 to July 2016 were studied and the most commonly prescribed antihistamines identified and their cost different between branded and generic versions analysed.Results: Most commonly prescribed antihistamine is cetrizine followed by levocetrizine and fexofenadine.   Conclusions: This study demonstrated a significant price difference, ranging from 4% to 83.75% between the branded and generic version of given drugs. This in turn is leading to an increase in the cost of total treatment

Frequency of Abnormal Menstrual Cycles Associated with Raised BMI

Objective: The main aim of this study was to find the frequency of menstrual cycle abnormalities which were associated with higher BMI.Study Design: It is a cross sectional type of study.Place and Duration of study: This study was carried out in a duration of 9 months from August 2018 to April 2019 in Gynecology and Obstetrics department of Services hospital Lahore.Materials and Methods: A total of 100 cases which were in fertile group i.e. Age greater than 12 years were included in this study. Inclusion criteria was to have menstrual abnormalities for at least last 3 cycles. Exclusion criteria included patients with bleeding tendencies, abnormalities of uterus and hormonal abnormalities. Body mass index of every patient was calculated and the patients who had BMI greater than 25kg/m2 were labeled as high. Informed consent was taken from all the patients or their relatives. A pre-designed proforma was used to collect the data. Ethical committee approval was taken.Results: There were 100 patients selected for the study. Mean age in our study was 20.21±4.57 years. The mean time period for there were menstrual abnormalities was 7.21±2.34 months. 32% of the patients had raised BMI. 64% were taking treatment for this. The patients who had age of menarche greater than 14 years, incidence of increased BMI was much higher seen in 16 (47. 06%) of cases. Patients who had previous treatment for delayed menstruation also had increased BMI which was seen in 23 (40. 35%) cases.Conclusion: There is high association of menstrual abnormalities with Raised BMI and other factors like delayed menarche and prior treatment for it increases the incidence significantly

Reservoir Quality in the Jurassic Sandstones reservoirs located in the Central Graben

ABSTRACT This study investigates the diagenesis and reservoir quality of Upper Jurassic Sandstones from the Central Graben. Petrophysical and petrographical studies have been done on cored interval from well 2/1-6. Precipitation of quartz cement is the main porosity destroying process in deeply buried quartz rich sandstone reservoirs of the North Sea. Quartz cement precipitate in the form of syntaxial overgrowth over detrital grain of quartz. Grain coatings like micro-quartz and illite are the main reasons of preservation of porosity in the area. Grain coats preserve porosity by covering the grain and inhibiting the quartz overgrowth. Petrographical and petrophysical data in this study clearly indicates that grain coatings are present in the Central Graben. Micro-quartz grain coating is the most common grain coat in the Upper Jurassic Sandstones of Ula Formation. Micro-quartz grain coat are generated from the transformation of siliceous sponge spicules known as Rhaxella Perforata. Though micro-quartz is present in all low and high porosity zones but it could not preserve porosity in low porosity zones. Clay grain coats like illite and chlorite grain coats are also present but in variable amounts. Relation between Intergranular volume (IGV) vs matrix and quartz cementation vs porosity have been also been studied. IGV is strongly affected by mechanical compaction, grain size, grain shape, quartz cementation, and carbonate cement. Sandstones with high amount of matrix and fine grained grains have high IGV as compared to coarse grained sandstones because coarse grained sandstones are compacted more when they are subjected to mechanical compaction. Grain shape has also a pronounced affect on the porosity in the area. Angular grains loose porosity as they are subjected to stress. In angular grains contact forces are more concentrated because of small contact areas. This is the reason we have low porosity zones which have angular grains and were not influenced by micro-quartz grain coatings

Impact of mobility models on clustering based routing protocols in mobile WSNs

This paper presents comparison of different hierarchical (position and non-position based) protocols with respect to different mobility models. Previous work mainly focuses on static networks or at most a single mobility model. Using only one mobility model may not predict the behavior of routing protocol accurately. Simulation results show that mobility has large impact on the behavior of WSN routing protocols. Also, position based routing protocols performs better in terms of packet delivery compared to non position based routing protocols

An audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan

BACKGROUND: Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. METHODS: For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient\u27s medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority (68%) of the audited medical records were of females. RESULTS: Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of \u27excellent\u27 or \u27good\u27 diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% (95% CI: 71.1-87.9) of cases. Physical activity advised/reinforced at every visit was least observed (27.3%; 95% CI: 18.0-36.6). In addition, blood sugar control was reported in less than a quarter (23.9%) with 95% CI of 15.0-32.8. CONCLUSION: This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale

PO5.53 critical illness polyneuropathy and myopathy: experience at a tertiary care center in Pakistan

Background: Polyneuropathy and Myopathy are frequently encountere in the setting of Critical illness patients. Up to 50% of intensive care unit (ICU) patients show electrophysiological features of either or both conditions. These conditions interfere with functional recovery and delay weaning from mechanical ventilation, resulting in excess morbidity,mortality and cost of care. This study was to define the clinical spectrum of critical illness Polyneuropathy (CIP) and Myopathy (CIM) in a setting of developing country. Methods: Hospital records spanning the period 2000 through 2005 weresearched with ICD-9 codes to identify patients with CIP and CIM. Functional improvement was judged by (i) increment of at least 1grade on the Medical Research Council scale of motor strength: and (ii)reappearance of deep-tendon reflexes. Results: CIP or CIM was established in 47 patients of these, mean age was 54: mean length of stay in hospital 34 (range 8100) electrophysiological studiesrevealed CIP in 31 patients (66%) CIM in 12 (26%) and a mixedpicture in 4 (8%). Major co-morbid conditions included sepsis (39%) anddiabetes mellitus (17%), with an additional 28% having both and 17% having either. Neuromuscular blocking drugs were administered to 14 (30%) and steroids to 10 (21%) patients: an additional 11 (23%) patients received both agents while 12 (26%) patients received neither. In hospital mortality was 51%. At discharge and follow-up, motor improvement was seen in 11 (23%) while 12 (26%) remained neurologically unchanged. Conclusions: We conclude that CIP and CIM are frequent identifiable complications of critical illness in our setting. These observations need further prospective studies to delineate risk factors and out come predictors, to improve critical care patients

Prevalence of Diabetic Retinopathy and Correlation with HbA1c in Patients Admitted in Khyber Teaching Hospital Peshawar

Objective: To determine the prevalence of diabetic retinopathy in patients admitted in Khyber Teaching Hospital Peshawar and to correlate different stages of diabetic retinopathy with HbA1C levels. Methodology: This cross sectional study was conducted at Department of Ophthalmology, Khyber Teaching Hospital, MTI, Peshawar from December 2019 to May 2020. All patients over the age of 15 years who were diagnosed with diabetes mellitus were included in the study while patients with cataract or retinopathy due to other pathologies were excluded. All diabetic patients were admitted through outpatient department. In the ward their blood pressures were recorded and HbA1c levels were also measured. Visual acuity (VA) was checked. Screening for diabetic retinopathy was done by a consultant ophthalmologist by Optos Ultrawide Field Imaging of retina and Optical Coherence Tomography (OCT) of macula to establish stages of diabetic retinopathy and presence of diabetic macular edema respectively. Results: A total of 103 diabetic patients were included. Their retina was photographed, viewed and analyzed. Diabetic retinopathy, irrespective of the type, was found in 69 patients with a prevalence of 66.9%. Patients with lower ranges of HbA1c (below 6%) showed no evidence of DR. The clustering of majority of patients with diabetic retinopathy with HbA1c levels of 8 to 12 %, showed a significant relationship between high blood sugar levels and severity. Conclusion: In our study the higher frequency of retinopathy is alarming by considering it one of the leading causes of blindness in working class. It is highly recommended that routine ophthalmologic examination may be carried out along with optimal diabetic control

Effects of Emblica Officinalis Extract Cream on Human Skin Trans-epidermal Water Loss Measured with Non Invasive Probe

The purpose of this study was to assess hydroalcoholic Emblica officinalis fruit extract cream on human skin trans-epidermal water loss (TEWL). Ten male volunteers were examined in this study. Measurements were made on cheeks. Creams with different concentrations of ABIL® EM 90 and liquid paraffin containing 3% hydroalcoholic Emblica officinalis fruit extract were developed and tested for stability studies for a period of 28 days. Selected cream and its base were further assessed in different conditions at 8 °C (in refrigerator), 25 °C (in incubator), 40 °C (in incubator) and 40 °C (in incubator) with 75% relative humidity (RH) for color, odor, thickness, grittiness liquefaction, phase separation, and pH at different time intervals. Trans-epidermal water loss (TEWL) was monitored every week by non-invasive bio-instrument Tewameter MPA 5. All measurements were made statistically by ANOVA and t-paired test. Significant decrease on skin TEWL was produced. Keywords: Hydroalcoholic Emblica officinalis fruit extract, Facial cream, Biophysical paramete

Indian Medical Mission at Hajj-2016: Mass-Gathering Medicine Perspectives, Challenges, and Opportunities in a Mission Posture

Introduction: Hajj is an annual mass gathering of over 3.5 million pilgrims congregating from 200 countries in the desert climate of Saudi Arabia. Mass gathering medicine at Hajj is challenged by issues of healthcare accessibility, infection control, on-site treatment, referral, evacuation, and response to disasters and public health emergencies. The Indian Medical Mission at Hajj 2016 established, operated, and coordinated a strategic network of mass gathering medical operations, the proceeds of which are discussed herein. Methods: The mission was designed to provide holistic health security through health intelligence for pre-existing chronic diseases, epidemic intelligence for endemic and exotic diseases, public-health and disaster-health preparedness, and tiered healthcare through mobile medical task forces, static clinics, tent clinics, secondary care hospitals, and evacuation capabilities. Results: Primary care, secondary care, and tertiary care treated 374 475, 930, and 523 patients, respectively. Patients exhibited limited compliance with pre-instituted treatments and precautionary protocols. Respiratory and gastrointestinal infections, cardiorespiratory, trauma, and heat illnesses were seen. Epidemic intelligence revealed an outbreak of food poisoning. Respiratory infections were reported by 90% of the healthcare personnel. Surge capacity was overwhelmed with patient throughput and ambulance transfers. Crude unadjusted mortality was 11.99/10 000. Conclusion: The Indian Medical Mission at Hajj 2016 yielded solutions to the challenges faced during the 2016 Hajj pilgrimage. The mission posture of the Indian Medical Mission in Hajj presents a modus operandi for handling crisis scenarios in mass gathering. The situational analysis of the Hajj health mission calls for dynamic interventions in preparedness, clientele, and health systems

Conocimiento, actitud y conciencia de COVID-19 entre estudiantes de odontología preclínica y clínica: Una encuesta transversal en línea.

Objective: The aim of this study was to assess the understanding and perception of Coronavirus Disease 2019 (COVID-19) among the undergraduate preclinical and clinical dental students within Pakistan. Material and Methods: An online survey was developed by the researchers and conducted amongst the undergraduate students at various dental colleges of Pakistan. A pretested questionnaire was used and distributed using social media platforms. The questionnaire consisted of demographics, health status, perception related to general hygiene, understanding and learning attitudes of dental students. Knowledge scores and the attitude responses were compared with the demographics using independent t-test, one-way ANOVA and chi-square, as appropriate. Results: A total of 800 undergraduate dental students responded to the survey, out of which 304(38%) were males and 496(62%) were female students. Students in pre-clinical years were 600(75%), while 200(25%) students were in the clinical years. The knowledge of clinical students regarding COVID-19 was statistically higher (4.71/6), compared to the students in pre-clinical years (4.49/6) (p=0.004). Both groups showed adequate knowledge regarding the route of transmission, symptoms and origin of COVID-19, and COVID-19 being a threat to life. Clinical students did not want to re-use the face mask (75%), compared to the preclinical students (68%) (p-0.048). Students in clinical years reported more awareness regarding the recommended hand washing technique during COVID-19 (p-<0.001). Conclusion: It can be concluded that dental students in clinical years have adequate knowledge regarding the COVID-19 as compared to the preclinical students. The study identifies all areas where preclinical and clinical students lack basic knowledge. This should be compensated by arranging different webinars and online courses to increase the understanding of both clinical and preclinical students during the pandemic.Objetivo: El objetivo de este estudio fue evaluar la comprensión y la percepción de la enfermedad por coronavirus 2019 (COVID-19) entre los estudiantes de pregrado de odontología clínica y preclínica en Pakistán. Material y Métodos:  Los investigadores desarrollaron una encuesta en línea que se llevó a cabo entre los estudiantes de pregrado de varias facultades de odontología de Pakistán. Se utilizó y distribuyó un cuestionario, previamente probado, a través de plataformas de redes sociales. El cuestionario comprendía datos demográficos, estado de salud, percepción relacionada con la higiene general, comprensión y actitudes de aprendizaje de los estudiantes de odontología. Las puntuaciones de conocimiento y las respuestas de actitud se compararon con los datos demográficos mediante la prueba t independiente, ANOVA de una vía y chi-cuadrado, según corresponda.  Resultados: Un total de 800 estudiantes de odontología de pregrado respondieron a la encuesta, de los cuales 304 (38%) eran hombres y 496 (62%) eran mujeres. Los estudiantes en los años preclínicos eran 600 (75%), mientras que 200 (25%) estaban cursando años clínicos. El conocimiento de los estudiantes de clínica sobre COVID-19 fue estadísticamente mayor (4.71/6), en comparación con los estudiantes en años preclínicos (4.49/6) (p=0.004). Ambos grupos mostraron un conocimiento adecuado sobre la vía de transmisión, síntomas y origen de COVID-19, y que COVID-19 es una amenaza para la vida. Los estudiantes en fase clínica no querían reutilizar la mascarilla (75%), en comparación con los estudiantes preclínicos (68%) (p-0.048). Los estudiantes en años clínicos informaron más conciencia sobre la técnica de lavado de manos recomendada durante COVID-19 (p<0,001). Conclusión: Se puede concluir que los estudiantes de odontología en años clínicos tienen un conocimiento adecuado sobre el COVID-19 en comparación con los estudiantes en años preclínicos. El estudio identifica todas las áreas donde los estudiantes clínicos y no clínicos carecen de conocimientos básicos. Esto debe compensarse organizando diferentes seminarios web y cursos en línea para aumentar la comprensión de los estudiantes clínicos y no clínicos durante la pandemia