Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study.

Background: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication’’. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center. Methods: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University Hospital April 2012 to March 2013. One thousand geriatrics patients (age $65 years) visiting ambulatory clinics were identified. They were divided on the basis of exposure (polypharmacy vs. no polypharmacy). We followed them from the time of their enrollment (day zero) to six weeks, checking up on them once a week. Incidence was calculated and Cox Proportional Hazard Model estimates were used. Results: The final analysis was performed on 1000 elderly patients. The occurrence of polypharmacy was 70% and the incidence of ADRs was 10.5% among the study cohort. The majority (30%) of patients were unable to read or write. The use of herbal medicine was reported by 3.2% of the patients and homeopathic by 3%. Our Cox adjusted model shows that polypharmacy was 2.3 times more associated with ADRs, con-current complementary and alternative medicine (CAM) was 7.4 times and those who cannot read and write were 1.5 times more associated with ADRs. Conclusion: The incidence of ADRs due to poly pharmacy is alarmingly high. The factors associated with ADRs are modifiable. Policies are needed to design and strengthen the prescription pattern

Interpretations of Educational Experiences of Women in Chitral, Pakistan

This feminist oral history project records, interprets, and analyzes the educational experiences of seven Ismaili college women in Chitral, Pakistan. Chitral is a part of the world where educating girls and women is not a priority. Yet in the scarce literature available one can observe an increase in the literacy rates, especially amongst the Ismaili Muslims in the North of Chitral District. This thesis introduces students\u27 accounts of their personal educational journeys. I argue that the students\u27 accounts exemplify third space feminism. They negotiate contradictions and social invisibility in their daily lives in quiet activism that shadows but changes the status quo of the society. Through their narratives the narrators see themselves as devout Muslim women who are receiving Western-style education through which they have learned to be women\u27s rights advocates. The narrators now wish to pay forward their knowledge and help their families financially. Analysis of the oral histories revealed six themes: (1) distance from educational institutions, (2) sacrifices by the family, (3) support from family, (4) narrators as the first generation of women to attend school, (5) early memories of school including severe winters and corporal punishment, and (6) feminist touchstones. While honoring their families and communities, the narrators plan to become educators and advocates to empower girls and women in their own villages. In response to these oral histories, I recommend that the government of Pakistan, non-government organizations working in Pakistan, men and women, and teachers in schools work together to improve the educational journeys of future Chitrali women. Education for women needs to be introduced as a universal human right in Chitral so women, too, can get financial and psychosocial support from their families as well as communities to achieve their educational goals

Incidence of polypharmacy among emergency patients at a tertiary care hospital in Karachi: An ignored paradigm for quality drug therapy

Introduction: A prescription containing five or more drugs is likely to result in adverse consequences that may involve hospital admission or falls. Increasing incidence of Polypharmacy among Emergency patients calls for a more judiciary and cautious approach to prescribing with a focus on long term as well as short term health. Objective: To estimate the incidence of polypharmacy and its strength of association with respect to medication regimen among patients (pediatric and adults) visiting ED of a tertiary care hospital in Karachi Pakistan. Methods: Data will be collected retrospectively of all patients, who visited the Emergency Department (ED) of Aga Khan University Hospital, Karachi (AKUH) during January, 2012 to December, 2012. The detailed clinical records on medication prescribing from admission through discharge of all patients will be reviewed. Results: Total 51,000 patients visited ED during January 2012 till December 2012, out of those polypharmacy was common in 40% of patients. Male were 56.6%(9,837) while 43.4% (7,553) were females. Peadiatric patients were 17.9% (3,145) while 79% (14,279) were adults. The most common triage category for patients with was P3 with 37.2% (6,483). Most of these patients were those who were recommended admission in other wards 59.6% (10,146), 26.5% (4,514) discharged patients and 9% (1,536) LAMA patients. Conclusion: The perils and problems associated with Poly pharmacy are a subject of interest as polypharmacy was significant finding among all ED patients. Keywords: Polypharmacy, Emergency, Karachi, Pakista

Child injury prevention short course in Karachi, Pakistan – lessons learnt

Introduction: Department of Emergency Medicine (WHO Collaborating Center for Emergency and Trauma Care) in collaboration with Department of Continuing Professional Education, Aga Khan University organised a two day course “WHO Prevention of Child Injury”. The purpose of this course was to describe epidemiologic trend and understand principles of child injury prevention methodology. Pretest and posttest were taken to assess the impact of course in improving knowledge. Methods: The two day workshop was organized on 17th and 18th March the topics/ presentations were followed by different group and individual activities. The Wilcoxon signed rank test was applied to see the difference in pre and posttests. Result: There were a total of 25 participants in the course. Most of them were from Karachi while seven participants were from other cities including Islamabad, Peshawar, Lahore, Umerkot and Sukkur. The participants included master candidate in epidemiology and biostatistics (n=5), research officers (n=4), police officer (n=1), pediatrician (n=2), health department administrators (n=6), forensic expert (n=2), and public health professionals (n=5). The mean score in pretest was 54.6% ±14.1% while posttest revealed a mean score of 66.8% ±12%. (p -value of \u3c0.029). On a scale of 1-5, 60% and 70% of the participants evaluated this workshop on 4 points. Conclusion: This workshop had a positive impact on knowledge of participants related to injury prevention principles and methodology. Such trainings/ course should be held on regular basis or incorporated in master level course to highlight the neglected injury area. Keywords: Injury, Emergency, Karachi, Pakista

Characteristics of Eligible Participants Attending Tertiary Care Center, According To Exposure Status.

<p>Characteristics of Eligible Participants Attending Tertiary Care Center, According To Exposure Status.</p

Descriptive and Univariate Cox Analysis Along With 95% Confidence Intervals of Eligible Geriatrics Attending Tertiary Care Center.

<p>Descriptive and Univariate Cox Analysis Along With 95% Confidence Intervals of Eligible Geriatrics Attending Tertiary Care Center.</p

Adjusted Multivariable Analysis Showing Relative Risk of Adverse Drugs Reactions Along With 95% CI.

<p>Adjusted Multivariable Analysis Showing Relative Risk of Adverse Drugs Reactions Along With 95% CI.</p

Resveratrol attenuates experimental allergic asthma in mice by restoring inositol polyphosphate 4 phosphatase (INPP4A)

Asthma is a chronic airway inflammatory disorder which is characterized by reversible airway obstruction, airway hyperresponsiveness and airway inflammation. Oxidative stress has been shown to be strongly associated with most of the features of asthma and leads to accumulation of phosphatidyl inositol (3,4) bis-phosphate {PtdIns(3,4)P2} which is the major substrate for inositol polyphosphate 4 phosphatase (INPP4A). PtdIns(3,4)P2 in turn activates PI3K pathway and contributes to oxidative stress. Thus, there exists a vicious loop between oxidative stress and lipid phosphatase signaling. In this context, we have recently shown that INPP4A, a crucial molecular checkpoint in controlling PI3K-Akt signaling pathway, is downregulated in allergic airway inflammation. Resveratrol, a potent antioxidant found in red wines, has been shown to attenuate asthma features in murine model of allergic airway inflammation (AAI), however the underlying mode of its action was not completely understood. In this study, the effect of resveratrol on mitochondrial dysfunction, PI3K-Akt signaling and inositol polyphosphate 4 phosphatase was studied in murine model of allergic airway inflammation. We observed that resveratrol treatment of allergic mice was found to significantly downregulate oxidative stress and restore mitochondrial function. It also decreased calpain activity and restored the expression of INPP4A in lungs which in turn reduced Akt kinase activity and Akt phosphorylation. These results suggest a novel mechanism of action of resveratrol in attenuating asthma phenotype by downregulating PI3K-Akt pathway via upregulating INPP4A