Patients Comprehension of Pharmaceutical Package Inserts Information in Karachi, Pakistan

Purpose: To investigate the knowledge and attitude of outpatients regarding pharmaceutical package inserts (PPIs) in Karachi, Pakistan.Methods: The study design was cross-sectional and conducted from August to December 2013. A previously validated questionnaire was adopted, modified and revalidated. Outpatients were asked to respond to the questionnaire.Results: A total of 456 patients responded to the questionnaire. The patients (n = 226, 49 %) were found to be keen on reading inserts in their mother language. Among the study population, 24.1 % (n = 110) of respondents faced problem in reading and 29.8 % (n = 136) in understanding inserts. There was general awareness of the essential components of package inserts and 78.3 % (n = 357) of patients opted for further improvement in PPIs of drugs available in Pakistan. Chi square test revealed that educational status of patients was significantly associated with all of the items of the questionnaire (p < 0.05).Conclusion: The current status of PPIs of drugs available in local markets in Pakistan does not satisfy the patients’ criteria and, therefore, needs improvement. The findings of this study provide a direction necessary to overcome problems related to PPIs and hence promote safe and effective use of medicines.Keywords: Patients, Pharmaceutical package inserts, Awareness, Patients, Safe use of medicine

THE STRUCTURAL MODIFICATION CAUSES THE ENHANCEMENT OF ANALGESIC ACTIVITY OF 4-(4′ CHLORO –PHENYL)-4- HYDROXY PIPERIDINE

Objective- The outstanding  position of piperidine analogues  has proven them an important core in the structures of pharmaceutically active molecules, naturally occurring alkaloids, pharmaceuticals and as synthetic intermediates with interesting biological, physical and pharmacological behaviors. The  piperidine ring containing compound like pethidine having strong opiod analgesic activity, more potent than codein and controls the pain of smooth muscle spasm. Because of having similarity in structure the present study was aimed to estimate the analgesic activity of synthesized derivatives of 4-(4′-Chlorophenyl)-4-hydroxy piperidine.Method- The present study was conducted in animal model, mice by using Pethidine as standard drug. For which the Eddy's hot plate method was adopted and analgesia ( mean increase in latency)  was observed.Result- The result showed the more prominent response of substituted compound than the parent one 4-(4′-Chlorophenyl)-4-hydroxy piperidine†and it was studied that alteration in the molecule structure is accountable for  a better analgesic response.Conclusion- The studies proved the positive pharmacological responsiveness of the combination of 4-(4′-Chlorophenyl)-4-hydroxy piperidine with phencyl halides. These synthesized derivatives will establish as potent analgesics.KEY WORDS:AlkaloidsOpiodAnalgesicPiperidin

Validation of patients’ satisfaction regarding medications’ information questionnaire (Psmiq) in Karachi, Pakistan

SUMMARY. The aim of present study was to develop a validated patient satisfaction regarding medications’ information questionnaire (PSMIQ). It was an extra cultural adaptation of previous questionnaires used in other part of the world. The PSMIQ was premeditated by an expert group of 15 physicians and 15 pharmacists from a formerly validated questionnaire. A preliminary draft of PSMIQ comprised of seventeen items, with responses recorded on a five Likert scale. The internal validation of PSMIQ was approved by conducting a cross-sectional and analytical study. Around one thousand and fifty patients participated in present study. The validity of PSMIQ items was determined through factor analysis, and the reliability was evaluated with Cronbach’s alpha coefficient (α). Cronbach alpha value for transformed 13-item questionnaire was found to be 0.738. These items were assigned four sub scales. When compared it was observed that these subscales were significantly correlated with one another (p < 0.01). Patient satisfaction level for items regarding general information and usage instructions was above 70% however their satisfaction regarding potential problems and cost issues was less than 40%. Their satisfaction was positively associated with females for subscale 1 and 4 (p < 0.01). Responders who were stable had better total satisfaction scores compared with unstable ones in response to subscale 1, 2 and 3. In response to item regarding potential problematic issue, hypertension patients were 1.687 times more satisfied than patients suffering from other diseases (OR = 1.687; 95% CI = 1.247-2.283). Patient satisfaction survey used in the present study was found to be reliable and valid. Respondents were more satisfied regarding medications’ general information and usage instructions, however not satisfied with information regarding potential problems and cost issues

Neurological complications in patients with plasmodium vivax malaria from Karachi, Pakistan

Background: Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide. Method: We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan. Results: The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral complications. P. vivax infections were diagnosed based on peripheral smears and rapid diagnostic testing. Conclusion: P. vivax infection can lead to severe complications, although not with the frequency of Plasmodium falciparum infection. Current cases highlight an increasing trend of cerebral complications caused by P. vivax

Trends of acute poisoning: 22 years experience from a tertiary care hospital in Karachi, Pakistan.

Objective: To determine the trends of acute poisoning in terms of frequency, nature of poisoning agent, clinical presentation and its outcome. Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who presented with poisoning between January 1989 and December 2010.The patients were randomly selected , and demographic, chemical information, clinical feature, treatment and outcome were analysed using SPSS 16. Results: Of the total hospital admissions during the period, 3,189(0.3%) were cases of poisoning. Of them, medical records of 705(22%) cases were reviewed; 462(65.5%) adult and 243(34.5%) paediatric cases below 16 years of age. The overall median age was 21 years (interquartile range: 4-32 years)Moreover, 544(87%) were critical at the time of presentation. In 647(92%) cases, the poisoning occurred at home. Psychiatric drugs were found involved in 205(29%) cases, followed by prescription drugs 172(24.4%), pesticides 108(15.3%), hydrocarbons 71(10%), analgesics 59(8.7%), household toxins 59(8.7%), alcohol and drug abuse 21(2.97%) and others 47(6.67%). Conclusion: Poisoning was a serious cause of morbidity in children and young adults. Medications were the leading cause and home was the most common place of incident

Utilization and impact of electronic and print media on the patients’ health status: physicians’ perspectives

Aims: Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors’ opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients. Setting and Design: The current research is a cross-sectional study conducted from January 2015 to July 2015. The study population comprised physicians rendering their services in different hospitals of Karachi, Pakistan, selected by the nonprobability convenience sampling technique. In this study, 500 questionnaires were distributed through email or direct correspondence. Methods and Materials: Physicians’ perception toward the impact of electronic and print media on the health status of patients was assessed with a 20-item questionnaire. Different demographic characteristics, such as age, gender, institution, position, and experience of respondents, were recorded. Quantitative data were analyzed with the use of Statistical Package for Social Sciences, version 20.0 (SPSS, Chicago, IL). The association of the demographic characteristics of the responses of physicians was determined by one-way ANOVA using 0.05 level of significance. Results: In this study, 254 physicians provided consent to show their responses for research purposes. A response rate of 50.8% was obtained. Nearly one-third of the respondents negated that patients get health benefit using electronic and print media. The majority did not consider electronic and print media as lifestyle-modifying factors. Physicians thought that patients particularly do not rely on mass media for acquiring health information and consider healthcare professionals as unswerving information resource. Conclusions: Mass media can be productive resources to augment awareness among patients, although physicians seem unconvinced about the extended usage of print/electronic media

PRESCRIPTION WRITING PRACTICES AND ERRORS IN PRESCRIPTIONS CONTAINING CARDIOVASCULAR DRUGS ESPECIALLY ACE INHIBITORS IN KARACHI, PAKISTAN

ABSTRACTObjective: This is the first study related to the prescribing errors in cardiovascular prescription drugs especially Angiotensin converting enzymeinhibitors (ACEIs) conducted with the aim to identify the prescribing errors in ACEIs prescriptions and to determine how to reduce these errors.Methods: The study period was September' 2012 till September' 2013. A total of 460 prescriptions containing ACE inhibitor drugs were retrospectivelyanalyzed to identify the common errors in them after collecting from different outpatient settings of Karachi, Pakistan.Results: The extent of occurrence of errors was calculated; the highest number of the prescriptions (94.34%) failed to mention the patient's weightand in least proportion of the prescriptions (0.43%) prescriber signature was not mentioned. The drug-drug interaction was found in 80.65% ofprescriptions. Only the brand name of the drug was mentioned in all the prescriptions. The main reason of prescription errors was maximum numbersof patients, less knowledge related to prescription writing guidelines to prescribers, and lack of pharmacy services.Conclusions: We concluded from this study, that there is a high percentage of prescription errors in outpatient settings. The only solution is thatthe physicians should be provided with the educational training to improve their prescription writing skills according to World Health Organizationguidelines for prescription writing or other recognized and published standards. The computerized physicians order entry system should beintroduced. The pharmacist can also play a vital role in minimizing and preventing these prescription errors. The health care system withoutpharmacists is unable to cope effectively.Keywords: Angiotensin converting enzyme inhibitors, Outpatients, Prescriptions, Prescribing error , Karachi.  Â

Poisoning in children: 22 years’ experience from a tertiary care center in Karachi, Pakistan

Objective: To determine the nature of agents involved in poisoning in pediatric patients \u3c 16 years; its clinical presentation and outcome, over a period of 22 years in an emergency department (ED) of tertiary care hospital of Karachi, Pakistan. Methods: This retrospective cross-sectional study was conducted over a time period of 22 years from January 1989 to December 2010 and included all pediatric (\u3c 16 years) poisoning cases presenting to the Emergency Department of the Aga Khan University Hospital. Data collection from patient files was carried out using the case record forms. The charts of all pediatric patients who were admitted with a diagnosis of any poisoning during the study period of 22 years (1989-2010) were reviewed retrospectively. Results: A total of 243 pediatric cases were admitted during the study period. Fifty six percent (136) males and forty four percent (107) were females. The time taken by patients from incidence to presentation was \u3c one hour in (73) 30% and \u3e one hour in 170 (70%). Most common substance involved was prescription medicine 64 (26.3%), hydrocarbons 56 (23%) and pesticides in 33 (13.6%) of the cases. Moreover, fluid and tablets were the most commonly used substances 127 (52.3%) and 96 (39.5) respectively. While out of the total pediatric poisoning cases 205 (84.4%) were unintended. Conclusion: Prescription medications, hydrocarbons and pesticides are the most common agents used by pediatrics for poisoning in Pakistan, requiring ED supervision and subsequent admissions Keywords: toxicology, Emergency, Karachi, Pakista

Perspectives about pandemic influenza and its prophylactic measures among final year pharmacy students in Karachi, Pakistan

Aims: In flu pandemics, pharmacy students' knowledge, attitudes, and practices are critical to save patients life. The objective of study was to determine the knowledge of and attitude toward the pandemic influenza among the pharmacy students of Karachi, Pakistan. Settings and Designs: The cross-sectional study was conducted from September to December 2014 by adopting a prevalidated questionnaire distributed to senior pharmacy students (final year) in seven private and public sector universities of Karachi. Materials and Methods: A total of 443 pharmacy students responded the survey. Data regarding sociodemographic characteristics of the students, perceptions, level of knowledge and attitudes toward influenza, and prophylactic measures were collected. Statistical Analysis: To compute the correlation between different variables, data were analyzed using Pearson's Chi-square statistic method. P< 0.05 was considered statistical significance for all analysis. Results: Influenza was identified as a viral disease (n = 423; 95.48%) and 282 (71.2%) students correctly identified it as disease affecting humans and pigs. Textbooks reported as most common source of knowledge (n = 282; 64%). Most common symptoms identified were fever (81.94%), sore throat (64.1%), and nonproductive cough (43.34%). The most common preventive measures were covering nose and mouth (268; 60.5%) and wearing protective coverings (254; 57.3%). Only half of the students correctly reported about the route of administration (180; 40.6%) and strains in vaccine (186; 41.98%). The best time for administration of such vaccine was known by only 156 pharmacy students (35.34%). The majority of the students (82.6%) had no idea about the manifestation of influenza pandemic. Knowledge regarding influenza differed according to gender and institutions differing in their affiliation with tertiary care hospitals. Conclusion: It was observed that knowledge about disease progression, transmission, vaccination, and treatment in pharmacy students, especially those who are not getting clinical training in tertiary care hospitals was limited. There is an urgent need to develop awareness programs to increase knowledge of influenza among clinical pharmacists as they are more susceptible to infections and community as a whole. © 2017 Journal of Pharmacy and Bioallied Sciences | Published by Wolters Kluwer - Medknow