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

Synthesis, characterization and evaluation of biological activities of manganese-doped zinc oxide nanoparticles

Purpose: To synthesize, characterize and investigate the antimicrobial properties of pure and manganese-doped zinc oxide nanoparticles.Method: Un-doped and manganese-doped zinc oxide (Mn-doped ZnO) nanoparticles were prepared using co-precipitation method. The synthesized Mn-doped ZnO  nanoparticles were characterized using energy-dispersive x-ray spectroscopy  (EDX), scanning electron microscopy (SEM), and x-ray diffraction (XRD)  spectroscopic techniques. Their band gap energies were measured with ultraviolet-visible (UVVis) spectroscopy, while their antioxidant properties were evaluated by ferric reducing antioxidant power (FRAP), DPPH radical-scavenging, ferric  thiocyanate (FTC) and total phenolic content (TPC) assays. The antimicrobial  activities of the nanoparticles against different bacterial strains were determined using agar diffusion method.Result: Results from XRD, SEM, EDX and UV-Vis analyses demonstrated  successful synthesis of undoped and Mn-doped ZnO nanoparticles as seen in their hexagonal, wurtzite structures. The un-doped and Mn-doped ZnO nanoparticles had average grain sizes of 16.72 nm and 17.5 nm, and band gap energies of 3.585 eV and 2.737 eV, respectively. Significant antibacterial activity was manifested by Mndoped ZnO against E. coli, S. aureus, Klebsiella and B. subtilis, with zones of inhibition (ZOIs) of 13 ± 0.09 mm, 14 ± 0.01 mm, 18 ± 0.07 mm and 20 ± 0.10 mm, respectively. The Mn-doped ZnO nanoparticles also exhibited effective and significant antioxidant potential relative to butylated hydroxytoluene (BHT) and un-doped ZnO nanoparticles.Conclusion: Mn-doped ZnO nanoparticles demonstrate significant antimicrobial and antioxidant activities. Thus, the preparation is a good candidate for further development into therapeutic formulations.Keywords: Mn-doped ZnO, Nanoparticles, Properties, Antioxidant, Antibacteria

Synthesis, characterization and pharmacological evaluation of mixed ligand-metal complexes containing omeprazole and 8-hydroxyquinoline

Purpose: To synthesize a series of mixed ligand-metal complexes and to evaluate their alkaline phosphatase inhibitory capacities, antioxidant potential and antimicrobial activities.Method: Mixed ligand-metal complexes of Zn (II), Ni (II), Co (II), Cu (II), omeprazole and 8- hydroxyquinoline were synthesized. The ligand-metal complexes were characterized by various physicochemical techniques, including elemental analysis, magnetic susceptibility, scanning electron microscope (SEM), mass spectrometry (EI-MS), ultraviolet-visible (UV-Vis) spectrophotometry, Fourier transform infrared spectroscopy (FTIR), proton nuclear magnetic resonance (1H-NMR) and conductance studies. The new compounds were also investigated for their alkaline phosphatase (ALPs) inhibition, 2,2’-diphenyl-1-picrylhydrazyl (DPPH) radical-scavenging and antimicrobial activities.Results: Spectroscopic studies revealed the chemical composition of synthesized compounds as well as the bidentate bonding behavior of the coordinating ligands with metal ions. Conductance measurement suggested that the metal complexes were non-electrolytes. Ni(II) complex exhibited antioxidant activity (30.48 ± 0.32 μM) higher than those of BHT (standard) and other complexes. Stronger inhibition of ALPs by Ni (II) mixed ligand complex compared to the other complexes was evident. The synthesized compounds showed moderate to very good antimicrobial activity against bacterial strains, i.e., Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Actinomyces viscosus, Staphylococcus aureus, Bacillus subtilis; as well as against the fungal strains, Candida albicans, Aspergillus flavus and Aspergillus niger.Conclusion: All the mixed ligand complexes demonstrate higher antioxidant, ALPs-inhibitory and antimicrobial activities than their corresponding ligands. This indicates their therapeutic potential as future drug candidates for the concerned diseases.Keywords: Omeprazole, 8-Hydroxyquinoline, Mixed-ligand complexes, Alkaline phosphatase, Bidentate bonding behavior

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

From text to e-text: perceptions of medical, dental and allied students about e-learning

ObjectiveMore than a year ago, Pakistan like the rest of the word, was hit by a global pandemic, due to which students of higher education had to accept the new era and adapt to the electronic learning environment for the very first time. This study aims to analyze the perceptions of medical, dental, and allied health students about e-learning in Pakistan. MethodsA descriptive, cross-sectional study was conducted throughout the country. A pre-validated, anonymous online questionnaire regarding demographics, past-experience of e-learning, advantages disadvantages of e-learning, and general perception of students towards e-learning was distributed. Descriptive statistics were computed for all demographics. Chi-square test was used to compare the differences of perceptions between pre-clinical year and clinical years students. Chi-square was used to compare overall category-wise positive and negative responses of students. The association between participant demographics and their perception towards e-learning was also calculated using chi square. ResultsA total of 1200 students participated in the study of which 797 (66.4%) were from pre-clinical years and 403 (33.6%) were from clinical years. The major advantage identified by all students was the ‘comfortable environment’ (70%) and ‘technical problems with IT equipment’ was listed as the biggest disadvantage (89%) of e-learning. For preclinical year students, ‘anxiety due to social isolation’ was selected as the biggest issue (p < 0.05) whereas, for clinical year students, it was ‘lack of patient interaction’ (p < 0.05). Overall, 72% of students had a negative perception of e-learning. ConclusionAfter more than a year of online studying, medical and allied students of Pakistan have expressed dissatisfaction towards e-learning. Student-teacher training, student counselling sessions, and innovative techniques need to be introduced to enhance student engagement and reduce pandemic stress.We are thankful to all the students who participated in the study. We are grateful to biostatistician Mr. Kashif Siddique for his inputs. Open Access funding was provided by the Qatar National Library

Antioxidant activity and hepatoprotective effect of Cichorium intybus (Kasni) seed extract against carbon tetrachloride-induced liver toxicity in rats

Purpose: To assess the antioxidant and hepatoprotective activity of the aqueous-methanol extract of Cichorium intybus seeds (C. intybus) against carbon tetrachloride (CCl4)-induced liver toxicity in albino Wistar rats.Method: The seed extract of C. intybus was prepared in aqueous methanol (20:80) via Soxhlet solvent extraction process. CCl4 (0.8 mL/kg) was administered to induce hepatic damage in Wistar rats. The seed extract (100, 250 and 500 mg/kg doses) and a 25 mg/kg dose of silymarin (as standard drug) were administered orally to separate groups of albino Wistar rats for 14 days. Blood samples from the rats were analyzed for biochemical markers for hepatic injury. The tissue samples of the rats were subjected to histopathological studies as well as analyzed for liver antioxidants.Results: The results for biochemical markers revealed that the rats treated with the extract (500 mg/kg dose) showed a maximum elevation of catalase (48.90 μmole of H2O2 consumed/min/mg protein), glutothione peroxidase (22.1 mg GSH consumed/min/mg protein), superoxide dismutase (14.2 units/min/mg protein), and a reduction in glutathione (18.1 μmole of GSH/mg protein). Serum biochemical parameters including serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), alkaline phosphate (ALKP), and direct bilirubin were significantly (p &lt; 0.01) increased in the treated groups. Oral administration of different doses of C. intybus seed extract significantly (p &lt; 0.01) protected the hepatic cells from impairment. The biochemical markers and hematological parameters were also normal in extract-treated rats in contrast to the standard (silymarin) and control groups.Conclusion: The results show that C. intybus plant is potential a good natural source of natural hepatoprotective and antioxidants agents.Keywords: Cichorium intybus, Antioxidant, Hepatoprotective Biomarkers, Silymarin, Hematological parameter

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

Comparative Analysis of Understanding of Pictograms among Pharmacy and Non-Pharmacy Students.

The objective of the present study was to evaluate awareness and significance of pictograms among pharmacy and non-pharmacy students. The study was conducted in two public and private sector institutes of Karachi during July to Oct 2013. Altogether 306 pharmacy and non pharmacy students participated in the study. A self administered questionnaire was used for this purpose. Nineteen pictograms from the USP-DI and corresponding set of 19 locally developed pictograms conveying the same medication instructions or messages were evaluated. Respondents were evaluated for their interpretation of all 38 pictograms. More than 98% of the pharmacy students agreed that pictograms attracts attention of people to provide information about medicine use. 97% considered that pictograms are used as universal language that can be easily understood by everyone and they are effective tools for educating the illiterate patients. 97.87% non pharmacy students agreed that patients are unfamiliar with medical terminologies and pictograms may be used to convey the medically significant information to patients. Both pharmacy and non pharmacy students preferred USP-DI pictograms over the pictograms of local origin. It is a need of time to introduce pictograms as a topic in curriculum of Pharm -D courses like Dispensing Pharmacy, Hospital pharmacy and Community pharmacy so that during professional life pharmacist can use these tools to improve patient counseling techniques. It is a way to maximize patient care and provide patient education regardless of any barrier

The Approach of Pharmacy Students Towards Communication of Medication Errors in Karachi, Pakistan

Purpose: To assess pharmacy students’ knowledge of communicating medication errors in Karachi, Pakistan.Methods: The study design was cross-sectional and conducted from February to May 2014. A previously validated questionnaire was adopted, modified and distributed to final year pharmacy students in four universities of Karachi. Descriptive statistics were used to present students’ demographic information and their response to the questionnaire items. Pearson chi square test and Logistic regression model were executed to evaluate the association of gender and institution of students with their response.Results: Out of 600 survey questionnaires distributed, only 464 were returned in useable form, giving a response rate of 77.33 %. A majority of the students showed moderately positive attitude towards general communication and training in communicating medication errors. More than 40 % of the respondents were not satisfied with the training they received in communicating and reporting incidence of medication errors. Incorrect drug (14.65 %), incorrect dose (8.40 %) and improper storage of medicines (7.97 %) were the most common errors observed by the students during clerkship.Conclusion: The findings indicate the need for a more standardized approach to improving knowledge of medication errors as well as training in the communication of occurrence of medication errors.Keywords: Communication, Medication error, Pharmacy students, Standardized trainin