Islamic International law and its significance in the contemporary global landscape

Islamic international law, also known as "Fiqh al-Siyar," is a legal framework that governs the conduct of Muslim individuals and states in their interactions with the international community. This research article aims to explore the Islamic international law historical development, principles, application, and contemporary challenges. After analyzing the Islamic sources, including the Quran, Hadith, and scholarly consensus, this study sheds light on the unique features and contributions of Islamic international law to the broader field of international law. This research article explores the topic of Islamic international law and its significance in the contemporary global landscape. The study provides a comprehensive analysis of Islamic international law, its historical development, principles, sources, and application. A comparative analysis is conducted to highlight the similarities and differences between Islamic international law and other legal systems and international legal frameworks. The research also addresses the contemporary challenges faced by Islamic international law and the debates within the Muslim world regarding its interpretation and application. The research emphasizes the constructive role that Islamic principles play in addressing contemporary global challenges, such as climate change, poverty alleviation, and sustainable development. A comparative analysis is conducted to compare Islamic international law with other legal systems and international legal frameworks, identifying similarities, differences, and potential areas of convergence. The study highlights the shared principles of justice, respect for sovereignty, and treaty obligations, while also noting differences in sources of law and legal concepts. Keywords: Islamic international law; Fiqh al-Siyar; Muslim states; Quranic principles; Contemporary challenge

Antibiotic overprescribing among neonates and children hospitalized with COVID-19 in Pakistan and the implications

There are concerns with excessive antibiotic prescribing among patients admitted to hospital with COVID-19 increasing antimicrobial resistance (AMR). Most studies have been conducted in adults with limited data on neonates and children including in Pakistan. A retrospective study was conducted among four referral/tertiary care hospitals including the clinical manifestations, la-boratory findings, the prevalence of bacterial co-infections or secondary bacterial infections and antibiotics prescribed among neonates and children hospitalized due to COVID-19. Among 1237 neonates and children, 511 were admitted to the COVID-19 wards and 433 were finally included in the study. The majority of admitted children were COVID-19 positive (85.9%) with severe COVID-19 (38.2%), and 37.4% were admitted to ICU. The prevalence of bacterial co-infections or secondary bacterial infections was 3.7%; however, 85.5% were prescribed antibiotics during their hospital stay (average 1.70 ± 0.98 antibiotics per patient). 54.3% were prescribed two antibiotics via the parenteral route (75.5%) for ≤ 5 days (57.5), with most being ‘Watch’ antibiotics (80.6%). In-creased antibiotic prescribing was reported among patients requiring mechanical ventilation and high WBCs, CRP, D-Dimer and ferritin levels (p < 0.001). Increased COVID-19 severity, length of stay and hospital setting were significantly associated with antibiotic prescribing (p < 0.001). Ex-cessive antibiotic prescribing among hospitalized neonates and children despite very low bacterial co-infections or secondary bacterial infections requires urgent attention to reduce AMR

Understanding of final year medical-, pharmacy- and nursing students in Pakistan towards antibiotic use, antimicrobial resistance and stewardship : findings and implications

Antimicrobial resistance (AMR) is a leading public health threat, which is exacerbated by high and inappropriate use of antibiotics. Consequently, there is a need to evaluate knowledge regarding antibiotic use, AMR and their readiness to implement antimicrobial stewardship programmes (ASPs) among final year medical, pharmacy and nursing students in Pakistan. This reflects high and increasing rates of AMR in the country, and students being the future healthcare professionals (HCPs). A cross-sectional study was conducted among 1251 final year students from 23 public and private educational institutions in Punjab. The majority of the surveyed participants possessed good knowledge of antibiotic use, AMR and the potential causes of AMR. The most common sources of the information on antibiotics were physicians (69.9%), peers (35.9%) and medical journals (30.6%). However, most surveyed participants were not fully prepared to participate in ASPs. They knew though how to reduce AMR by educating HCPs about appropriate prescribing, implementing ASPs and improving laboratory facilities. There was a significant association between antibiotic knowledge and causes of AMR with sex, family income, and student type (p < 0.05). Being a student at a public sector university (OR= 4.809; CI= 3.261- 7.094; p<0.001), and age (OR=0.524, CI=0.327-0.842; p<0.008) were among key factors impacting students training on ASPs. Educational curricula must be improved to include more information about appropriate antibiotic use and ASPs along with sufficient training, workshops and clinical rotations in the final year to fully equip students on graduation

Co-infections, secondary infections, and antimicrobial use in patients hospitalized with COVID-19 during the first five waves of the pandemic in Pakistan; findings and implications

Background: COVID-19 patients are typically prescribed antibiotics empirically despite concerns. There is a need to evaluate antibiotic use among hospitalized COVID-19 patients during successive pandemic waves in Pakistan alongside co-infection rates. Methods: Retrospective review of pa-tient records among five tertiary care hospitals during successive waves. Data collected from confirmed COVID-19 patients during first five waves. Results: 3,221 patients were included. The majority were male (51.53%), resident in urban areas (56.35%) and aged >50 years (52.06%). Cough, fever, and sore throat were clinical symptoms in 20.39%, 12.97% and 9.50% respectively. 23.62% of COVID-19 patients presented with typically mild disease and45.48% with moderate disease. High prevalence of antibiotic prescribing (89.69%), averaging 1.66 antibiotics per patient despite only 1.14% bacterial co-infections and 3.14% secondary infections. Antibiotics use significantly in-creased with increasing severity, elevated WBCs and CRP levels, need for oxygen and admittance to ICUs; however, decreased significantly after the second wave (p < 0.001). Commonly prescribed antibiotics were piperacillin plus enzyme inhibitor (20.66%), azithromycin (17.37%) and mero-penem (15.45%). Common pathogens were Staphylococcus aureus (24.19%) and Streptococcus pneumoniae (20.96%). The majority of the prescribed antibiotics (93.35%) were from WHO “Watch” category. Conclusion: Excessive prescribing of antibiotics is still occurring among COVID-19 patients in Pakistan; however, rates are reducing. Urgent measures are needed for further reduc-tions

Short-term adverse effects of COVID-19 vaccines after the first, second, and booster doses : a cross-sectional survey from Punjab, Pakistan, and the implications

Safety and efficacy concerns regarding coronavirus disease 2019 (COVID-19) vaccines are common among the public and have a negative impact on their uptake. We aimed to report the adverse effects currently associated with the vaccine in Pakistan to build confidence among the population for its adoption. A cross-sectional study was conducted in five districts of the Punjab province of Pakistan between January and March 2022. The participants were recruited using convenience sampling. All data were analyzed using SPSS 22. We recruited 1622 people with the majority aged between 25-45 years. Of these, 51% were female, including 27 pregnant women and 42 lactating mothers. Most participants had received the Sinopharm (62.6%) or Sinovac (17.8%) vaccines. The incidences of at least one side effect after the first (N = 1622), second (N = 1484), and booster doses (N = 219) of the COVID-19 vaccine were 16.5%, 20.1%, and 32%, respectively. Inflammation/erythema at the injection site, pain at the injection site, fever, and bone/muscle pain were common side effects of vaccination. No significant differences were observed in the adverse effect scores between all demographic variables except for pregnancy (P = 0.012) after the initial dose. No significant association was observed between any variable and the side effect scores of the second and booster doses of the vaccine. Our study showed a 16-32% prevalence of self-reported side effects after the first, second, and booster COVID-19 vaccinations. Most adverse effects were mild and transient, indicating the safety of different COVID-19 vaccines

Awareness and practices towards vaccinating their children against COVID-19 : a cross-sectional study among Pakistani parents

There are typically lower COVID-19 vaccination rates among developing versus higher-income countries, which is exacerbated by greater vaccine hesitancy. However, despite the increasing evidence of safety, parents are still reluctant to vaccinate their children against COVID-19. This is a concern in countries experiencing successive waves, such as Pakistan. Consequently, the objective of this study was to gain better understanding and practice regarding parents vaccinating their children against COVID-19 in Pakistan. A cross-sectional study was conducted to measure parents’ attitudes towards vaccinating their children. In total, 451 parents participated in the study, giving a response rate of 70.4%; 67.4% were female, 43.2% belonged to the 40–49 years age group, and 47.7% had three children, with 73% of parents fully immunized against COVID-19. We found that 84.7% of parents did not consider COVID-19 to be a very serious issue, and 53.9% considered that their children were not at high risk of COVID-19. Overall, only a quarter of the study participants had currently vaccinated their children and 11.8% were willing to vaccinate their children in the near future. Parents who had a better knowledge of COVID-19, secondary or higher education, children who had chronic illness, and those parents whose children had been infected with COVID-19 were more likely to have their children vaccinated. The most common reasons for vaccine hesitancy were “my child is not at high risk of COVID-19” (61%) and “I am afraid to put/inject a foreign object inside my child’s body” (52.2%). Overall, vaccine acceptance was low among the parents of the children. Those parents with higher education, chronic illnesses, greater knowledge of COVID-19 and its vaccines, and those whose children had been infected with COVID-19 were significantly (p < 0.001) inclined towards vaccinating their children. Effective campaigns as well as awareness sessions are needed to address misinformation and reduce vaccine hesitancy

Antimicrobial dispensing practices during COVID-19 and the implications for Pakistan

Antibiotics are one of the most frequently dispensed classes of medicines. However, excessive misuse and abuse enhances antimicrobial resistance (AMR). Previous studies in Pakistan have documented extensive dispensing of 'Watch' and 'Reserve' antibiotics, which is a concern. In view of this, there is a need to assess current dispensing patterns following COVID-19. A cross-sectional study was undertaken collecting dispensing data from 39 pharmacies and 53 drug stores from November 2022 to February 2023. Outlets were principally in urban areas (60.9%) with pharmacists/pharmacy technicians present in 32.6%. 11,092 prescriptions were analyzed. 67.1% of patients were supplied at least one antimicrobial, 74.3% were antibiotics, 10.2% antifungals and 7.9% anthelmintics. 33.2% of antimicrobials were supplied without a prescription. Common indications for dispensed antibiotics were respiratory (34.3%) and gastrointestinal (16.8%) infections, which can be self-limiting. 12% of antibiotics were dispensed for the prevention or treatment of COVID-19. The most frequent antibiotics dispensed were ceftriaxone (18.4%) and amoxicillin (15.4%). 59.2% antibiotics were 'Watch' antibiotics followed by 'Access' (40.3%) and 'Reserve' (0.5%) antibiotics. Of the total antibiotics dispensed for treating COVID-19, 68.3% were 'Watch' and 31.7% 'Access'. Overall, there appeared to be an appreciable number of antibiotics dispensed during the recent pandemic including for patients with COVID-19. Alongside this generally extensive dispensing of 'Watch' antibiotics. This needs urgent addressing with appropriate programs among pharmacists/pharmacy technicians to reduce AMR

Covid-19 vaccines status, acceptance and hesitancy among maintenance hemodialysis patients : a cross-sectional study and the implications for Pakistan and beyond

COVID-19 vaccine hesitancy continues to be a widespread problem in Pakistan due to various conspiracy beliefs, myths and misconceptions. Since the hemodialysis population is at higher risk of contracting infections, we sought to investigate the current COVID-19 immunization status and reasons for any vaccine hesitancy among these patients in Pakistan. This cross-sectional study was conducted among maintenance hemodialysis patients at six hospitals of Punjab Province of Pakistan. Data were collected anonymously using a questionnaire. 399 hemodialysis patients took part in the survey, the majority of them were male (56%) and aged 45 – 64 years. 62.4% of the patients reported receiving at least one dose of COVID-19 vaccine. Of those vaccinated (249), 73.5% had received two dose and 16.9% had received a booster dose. The most common reasons for vaccination were “being aware they were at high risk” (89.6%), “fear of getting infected” (89.2%) and “willingness to fight against COVID-19 pandemic” (83.9%). Of the 150 patients who had not yet been vaccinated, only 10 showed willingness to take the COVID-19 vaccine. The major reasons for refusal included “COVID-19 is not a real problem” (75%), “corona vaccine is a con-spiracy (72.1%)” and “I don’t need the vaccine” (60.7%). Our study revealed that only 62% pa-tients receiving hemodialysis were partially or completely vaccinated against COVID-19. Con-sequently, there is a need to initiate aggressive approaches to educate this high-risk population in order to address their vaccine safety and efficacy concerns and correct current myths and mis-conceptions to improve the COVID-19 immunization status in this population

Knowledge, attitude and practices of self-medication including antibiotics among health care professionals during the COVID-19 pandemic in Pakistan; findings and implications

Since the emergence of COVID-19, several different medicines including antimicrobials have been administered to patients to treat COVID-19. This is despite limited evidence of the effectiveness of many of these, fueled by misinformation. These utilization patterns have resulted in concerns with patients’ safety and a rise in antimicrobial resistance (AMR). Health care workers (HCWs) were required to serve in high-risk areas throughout the pandemic. Consequently, they may be inclined towards self-medication. However, they have a responsibility to ensure any medicines recommended or prescribed for the management of patients with COVID-19 are evidence based. This though is not always the case. A descriptive cross-sectional study was conducted among HCWs in six districts of the Punjab to assess their knowledge, attitude and practices of self-medication during the ongoing pandemic. This included HCWs working a a range of public sector hospitals in Punjab Province. A total of 1173 HCWs were included in the final analysis. The majority of HCWs possessed good knowledge regarding self-medication and good attitudes. However, 60% were practicing self-medication amid the COVID-19 pandemic. The most frequent medicines consumed by the HCWs under self-medication were antipyretics (100%), antibiotics (80.4%) and vitamins (59.9%). Azithromycin was the most commonly purchase antibiotic (35.1%). In conclusion, HCWs possess good knowledge of, and attitude, regarding medicines they pur-chased. However, there are concerns that high rates of purchasing antibiotics, especially ‘Watch’ antibiotics, for self-medication may enhance AMR. This needs addressing

Tackling antimicrobial resistance in primary care facilities across Pakistan : current challenges and implications for the future

Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000–2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations