Characterization of Mutations Linked with Second Line Anti-TB Drug Resistance in Pakistan

Background: The incidence of multiple drug resistance tuberculosis is on the rise worldwide and Pakistan is one of 30 high TB burden countries. Resistance to second line drugs especially fluoroquinolones is being reported by many laboratories. This is increasing the gravity of the situation resulting in extensively drug resistant cases, which is difficult to treat, and has more side effects.Methods: One hundred and thirty-three (133) clinical isolates of M. tuberculosis, collected by convenience sampling, were characterized for mutations in eth-A, gyrA, msh-A, rrs genes, and the promoter region of inh-A gene that confer resistance to second line anti-TB drugs. The mutations were detected by allele-specific-PCR and PCR amplification followed by SSCP and DNA sequencing.Results: Mutations in gyrA gene at codon 91, 94 and 95 were found in 4 (3.0%) M. tuberculosis isolates. Mutations in rrs gene were found in 17 (12.8%) isolates, ten (7.5%) isolates had mutation at A1401G position, 5 (3.76%) isolates at C1402T position and 3 (2.25%) isolates had G1484T mutation. For resistance to ethionamide, none of the isolates showed mutation in eth-A gene. In promoter region of inh-A gene, mutations were detected at -C15T, -A112G, -C110T in two samples. Two mutations, A312T and A332G, were found in msh-A gene in one sample. Collectively, 24 (18%) isolates were found to harbor mutations associated with second line anti TB drug resistance.Conclusion: Our work revealed high frequency of mutations (18%) associated with resistance against second line anti-TB drugs. This situation can lead to increase in XDR-TB cases. We, therefore, recommend improved diagnostic and drug sensitivity testing, better prescription, and development of superior drugs to control tuberculosis.   Keywords: Antibiotic resistance; Mycobacterium tuberculosis; Second line anti-TB drug

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

Phytohormones as Plant Growth Regulators and Safe Protectors against Biotic and Abiotic Stress

Plants are playing important role in the planet by providing food for humans and stability in the environment. Phytohormones are key regulators in various physiological processes and among the most important small signaling molecules affecting plant growth and yield production. These biochemical also initiate adaptive responses caused by external stimuli, such as biotic and abiotic stress. Generally, on the basis of physiology, plant hormones roughly fall into two classes. In class one, phytohormones fall which is responsible for plants growth-promoting activities, such as cell division, cell elongation, seed and fruit development, and pattern of differentiation. On the other hand, the second class of hormone play important role in plants’ response, such as biotic and abiotic stresses. Some other hormones, such as jasmonates, salicylic acid, brassinosteroids, and strigolactones, also play a key role in plants. Their biochemical signaling network and their crosstalk ability make plant hormones excellent candidates to optimize plant growth and/or mediate abiotic and biotic stresses in agriculture. In the end, the future trends of plant hormone analysis are exploring plant hormones and their applications. We believe the perspective may serve as guidance for the research of plant hormones in the analytical, environmental, and botanical fields

Maternal anaemia and the risk of postpartum haemorrhage: a cohort analysis of data from the WOMAN-2 trial

Background: Worldwide, more than half a billion women of reproductive age are anaemic. Each year, about 70 000 women who give birth die from postpartum haemorrhage. Almost all deaths are in low-income or middle-income countries. We examined the association between anaemia and the risk of postpartum haemorrhage. Methods: We did a prospective cohort analysis of data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. This trial enrols women with moderate or severe anaemia giving birth vaginally in hospitals in Pakistan, Nigeria, Tanzania, and Zambia. Hospitals in each country where anaemia in pregnancy is common were identified from a network established during previous obstetric trials. Women who were younger than 18 years without permission provided by a guardian, had a known tranexamic acid allergy, or developed postpartum haemorrhage before the umbilical cord was cut or clamped were excluded from the study. Prebirth haemoglobin, the exposure, was measured after hospital arrival and just before giving birth. Postpartum haemorrhage, the outcome, was defined in three ways: (1) clinical postpartum haemorrhage (estimated blood loss ≥500 mL or any blood loss sufficient to compromise haemodynamic stability); (2) WHO-defined postpartum haemorrhage (estimated blood loss of at least 500 mL); and (3) calculated postpartum haemorrhage (calculated estimated blood loss of ≥1000 mL). Calculated postpartum haemorrhage was estimated from the peripartum change in haemoglobin concentration and bodyweight. We used multivariable logistic regression to examine the association between haemoglobin and postpartum haemorrhage, adjusting for confounding factors. Findings: Of the 10 620 women recruited to the WOMAN-2 trial between Aug 24, 2019, and Nov 1, 2022, 10 561 (99·4%) had complete outcome data. 8751 (82·9%) of 10 561 women were recruited from hospitals in Pakistan, 837 (7·9%) from hospitals in Nigeria, 525 (5·0%) from hospitals in Tanzania, and 448 (4·2%) from hospitals in Zambia. The mean age was 27·1 years (SD 5·5) and mean prebirth haemoglobin was 80·7 g/L (11·8). Mean estimated blood loss was 301 mL (SD 183) for the 8791 (83·2%) women with moderate anaemia and 340 mL (288) for the 1770 (16·8%) women with severe anaemia. 742 (7·0%) women had clinical postpartum haemorrhage. The risk of clinical postpartum haemorrhage was 6·2% in women with moderate anaemia and 11·2% in women with severe anaemia. A 10 g/L reduction in prebirth haemoglobin increased the odds of clinical postpartum haemorrhage (adjusted odds ratio [aOR] 1·29 [95% CI 1·21–1·38]), WHO-defined postpartum haemorrhage (aOR 1·25 [1·16–1·36]), and calculated postpartum haemorrhage (aOR 1·23 [1·14–1·32]). 14 women died and 68 either died or had a near miss. Severe anaemia was associated with seven times higher odds of death or near miss (OR 7·25 [95% CI 4·45–11·80]) than was moderate anaemia. Interpretation: Anaemia is strongly associated with postpartum haemorrhage and the risk of death or near miss. Attention should be given to the prevention and treatment of anaemia in women of reproductive age. Funding: The WOMAN-2 trial is funded by Wellcome and the Bill & Melinda Gates Foundation

Aceclofenac fast dispersible tablet formulations: Effect of different concentration levels of Avicel PH102 on the compactional, mechanical and drug release characteristics.

The objective of this study was based on the formulation development of fast dispersible Aceclofenac tablets (100 mg) and to evaluate the influence of pharmaceutical mixtures of directly compressible Avicel PH102 with Mannitol and Ac-di-sol on the compressional, mechanical characteristics and drug release properties. Fast dispersible Aceclofenac formulations were developed by central composite design (CCD). Among them the best possible formulation was selected on the basis of micromeritic properties, appropriate tablet weight and disintegration time for further study. Tablets were directly compressed using manual hydraulic press with a compressional force ranging from 7.2 to 77.2 MN/m2. Pre and post compression studies were performed and the compressed formulations (FA-FF) were assessed for different quality tests. The Heckel and Kawakita equations were applied for determination of compressional behavior of formulations. The quality attributes suggested that formulation (FB) containing avicel PH 102 (20%), mannitol (25%) and ac-di-sol (3%) as best optimized formulation showing better mechanical strength i.e. hardness 35.40 ± 6.93N, tensile strength 0.963 MN/m2, and friability 0.68%. Furthermore, compressional analysis of FB showed lowest PY value 59.520 MN/m2 and Pk value 1.040 MN/m2 indicating plasticity of the material. Formulation FB disintegrated rapidly within 21 seconds and released 99.92% drug after 45 min in phosphate buffer pH 6.8. Results of drug release kinetics showed that all formulations followed Weibull and First-order models in three different dissolution media. Avicel PH102 based formulation mixture exhibit excellent compactional strength with rapid disintegration and quick drug release

Industry 4.0 Applications for Medical/Healthcare Services

At present, the whole world is transitioning to the fourth industrial revolution, or Industry 4.0, representing the transition to digital, fully automated environments, and cyber-physical systems. Industry 4.0 comprises many different technologies and innovations, which are being implemented in many different sectors. In this review, we focus on the healthcare or medical domain, where healthcare is being revolutionized. The whole ecosystem is moving towards Healthcare 4.0, through the application of Industry 4.0 methodologies. Many technical and innovative approaches have had an impact on moving the sector towards the 4.0 paradigm. We focus on such technologies, including Internet of Things, Big Data Analytics, blockchain, Cloud Computing, and Artificial Intelligence, implemented in Healthcare 4.0. In this review, we analyze and identify how their applications function, the currently available state-of-the-art technologies, solutions to current challenges, and innovative start-ups that have impacted healthcare, with regards to the Industry 4.0 paradigm

Table1_Public awareness regarding the manufacturer provided information about medicine usage, safety, and adverse drug reactions in Balochistan, Pakistan.DOCX

Objectives: This study aimed to analyze the general public’s awareness of medicine information, safety, and adverse drug reactions in Quetta, Pakistan.Methods: A cross-sectional descriptive study was conducted using random sampling from April 2020 to April 2021 in Quetta. Samples were collected from respondents who met the inclusion criteria and had visited community pharmacies. The analysis was done using SPSS version 23. Bivariate and multivariate analyses were performed to assess factors associated with good knowledge.Results: Multivariate analysis revealed that purchase on prescription was a determining factor of knowledge regarding knowledge of pharmaceutical products and their provided information, medicines usage and safety, and Medication ADRs. Patients who bought medicines on prescriptions were more likely to have better knowledge. Patients having education were more likely to have better knowledge.Conclusion: Public awareness about medicine information, safety, and the information provided by manufacturers is crucial to ensuring that patients have access to accurate information about their medications and can make informed decisions about their health. Healthcare providers and regulatory bodies must work together to improve access to information and promote safe medication practices.</p