Provincial differences in levels, trends, and determinants of childhood immunization in Pakistan

Background: Efforts to improve immunization rates are urgently needed in Pakistan but national statistics mask important local differences in immunization levels and determinants.

Aim: In this study we aimed to determine how similar or different are recent trends and levels of immunization coverage in Pakistan's 4 main provinces [Punjab, Sindh, Khyber Pakhtunkhwa [KPK] and Balochistan], and what factors are associated with complete childhood immunization in each province.

Method: We analysed data from the 2006–07 and 2012–13 Pakistan Demographic and Health Surveys. Trends in immunization coverage among children aged 12–23 months were calculated for each province. Bivariate and multivariate analyses were conducted to identify factors associated with complete immunization.

Results: The proportion of children completely immunized had risen significantly in Punjab but had fallen significantly in Balochistan. Complete coverage ranged from 16.4% in Balochistan to 65.8% in Punjab [2012–13]. Tetanus toxoid injection during pregnancy was a significant predictor of complete immunization everywhere. Other predictors in specific provinces were: urban residence in Balochistan, wealth in Sindh and KPK, mother's education in Punjab and KPK, and distance to the facility in Punjab.

Conclusions: Although some strategies to increase immunization coverage are relevant nationwide, programme managers need to seek solutions specific to provincial trends and predictors. This analysis demonstrates that viewing childhood immunization in Pakistan through a provincial lens can help achieve a deeper understanding of the challenges and potential strategies to boost coverage

Impact of pharmacist's intervention on disease related knowledge, medication adherence, HRQoL and control of blood pressure among hypertensive patients

The present study was aimed to evaluate the effect of educational intervention provided to the patients of hypertension through pharmacist with the goal to improve knowledge about hypertension, adherence to prescribed medicines, blood pressure control and HRQoL [Health Related Quality of Life]. A total of 384 patients were assigned randomly into 2 groups including intervention and control groups each having 192 patients. Urdu versions of knowledge questionnaire regarding hypertension, medication adherence scale [MMAS-U] by Morisky and EuroQol scale [EQ-5D] were utilized. Each patient's blood pressure was measured. After educational intervention, an increase was found in mean knowledge score about hypertension [18.18 +/- 4.00], adherence score [5.89 +/- 1.90], HRQoL score [0.73 +/- 0.12] and Visual Analogue Scale [VAS] score [69.39 +/- 5.90] among the IG. The blood pressure control also improved and lower systolic [131.81 +/- 10.98 mmHg] and diastolic blood pressures [83.75 +/- 6.21 mmHg] were observed among the patients of IG. This study showed that educational programs are useful for patients in increasing patient's levels of knowledge about hypertension, improving adherence to prescribed medication and enhancing blood pressure control. This increase is in turn accountable to improve HRQoL

Development and formulation of metformin [antidiabetic] effervescent Granules: To increase patient compliance and its stability study

Convenience of administration and patient compliance are gaining importance in the formulation of dosage forms. Many patients, like elderly people and person with dysphagia find difficulty to swallow the tablets and thus do not comply with prescriptions. So the present study was conducted to develop and formulate metformin effervescent granules. The stability study was carried out for 24 weeks [168 days] at temperatures of 4[degree sign]C, Room temperature, 40[degree sign]C and 60[degree sign]C and at the end, the%age of drug remaining in the formulation was determined. The results showed that the formulation of metformin effervescent granules were remained best stable at 4[degree sign]C in refrigerator, as the%age of drug remaining is not decreased more than 5% and the formulation stored at room temperature, was also found to be very close to the standard at the end of 24 weeks. It is concluded from the study that granules may be another dosage form to use as antidiabetic pharmaceutical product

A case report of subependymal giant cell astrocytoma in 7 month old patient with tuberous sclerosis

Tuberous sclerosis is a neurocutaneous syndrome with a wide variety of clinical, pathologic, and radiologic manifestations. Intracranial phakomatosis has been reported to include subependymal nodules; cortical, and subependymal giant-cell astrocytomas. Subependymal giant-cell astrocytomas are rare, benign typically slow growing tumors of mixed neuroglial lineage, which can become aggressive and cause increased intracranial pressure, seizures, and focal neurologic signs. The standard treatment of these tumors is total neurosurgical resection [1,2,3]. We report a 07 month old male patient with tuberous sclerosis who underwent surgery for a large subependymal giant-cell astrocytoma [SEGA]. It is rare to find SEGA in this age period

Dural sinus thrombosis: frequency and imaging diagnosis

To determine the frequency of dural sinus thrombosis [DST] and highlight diagnostic importance of its subtle imaging findings in patients presenting for workup of their varied neurologic complaints and symptoms. Observational case series. Study Period: June 2002- May 2005. All new patients undergoing cranial computed tomography [CT] and magnetic resonance [MR] imaging were included in this study which consisted of 1676 consecutive subjects with 1780 examinations. These were reviewed in real time on monitors [as they were being performed] for evidence of DST before printing of hard copies prior to disposition of patients. CT studies were performed on Toshiba Auklet scanner with 5 mm thick axial slices and 1cm inter slice gap. MR imaging was performed on 1.5 Tesla Toshiba Visart scanner with T1 and T2 weighted [T1 and T2W], spin echo, FLAIR and post contrast T1 weighted [T1W] imaging in multiple planes. Subjects with inconclusive but suspicious conventional imaging [CT, MR] were evaluated by magnetic resonance venography [MRV]. Patients presenting for follow-up of established diagnoses including neoplasia, arterial infarcts, hypertensive parenchymal haemorrhages and postsurgical status were excluded. Delta and empty delta were the most commonly observed CT and MR signs diagnostic of DST on pre and postcontrast images and were present in 43 patients. Thrombus was also directly visible within lumen of superior sagittal, transverse and sigmoid sinuses on T1W MR images in 21 individuals. In 12 patients, these signs were either absent or too subtle to be conclusive. However, presence of venous haemorrhagic or non-haemorrhagic brain parenchymal edematous lesions prompted further evaluation by MRV, which confirmed presence of DST in these subjects as well. As a result, a total of 55 patients with a frequency of 3.3% were diagnosed and treated for DST. Frequency of DST in patients with neurological complaints and symptoms is 3.3%, which is significantly higher than has been clinically suspected or recognized. On routine CT and MR studies, diagnostic imaging signs, while highly specific for DST, can be absent or may be masked due to technical factors or associated complications. Presence of brain parenchymal venous haemorrhagic or non-haemorrhagic edematous lesions should prompt judicious and close scrutiny of images on monitors by changing viewing parameters to detect subtle signs of DST. If still in doubt, MRV must be pursued for definitive diagnosis