Hypertensive patients' readiness to use of mobile phones and other information technological modes for improvingtheir compliance to doctors' advice in Karachi

To determine the use of information technology [IT] and electronic media for improving compliance rate to doctors' advice in hypertensive patients in Karachi. Total 400 persons [200 males and 200 females] were randomly selected in six districts of Karachi. Data was collected through a pretested questionnaire. Following was sample criteria: age above 15 years, living in Karachi and ambulatory. Persons admitted in a hospital, individuals who were doing some physical activity during survey e.g. exercise, labor work etc., individual in stressed condition, non-cooperative individuals - not willing to get BP checked and fill questionnaire, and pregnant women were excluded. Those who did not sign the consent form were also excluded. SPSS was used for data analysis and descriptive statistics was employed for sensitivity analysis. For healthcare awareness, people look for health programs on radio and TV channels. Short Message Service [SMS] and phone are highly appreciated by patients for reminders. To increase compliance to doctors' advice, less educated people prefer phone calls over SMS whereas educated individuals favor SMS. Although price of medicine has not emerged as a major contributing factor for non-compliance, discount on medicinal products is highly appreciated by the patients. The study concludes that there is a widespread awareness of high blood pressure in the sample population of Karachi e.g. 72.5%. People consider reminder message system i.e. Calls and Short Messaging Service [SMS] would help them in improving compliance to doctors' advice

Current trends in treatment of hypertension in Karachi and cost minimization possibilities

This study finds out drug usage trends in Stage I Hypertensive Patients without any compelling indications in Karachi, deviations of current practices from evidence based antihypertensive therapeutic guidelines and looks for cost minimization opportunities. In the present study conducted during June 2012 to August 2012, two sets were used. Randomized stratified independent surveys were conducted in doctors and general population - including patients, using pretested questionnaires. Sample sizes for doctors and general population were 100 and 400 respectively. Statistical analysis was conducted on Statistical Package for Social Science [SPSS]. Financial impact was also analyzed. On the basis of patients' doctors1 feedback, Beta Blockers,and Angiotensin Converting Enzyme Inhibitors were used more frequently than other drugs. Thiazides and low-priced generics were hardly prescribed. Beta blockers were prescribed widely and considered cost effective.This trend increases cost by two to ten times. Feedbacks showed that therapeutic guidelines were not followed by the doctors practicing in the community and hospitals in Karachi. Thiazide diuretics were hardly used. Beta blockers were widely prescribed. High priced market leaders or expensive branded generics were commonly prescribed. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines

Comparison of in vitro antibacterial activity of levofloxacin and ciprofloxacin

Levofloxacin and ciprofloxacin are widely used antibiotics that belong to the class of fluoroquinolones. The in vitro antibacterial activity of these two antimicrobials were evaluated and compared in the present study by Disk Diffusion [Kirby-Bauer] method against 52 clinical isolates of Staphylococcus aureus [n = 36] and Klebsiella pneumoniae [n = 16]. These clinical isolates were obtained from different pathological laboratories and medical centers of Karachi. Among clinical isolates of Staphylococcus aureus the average zone of inhibition for levofloxacin was 16.7 mm while for ciprofloxacin the zone of inhibition was 21 mm. For the clinical isolates of Klebseilla pneumoniae the average zone of inhibition of levofloxacin was 16.5 mm while for ciprofloxacin was 16.9 mm. Comparison of susceptibility results indicated that both fluoroquinolones have excellent in vitro antibacterial activity but comparatively ciprofloxacin showed broader spectrum of activity against most of the tested clinical isolates

prevalence and predictors of female condom use amongst South Asian women

Background: The evidence regarding the use of female condoms [FCs] in the South Asian [SA] population living in London is lacking. This primary study aimed at investigating FC use and its predictors for the prevention of sexually transmitted infections [STIs] among South Asian [SA] females who were living in London and were sexually active. For this purpose, a survey wa conducted in London during July 2009. Methods: A total of 136 females within the age range of 19 to 35 years were recruited in the study. A self completed questionnaire was used to investigate their socio-demographic characteristics, habits regarding condom use, knowledge, and behaviour regarding FC use. Of the total population, 121 returned the questionnaire and eventually participated in the study. The data were analyzed at bivariate and multivariate levels. All the test were performed using SPSS. The significant level was set up at p-value<0.05 with 95% CI. Results: Among the surveyed females 2.5% of FC use was found. Knowledge regarding FC was significantly associated with FC use in bivariate and multivariate analysis. Females having higher levels of knowledge, acceptable [OR=68.8; 95% CI, 4.50 to 1054], good [OR=61.6; 95% CI, 2.86 to 1326], and extensive [OR=65.7; 95% CI, 0.78 to 5530] were more likely to use FC than females having poor and inadequate knowledge. Conclusion: Low prevalence of FC use and the association of higher levels of knowledge with its increased use suggest the need to educate SA females about FCs and their role in preventing STIs

Antimicrobial activity of erythromycin and clarithromycin against clinical isolates of Escherichia coli, Staphylococcus aureus, klebsiella and proteus by disc diffusion method

Fifty clinical isolates comprising of Escherichia coli, Staphylococcus aureus, Klebsiella and Proteus were collected from different local pathological laboratories and their resistant pattern against two well known macrolides; erythromycin and clarithromycin were studied using disc diffusion method. Klebsiella [41.67% against erythromycin and 58.34% against clarithromycin] and Proteus [66.67% against erythromycin and clarithromycin] species were found to be more resistant against the studied macrolides as compared to the rest of organisms. In case of Staphylococcus aureus and Escherichia.coli, resistant found were 27.78% and 23.54% against erythromycin and 22.23% and 35.30% against clarithromycin respectively. It is concluded from these figures that microbial resistance against these macrolides are increasing in our population which is alarming and therefore it is recommended to physicians to prescribe these antibiotics unless no other substitute is available in clinical practices

Studies of food drug interactions

Medicines can treat and alleviate many diseases provided that they must be taken properly to ensure that they are safe and useful. One issue related with the medicines is that whether to take on empty stomach or with food. The present work gives information regarding food-drug interactions that were studied by collecting seventy five prescriptions from various hospitals. In most of the collected prescriptions, food-drug interactions were detected using the literature available. It was also found that only few studies have been carried out so far on the effect of food on drug disposition in the Asian population. Thus more studies on food-drug interactions particularly in the local population is recommended in order to determine the effect of food and food components on drug disposition and to the kinetics of the drugs which has not yet well highlighted in this part of the world

Musculoskeletal problems and recommended remedies to computer users at Isra University

Objective: To determine the prevalence of musculoskeletal complications and recommend remedies to computer users at ISRA University, Hyderabad

Design:Descriptive cross-sectional study

Place and Duration: This study was conducted from October 2009 to March 2010 at ISRA University, Hyderabad

Methodology: One hundred computer users [54 males and 46 females] of Isra University were enrolled in this study. Through a questionnaire, data were collected and statistically evaluated using the Chi-square test. Furthermore, remedies [rest, physiotherapy, nonsteroidal anti-inflammatory drugs [NSAIDS] and muscle relaxant] were prescribed for relief, according to the grading of complications

Results: The frequency of musculoskeletal complications in either group [male or female] was 52.63% in those who had been in contact with computers for less than or equal to 2 hrs, 68.18% between 2-4 hrs, 81.48% between 4-6 hrs, and 93.75% more than 6 hrs, respectively. The frequency of musculoskeletal complications [neck pain, low backache, shoulder pain, and elbow and wrist pain] was graded according to a scale of pain ranging from grade I to grade V with respect to the number of hours spent with computers

Conclusion: The results of the study revealed that most subjects had complaints of musculoskeletal complications directly proportional to the extensive use of a computer. The pattern observed in evaluating pain on a grading scale suggests opportunities for remedies

Resistance pattern of ciprofloxacin against different pathogens

Ciprofloxacin is a broad-spectrum antibiotic widely prescribed in clinical and hospital settings. The emergence of antimicrobial resistance against effective antibiotics is a global issue. The objective of study is the surveillance of ciprofloxacin against common pathogens. To investigate the present status of antimicrobial resistance against ciprofloxacin, five hundred and twenty four clinical isolates of Escherichia coli [30%], Staphylococcus aureus [33%], Salmonella typhi [9%], Klebsiella pneumonia [14%] and Pseudomonas aeruginosa [14%] were collected during study from January, 2008 to February, 2009 from different pathological laboratories running in and out side hospitals located in Karachi, Pakistan. These pathogens were isolated from specimens of both in and out patients. The in-vitro antimicrobial activity of ciprofloxacin was carried out by Disc Diffusion Method [Kirby-Bauer test]. Showed that ciprofloxacin is 27.02%, 21.95%, 16.66%, 72.22% and 44.44% resistant to Escherichia coli, Staphylococcus aureus, Salmonella typhi, Klebsiella pneumonia and Pseudomonas aeruginosa respectively. It is concluded that these clinical isolates have started developing resistance against ciprofloxacin due to its irrational and inappropriate use. Continuous surveillance is crucial to monitor the antimicrobial resistance among pathogens

Pathological threat of developing resistance against broad spectrum antibiotics

The objectives of the study were to describe the recent sensitivity pattern against Escherichia coli and Staphylococcus aureus in relation to ciprofloxacin and cefepime as to maintain the effectiveness of the treatment regimen. Furthermore the resistance of these organisms was explored to estimate the impending burden of resistant infections. During the present study 50 isolates of Staphylococcus aureus and 50 isolates of Escherichia coli have been collected from Dr. Ziauddin Hospital Laboratory and Imam Clinic laboratory. The study was done in the department of Pharmaceuticals, Faculty of Pharmacy, Karachi University. The sensitivity pattern of these isolates to ciprofloxacin and cefepime was determined by using Disc Diffusion Method. Data was analyzed by using National Committee for Clinical laboratory Standard [NCCLS]. Data indicated that the clinical isolate of Eschericia coli has exhibited 58% sensitivity, 42% resistance to Cefepime. Where as Staphylococcus aureus has shown 54% sensitivity, 46% resistance to Cefepime. The clinical isolates of Eschericia coli has exhibited 36% sensitivity, 64% resistance to ciprofloxacin, where as Staphylococcus aureus, has shown 44% sensitivity, 56% resistance to Ciprofloxacin. The prescribed drugs must not be used frequently otherwise resistance threat against the relevant microorganism would be increased at an alarming level

Correlation of plasma endothelin-1 levels with pulmonary hypertension after inhaled nitric oxide therapy

Variable response to inhaled nitric oxide [iNO] therapy in patients with mitral stenosis [MS] having pulmonary hypertension [PH] has been documented in early studies. The objectives of this study were to measure plasma Endothelin-1 [ET-1] levels in those patients and to correlate them with pulmonary vascular indices after iNO therapy. It was Quesi-experimental study. Thirty patients with mitral or mixed mitral and aortic valve disease with severe pulmonary hypertension and vascular indices and cardiac output were recorded. After the surgery, 10-20 ppm iNO was administered for 1 hour and all the parameters were again recorded. Patients were grouped into responders and non responders on the basis of% reduction in Pulmonary Vascular Resistance [PVR] after iNO therapy. Plasma ET-1 levels were measured in both groups by ELISA before and after the iNO therapy. Paired sample t-test was used to compare mean values for significance. The correlations between variables were then calculated by using Pearson's coefficient. The plasma ET-1 levels were very high in all patients. They reduce in responders after iNO therapy; non-responders paradoxically showed significant increase in the levels of ET-1 after iNO therapy. Moreover, a positive correlation was observed in plasma ET-1 levels and post operative levels of PVR. The correlation of changes in PVR and plasma ET-1 is a key mediator of poor response in PH secondary to MS, after iNO therapy

Pharmacokinetic study of cephradine in Pakistani healthy male volunteers

To observe and discuss the difference in the pharmacokinetics of Cephradine in Pakistani population with the reported data of other ethnic origins. A Single group pharmacokinetic study was conducted having six healthy male volunteers of 20-24 years of age. Blood samples were collected at appropriate times up to 7 hours. Plasma concentrations of Cephradine was determined by HPLC technique and pharmacokinetic parameters were determined by both compartmental and noncompartmental methods using Kinetica ver 4.4.1 and Winnonlin ver 5.01. Peak plasma concentration was 11.49 +/- 1.73 microg/ml achieved at 0.76 +/- 0.12 hr, after the administration of 250 mg Cephradine to fasting volunteers. Area under the serum concentration-time curve was found to be 16.4 +/- 1.71 microg.hr/ml. Absorption, distribution, disposition and elimination half lives were calculated as 0.183 +/- 0.038hr, 0.248 +/- 0.143 hr, 2.126 +/- 0.341 hr and 0.441 +/- 0.193 hr respectively where as the volume of central compartment and total body clearance were found to be 9.65 +/- 3.78 L and 15.4 +/- 1.89 L/hr. The plasma concentration time curves showed the absorption rate constant was 3.968 +/- 0.05 hr-1, disposition rate constant was 0.333 +/- 0.05 hr-1, distribution rate constant was 3.64 +/- 2.18 hr-1 and elimination rate constant was 1.738 +/- 0.468 hr-1. The value of micro-constants i.e. K12 [central to peripheral compartment] and K21 [peripheral to central compartment] were found to be 1.529 +/- 1.499 hr-1 and 0.704 +/- 0.44 hr-1 respectively, where as MRT and AUMC were calculated as 2.04 +/- 0.09 hr and 35.92 +/- 1.86 hr[2]x micro g/mL. The findings showed that the results of Pakistani subjects are slightly different when compared with the reported data of other ethnic origin

Assessment of pollution status of fresh water lakes by metal ions and their hazards on the health of human being

Kalri and Haleji lakes of Sindh region, Pakistan, are the important and valuable sources of water supply for drinking and irrigation purposes. A study was done to determine the concentration of pollutants [metal ions] in water and in different organs of fish, Labeo rohita by atomic absorption spectrophotometry. The concentration of metal ions [in water] was higher during the months of March to July. The highest peak for lead was found in Kalri and Haleji lakes which were followed by iron, chromium and zinc. Ions such as cadmium and manganese were found in least concentration. Bioaccumulation of metal ions in different organs of fish Labeo rohita, was found highest in liver while minimum concentration was found in adipose tissues. Generally two peaks were observed i.e., one in April to August and the other in November. It was found that there is higher amount of metal ions in Haleji lake water and fish organs. Therefore, supply of drinking water has been stopped from Haleji lake, possibly due to hepatotoxic and nephrotoxic effects

Effect of nystatin, gentian violet and garlic extract on candidiasis patients undergoing radiation therapy in head and neck region

To evaluate the in-vivo anticandidal activity of Nystatin, Gentian Violet and Garlic extract on candidiasis patient receiving radiation therapy in Head and Neck region. The in-vivo antifungal activity of Nystatin, Gentian Violet and Garlic Extract were carried out on 60 patients. These patients were divided into 3 groups [Group I = Nystatin, Group 2= Gentian violet, Group 3= Garlic extract]. Each group consisted of 20 patients. The clinical lesion were recorded and graded during the treatment according to the Lindquist/Hickey scale on 0th 7th and 15th day and the anticandidal effect of these drugs were evaluated by oral lesion index evolution through simple mean. Result showed that Nystatin, Gentian violet and Garlic Extract were found to be very effective. It can be concluded from the study that all the drugs were effective against Candida albicans and secondly the organism has not developed any resistance to these drugs

Incidence rate and distribution of paediatric nosocomial infections

The mechanism of action of Nosocomial infection as in any other infectious disease is dependent on host, agent and environment factors. Risk factors for the host are age, nutritional status and co-existing disorders. The organism's intrinsic virulence as well as its ability to colonize and survive within institutions influence nosocomial infections. Diagnostic procedures, medical devices, medical and surgical treatments are risk factors in the hospital environment. Unlike the adults, children are the more susceptible subjects of such kind of infections especially the neonates. Neonatal intensive therapy units usually have a prevalence of about 20% and superimposed by virulent and usually antibiotic resistant strains because of following reasons: o Children that are admitted usually have weak immune system, so they may acquire the colonization of any type of organism. o Ill babies require more handling hence the spread via contact. In describing the incidence rate and distribution of nosocomial infections in children, for implementation and improving infection control measures, one hundred and twenty four isolates of Pseudomonas aeruginosa/Pseudomonas species, Staphylococcus aureus [MRSA/MSSA] and Klebsiella specie, were collected from a pediatric hospital setting in Karachi. The results showed more than 24% [124 isolates of 513 cultures that were suspected of acquiring nosocomial infection] incidence percentage rate. Nosocomial infections are caused in children in a developing country due to the lack of sanitation, monitoring and implementation of infection control procedures. Common sources of such infections were the water supply, poor ward/operation theatre hygienic conditions and utensils

Paediatric nosocomial infections: resistance pattern of clinical isolaten

Hospital acquired infections are transmitted to patients by hospital personnel and other patients, or they may arise from patient's own endogenous flora. Children are one of the most susceptible subjects associated in the hospitalacquired infections and have a higher prevalence rate for infections. This problem is at its extremes in developing countries like Pakistan where in most of cases the severity depends on the hygienic conditions of the Hospitals and lack or lapse of infection control measures. To have a surveillance type of data in this regard, one hundred and twenty four isolates of Pseudomonas aeruginosa/Pseudomonas species, Staphylococcus aureus [MRSA/MSSA] and Klebsiella species, that are commonest among the nosocomial infection causing organisms, were collected from pediatric hospital settings in Karachi. A study of incidence and resistance pattern by Kirby Baur disc diffusion method, with selected antimicrobials, was carried out. These isolates were resistant against most antimicrobials tested. Drugs like mmipenem, meropenem, amikacin, vancomycin [especially in MRSA or BRSA], Fucidic acid [for burns and other infections] and some of the 3rd generation cephalosporins were found quite effective

Lymphatic filariasis in a young girl

Lymphatic filariasis known as Elephantiasis put more than a billion people at risk. Over 120 million have already been affected by it; out of which over 40 million are seriously incapacitated and disfigured by the disease 1.2. Elephantiasis is a complication that occurs due to repeated infections caused by three species of filarial worms. Wuchereria bancrofti, Brugia malayi are the most common and Brugia timori is rarely implicated 2. In its most obvious manifestations, lymphatic filariasis causes enlargement of the entire leg or arm, the genitals, vulva and breasts. In endemic communities, 10-50% of men and up to 10% of women can be affected 3. The psychological and social stigma associated with these aspects of the disease arc immense. In addition, even more common than the overt abnormalities is hidden, internal damage to the kidneys and lymphatic system caused by the filariae 4.5. One-third of the people infected with the disease live in India. A primary cause of this increase is the rapid and unplanned growth of cities, which creates numerous breeding sites for the mosquitoes that transmit the disease

Screening of antibacterial activity of different brands of co-trimoxazole paediatric suspension available in the local market

Sulfonamides are the drug of choice for number of infections like pneumonia, toxoplasmosis, nocardiosis, urinary tract infections. Sulfonamides are most commonly used in combinations such as [Trimethoprim-Sulfamethoxazole] [TMP+SMZ] or co-trimoxazole. Sixty five isolates belonging to five different species, E. coli [22], S. aureus [18], Klebsiella [05], Pseudomonas [16] and Proteus [04] were used for screening antibacterial activity against different brands [A-G] of Co-trimoxazole by disc diffusion method. Brand G exhibited highest activity against E. coli with mean zone of inhibition 41mm +/-2.3 standard deviation. The antibacterial activity against other species S. aureus, Klebsiella and Pseudomonas were found as: [mean +/- standard deviation] observed as 39.73 mm +/- 10.59 mm +/- 38 mm +/- 2 and 24.93 mm +/- 5.32. However all isolates of Proteus were found resistant against different brands of co-trimoxazole

In vitro effect of nystatin, gentian violet and garlic extract on candida albicans isolates from oral cavity

To evaluate in-vitro anticandidal activity of Nystatin. Gentian Violet and Garlic extract on Candida albicans isolates from oral cavity. For screening of antifungal activity of Nystatin. Gentian Violet and Garlic Extract, 100 clinical isolates were collected from the department of Radiotherapy. Jinnah Postgraduate Medical Center and Fatima Jinnah Dental College and Hospital, Karachi. The samples were collected from the oral cavity and the sample site was buccal mucosa, tongue and hard palate. These isolates were finally identified on the basis of morphology and cultural characteristics and confirmed using germ tube method. The antifungal activity of Nystatin, Gentian Violet and Garlic Extract were carried out by disc diffusion method. Result showed that the mean zone of inhibition of Nystatin was 17.9mm, Gentian violet was 16.6mm and Garlic Extract was 16.6mm and all the drugs used were found to be very effective. It can be concluded from the study that all the drugs are very effective against clinical isolates of Candida albicans and secondly the organism had not developed any resistance to these drugs

Pesticides: is it a risk for human health?

Pakistan being an agricultural country spends billions of rupees on importing pesticides for saving crops, cereals etc. and for vector control. However, indiscriminate and careless use is causing pollution, resistance and health hazards. To avoid this 1PM program is necessary in which various pest control measures are integrated, especially use of phytopesticides [Indigenous products], biological control, and cultural control is done. Even in western countries use of 50% phytopesticides is being done to avoid health hazards. In Pakistan little attention is being paid on pesticide pollution and its after effects and EPA is doing nothing here