ABSTRACT
Irrational, over and misuse of antibiotics arise as global concern in both hospital and community settings and lead to adverse events including antimicrobial resistance, associated health problems, amplified hospitalization stay and cost. Hence, Drug Utilization Evaluation [DUE] studies are designed to evaluate and improve the prescribing, administration and the rational use of medications. The present study was designed to assess the pattern of antimicrobial drug utilization in in-patients cohort of tertiary care setup in Karachi, Pakistan. This cross sectional observational study was conducted in retrospective manner. World health organization [WHO] guidelines and criteria are considered to evaluate the appropriateness of drug use in various disease conditions. ATC/DDD system was applied to determine the study outcome. High frequency of antibiotics utilization found in respiratory tract infections of both lower [LRTI] 16.8% [n=42] and upper [UTI] 13.2% [n=33]. The estimated total number of drug units administered per month was greater with cefixime [46] and ciprofloxacin [45] both. DDD/100 bed days drug utilization of antibiotics was higher with ciprofloxacin, cefexime and meropenem [47, 46 and 29.25] correspondingly. In conclusion, the current investigation signifies extensive scope for progress in prescribing trend. Drug adherence to customary guidelines of disease management and constraint policies to endorse judicious drug use may be considered vital in healthcare setup
ABSTRACT
Pakistan is categorized to below to middle income countries where two third of the national annual health expenditure is in the form of out of pocket [OOP] cost. A prevalence based study was conducted to determine the OOP cost treatment of hypertension in Karachi by interviewing 350 hypertensive patients aged >30 years through a validated questionnaire. Hypertension [HTN] was classified into stage 1 and stage 2 and was found to be common in females [53.42%] than males [46.57%]. The total costs of stage 1and stage 2 HTN were calculated to be217869.7PKR and17545457.6 PKR respectively. The average treatment cost of stage 1 was observed to be significantly lower [p=0.006] than the cost of stage 2 HTN. Moreover; the cost of antihypertensive drugs, physician fees and laboratory tests were considerably different however; no variation was seen in cost of transport and loss of productivity through absenteeism from work. Overall, the present study indicates that the antihypertensive treatment has imposed a high burden on the pocket of common man and this is a major reason for treatment non-adherence. Consequently, it increases the risks of cardiovascular events, morbidity and mortality. Therefore, effective strategic planning is need of time to reduce OOP cost for better control on hypertension in Pakistan
ABSTRACT
Background and Objectives: Triple negative and triple positive breast cancer have adverse effects than other types of breast cancer. However, triple negative has poor prognosis with short survival as compared with triple positive breast cancer. Good prognosis is one of the key factors for successful treatment trial. This study aimed to find out the association of sociodemographic and reproductive features like parity, menopause, number of child bearing as risk factors in the development and prognosis of triple negative and triple positive breast cancer
Methods: This study is a part of an ongoing project which is being conducted in Karachi from 2013 to 2020. Informed consent from triple negative breast cancer [n=134] and triple positive breast cancer [n=87] patients were taken prior to their recruitment into the study. Demographic, anthropometric, reproductive and disease history of patients were recorded. Means, frequency distribution, data classification and association analyses were done by SPSS version 17.0
Results: Statistical analyses revealed that delayed first child bearing age and lower number of children are associated with the development of triple negative breast cancer. However, no significant effect of these parameters has been observed on the outcomes of triple positive breast cancer
Conclusions: Reproductive factors have more pathological implications than sociodemographic factors in both triple positive and triple negative breast cancer development. These findings might prove to be beneficial for effective and better breast cancer management
ABSTRACT
To determine the frequency of correct assessment by transcerebeller diameter [TCD] versus biparietal diameter [BPD] for gestational age measurement at 36 weeks of pregnancy using first day of last menstrual period [LMP] for actual period of gestation. Quasi experimental. Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital, Bahawalpur from May to November 2010. This study was performed on 228 patients at 36 weeks of pregnancy fulfilling the inclusion criteria. Ultrasound measurements of TCD and BPD was made and compared with LMP. Collected data was analyzed by SPSS version 10. Proportoin of correct diagnosis by each measurement was determined and compared using chi-square test with significance at p < 0.05. Out of 228 patients, TCD was found to give correct assessment in 209 patients [91.7%; p = 0.001] corresponding to the gestational age by LMP i.e 36 weeks. BPD was found to give correct assessment corresponding to the gestational age by LMP in 176 patients [77.2%]. Although both BPD and TCD are accurate biometric parameters at 36 weeks of gestation, transcerebellar diameter is more reliable method of gestational age determination in third trimester of pregnancy than biparietal diameter. TCD can be used as a tool to assist in the assessment of gestational age in third trimester
ABSTRACT
To compare the efficacy and maternal side effects of hydralazine with sublingual nifedipine in controlling blood pressure in severe pre-eclampsia [PE] and eclampsia. Quasi interventional The study was conducted in the Department of Obstetrics and Gynecology unit II, Bahawal Victoria Hospital [BVH] Bahawalpur, from January 2007 to January 2008. A total of sixty patients were divided in two groups of 30 each [group A-hydralazine and group B-nifedipine]. All were admitted through emergency. Allocation to each group was random. All patients matched for variables like age, parity, previous history of PE so as to minimize the confounding effects. There were 20 [66.67%] patients with complications in group A and 25 [83.33%] patients in group B [p 0.136]. Headache in group A was noted in 7 [35%] patients and in 10 [40%] patients of group B, palpitations reported in 6 [30%] cases of group A and 8 [32%] in group B. Maternal hypotension was found in 6 [30%] patients of group A and 7 [28%] in group B and fetal distress noted in one [5%] patient of group A only. P value in all above complications was>0.005. Hospital stay of up to 9 days was observed in 17 [56.67%] patients of group A, and four [13.33%] patients in group B. Patients who stayed 9-12 days were 12 [40%] in group A and 18 [60%] in group B, while the longest stay at hospital [12-15 days] was found in one [3.33%] patient of group A and 8 [26.67%] patients in group B. There was no patient who was admitted for more than 15 days in both the groups. When time taken to control BP was compared, one hour was observed in 15 [50%] patients in group A and 5 hours in 5 [16.67%] patients in group B after initial dose of both hydralazine and sublingual nifedipine respectively. Ten [33.33%] patients took 2-3 hours in group A and 16 [53.33%] patients in group B after 2nd dose. Total 4-5 hours time interval was observed in 5 [16.6%] patients in group A and in 9 [30%] patients of group B after receiving 4th dose. Hydralazine was significantly more effective in controlling blood pressure [BP] after administration of its initial dose, thus reducing the total dose of drug given and had better outcome of mother and fetus, with reduced hospital stay as compared to sublingual nifedipine