Evaluation of hypertension control among hemodialysis patients in Pakistan: a prospective follow-up study.

BACKGROUND: Hypertension is highly prevalent and uncontrolled among hemodialysis patients. In Pakistan published data does not provide enough information about the management and factors associated with uncontrolled hypertension in hemodialysis patients. OBJECTIVE: This study was conducted to evaluate the factors influencing the pharmacotherapeutic management and control of hypertension in hemodialysis patients. METHODS: A prospective follow-up study was conducted on hemodialysis patients who were enrolled at study sites between 1 June 2020 and 31 December 2020. The predialysis blood pressure (BP) readings were recorded as mean SBP and DBP at baseline and for each of 6 months. Multivariate analyses were applied to analyze the factors associated with uncontrolled hypertension in hemodialysis patients. RESULTS: The average predialysis BP (SBP and DBP) of study participants at baseline visit was 158.41 and 87.22 mmHg respectively. After 6 months the study participants have 150.27 mmHg and 80.03 mmHg average predialysis SBP and DBP respectively. Only 28.1% of hemodialysis patients were on target BP after 6 months. Results of multivariate analysis have shown that the use of beta-blockers and calcium channel blockers (CCBs) were significantly associated with hypertension control at baseline [odds ratio (OR) = 1.432, P value = 0.034] (OR = 1.499, P value = 0.045) and at after 6 months (OR = 2.824, P value = 0.015) (OR = 1.883, P value = 0.032). CONCLUSION: This study revealed that among the antihypertensive drugs, CCBs and beta-blockers provided better management in controlling hypertension among hemodialysis patients.

Knowledge, attitude, and perception of community pharmacists towards antimicrobial stewardship in Saudi Arabia: A descriptive cross-sectional study.

Background: Antimicrobial resistance is of paramount concern globally. Community pharmacists (CPs) play a vital role in supporting judicious antimicrobial use in the community as they are the key healthcare providers at a public level. This study aimed to assess the knowledge, attitude, and perception of CPs towards antimicrobial stewardship at the community level in Saudi Arabia. Methods: A self-administered questionnaire was distributed to all community pharmacies in four major cities of Saudi Arabia. A simple random sampling approach was used to select pharmacies in each chain. Results: A total of 520 CPs responded to the survey with a response rate of 98.6 %. Most of the pharmacists (n = 479, 92.1 %) accepted that antimicrobial stewardship programs are essential tools to limit injudicious usage of antimicrobials at the community level. Interestingly, very few (n = 105, 21 %) agreed to recommend antibiotics for common illnesses, including upper respiratory tract infections, cold, and flu without a valid prescription. Further, we found a significant role of Saudi health authorities, e.g., Saudi food & drug authorities and the Ministry of Health, in restricting antimicrobials sale in community pharmacies without a valid prescription. Conclusion: Our study findings revealed that CPs had good knowledge about antimicrobial stewardship in Saudi Arabia. The CPs play an active role in the optimization of antimicrobial therapy and infections caused by different microbes. Strict policies by the Saudi health care authority regarding the restricted dispensing of antimicrobials are welcomed by the CPs and thus may contribute toward lowering of antimicrobial resistance burden on the patients and Saudi health care authorities.

Excessive Daytime Sleepiness and Sleep Quality and their Impact on Health-Related Quality of Life in People with Epilepsy: A study from Pakistan.

BACKGROUND: Epilepsy is one of the most common but manageable neurological disorder. The relation between epilepsy, sleep, and health-related quality of life (HRQoL) in culturally distinct environment of Pakistan remains unclear. The purpose of this study was to determine prevalence and predictors of excessive daytime sleepiness (EDS), poor sleep quality (SQ), and to analyze their association with HRQoL in people with epilepsy (PWE). METHODS: A study was conducted among PWE attending two tertiary care hospitals of Islamabad and Rawalpindi, Pakistan. The EDS, SQ, and HRQoL were evaluated by Urdu versions of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31). RESULTS: The study included 200 PWE and 51 healthy controls with mean (SD) ages of 33.1 ±â€¯13.9, 32.9 ±â€¯10.9, and a disease duration of 5.01 ±â€¯6.17, respectively. The majority of the respondents (n = 130, 65%) had poor seizure control, and most of these (n = 88, 68%) were on combination antiepileptic drug (AED) therapy. In comparison to controls, a higher number of PWE had EDS by ESS (score ≥ 11, 10% vs. 40%, p-value 0.00), and poor SQ by PSQI (score > 5, 9% vs. 71%, p-value 0.00). A multiple logistic regression analysis reveals that the factors significantly associated with EDS were: female gender; increasing age; seizure control; duration of epilepsy; and combination AED therapy. A second multiple binary logistic regression analysis suggests that factors significantly associated with poor SQ were: increasing age; female gender; poor seizure control; and combination therapy. The Hierarchical multivariate analysis suggests that poor seizure control, EDS, and poor SQ were significant predictors of low HRQoL. CONCLUSION: The findings suggest high prevalence of EDS and poor SQ in PWE in Pakistan. A significant negative association exists between sleep complaints and HRQoL. During routine clinical consultations, awareness about sleep hygiene practices must be provided to enhance HRQoL.

Potentially Harmful Elements Accumulation and Health Risk Assessment of Edible Fish Tissues Caught from the Phander Valley, Northern Pakistan.

This study investigated the concentrations of potentially harmful elements (PHE) in edible tissues of trout fish (Salmo trutta) in the Phander Valley, Northern Pakistan. For this purpose, fish were sampled from the Phander Valley (Gilgit River and Phander Lake). PHE concentrations in edible fish tissues (muscle, fins, and skin) were determined using atomic absorption spectrometry (AAS, AAnalyst 700, Perkin Elmer, USA). Among PHE, zinc (Zn) showed the highest concentration of 1097 µg/kg in the skin, followed by manganese (Mn) of 241 µg/kg in the muscle, and the lowest of 3.78 µg/kg for cadmium (Cd) in fins. The concentration of PHE in fish tissues of the study area was observed within the threshold limits set by the food and agriculture organization (FAO). PHE concentration of fish tissues was used for the calculation of chronic risk assessment using the chronic daily intake (CDI) and hazard quotient (HQ) indices. The highest CDI values were observed for Zn through fish tissue consumption in juveniles, followed by Mn, and the lowest for Cd in adults. The HQ values were observed less than 1 for adults through PHE consumption in fish tissue; however, that of juvenile surpassed the threshold limit through Cd consumption in all studied tissues and that of Pb in the muscle and skins only. Higher HQ values than the threshold limit could pose a potential chronic risk to the exposed community. Spearman's non-parametric correlation showed a varying degree of correlation among PHE in fish tissues and canonical discriminant analyses were used to differentiate the tissues based on PHE accumulation tendencies.

Lupeol, a Plant-Derived Triterpenoid, Protects Mice Brains against Aß-Induced Oxidative Stress and Neurodegeneration.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that represents 60­70% of all dementia cases. AD is characterized by the formation and accumulation of amyloid-beta (Aß) plaques, neurofibrillary tangles, and neuronal cell loss. Further accumulation of Aß in the brain induces oxidative stress, neuroinflammation, and synaptic and memory dysfunction. In this study, we investigated the antioxidant and neuroprotective effects of the natural triterpenoid lupeol in the Aß1-42 mouse model of AD. An Intracerebroventricular injection (i.c.v.) of Aß (3 µL/5 min/mouse) into the brain of a mouse increased the reactive oxygen species (ROS) levels, neuroinflammation, and memory and cognitive dysfunction. The oral administration of lupeol at a dose of 50 mg/kg for two weeks significantly decreased the oxidative stress, neuroinflammation, and memory impairments. Lupeol decreased the oxidative stress via the activation of nuclear factor erythroid 2-related factor-2 (Nrf-2) and heme oxygenase-1 (HO-1) in the brain of adult mice. Moreover, lupeol treatment prevented neuroinflammation by suppressing activated glial cells and inflammatory mediators. Additionally, lupeol treatment significantly decreased the accumulation of Aß and beta-secretase-1 (BACE-1) expression and enhanced the memory and cognitive function in the Aß-mouse model of AD. To the best of our knowledge, this is the first study to investigate the anti-oxidative and neuroprotective effects of lupeol against Aß1-42-induced neurotoxicity. Our findings suggest that lupeol could serve as a novel, promising, and accessible neuroprotective agent against progressive neurodegenerative diseases such as AD.

Presentations of Meckel's diverticulum at Khyber Teaching Hospital Peshawar.

BACKGROUND: This study was conducted with an objective to observe various presentations of Meckel's Diverticulum in our setting and compare it with other national and international studies. METHODS: It was a retrospective analysis of hospital record carried out at the department of paediatric surgery Khyber Teaching Hospital, Peshawar. A total of 63 patients meeting the inclusion criteria were included in the study who had presented to our unit with signs and symptoms of Meckel's Diverticulum and who were diagnosed either by investigations or at surgery. All the patients were explored and resection and anastomosis performed. We did not do H. Pylori culture. Patients with bleeding per rectum were investigated by Meckel's scan. Analysis of the results was done by SPSS version 10. RESULTS: Majority of our patients presented with obstruction (82.5%) in contrast to the Western studies (around 40%) while only 4.7% presented with bleeding per rectum again in contrast to the Western countries (38.56%). CONCLUSION: There appears to be a geographical and/or racial difference in the presentation of Meckel's diverticulum.