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Aim The use of tobacco is responsible for many preventable diseases and deaths worldwide. Digital interventions have greatly improved patient health and clinical care and have proven to be effective for quitting smoking in the general population due to their flexibility and potential for personalization. However, there is limited evidence on the effectiveness of digital interventions for smoking cessation in Asian countries.Methods Three major databases – Web of Science (WOS), Scopus, and PubMed – for relevant studies published between 1 January 2010 and 12 February 2023 were searched for studies evaluating the effectiveness of digital intervention for smoking cessation in Asian countries.Results A total of 25 studies of varying designs were eligible for this study collectively involving a total of n = 22,005 participants from 9 countries. Among different digital tools for smoking cessation, the highest abstinence rate (70%) was reported with cognitive behavioural theory (CBT)-based smoking cessation intervention via Facebook followed by smartphone app (60%), WhatsApp (59.9%), and Pharmacist counselling with Quit US smartphone app (58.4%). However, WhatsApp was preferred over Facebook intervention due to lower rates of relapse. WeChat was responsible for 15.6% and 41.8% 7-day point prevalence abstinence. For telephone/text messaging abstinence rate ranged from 8-44.3% and quit rates from 6.3% to 16.8%. Whereas, no significant impact of media/multimedia messages and web-based learning on smoking cessation was observed in this study.Conclusion Based on the study findings the use of digital tools can be considered an alternative and cost-effective smoking cessation intervention as compared to traditional smoking cessation interventions.

Background: This study aimed to determine the association of Torsade de Pointes (TdP) with anxiolytic drugs and present a detailed overview of anxiolytic-induced cases of TdP reported to the Food and Drug Administration Adverse Event Reporting System (FAERS).Methods: All cases of anxiolytic-induced TdP (n = 260) between 1990 and 2020 were retrieved from the FAERS database using the Preferred Term ‘Torsade de Pointes, code: 10044066’ from the Medical Dictionary for Regulatory Activities (MedDRA version 22). Four data-mining algorithms were used for disproportionality analysis: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Empirical Bayes Geometric Mean (EBGM), and Information Content (IC). Anxiolytics with ≥3 TdP cases were included.Results: Of a total of eight drugs, this study identified seven signals of TdP, of which six signals were new, namely for alprazolam, bromazepam, lorazepam, meprobamate, midazolam, and oxazepam. Based on disproportionality analysis, among new signals, the highest risk of TdP was observed with bromazepam and midazolam. Alprazolam showed the lowest risk for TdP, while diazepam did not reach significant disproportionality.Conclusions: This study identified six new signals of TdP among anxiolytic drugs, so warranting stringent clinical studies to ascertain the actual risk of TdP and ensure patient safety.Clinical Trial Registration: This study is registered at ClinicalTrials.gov (NCT.gov ID: NCT04293432).

Alzheimer’s disease (AD) is the most predominant cause of dementia, considered a progressive decline in cognitive function that ultimately leads to death. AD has posed a substantial challenge in the records of medical science over the past century, representing a predominant etiology of dementia with a high prevalence rate. Neuroinflammation is a common characteristic of various central nervous system (CNS) pathologies like AD, primarily mediated by specialized brain immune and inflammatory cells, such as astrocytes and microglia. The present study aims to elucidate the potential mechanism of physcion that mitigates LPS-induced gliosis and assesses oxidative stress in mice. Physcion reduced the reactivity of Iba-1- and GFAP-positive cells and decreased the level of inflammatory cytokines like TNF-α and IL-1β. Physcion also reversed the effect of LPS-induced oxidative stress by upregulating the expression of Nrf2 and HO-1. Moreover, physcion treatment reversed LPS-induced synaptic disorder by increasing the level of presynaptic protein SNAP-23 and postsynaptic protein PSD-95. Our findings may provide a contemporary theoretical framework for clinical investigations aimed at examining the pathogenic mechanisms and therapeutic approaches for neuroinflammation and AD.

Abstract Regular blood transfusion is the mainstay of treatment in transfusion-dependent β-thalassemia (TDT); however, transfusions culminate in an array of serious complications. Therefore, a single-arm, non-randomized clinical trial was conducted in hydroxyurea refractory TDT patients to explore the long-term safety and efficacy of thalidomide. The primary outcomes for efficacy were rise in hemoglobin (Hb) level and changes in transfusion frequency. Whereas, several clinical and laboratory parameters were assessed for safety of thalidomide. Secondary outcomes included changes in serum ferritin, serum lactate dehydrogenase (LDH), serum uric acid, red blood cell indices, and size of liver and spleen. A total of 532 patients were followed for a period of 30 months. Significant increase in mean Hb level was identified at 6 months (1.4 g/dL, p ≤ 0.001) and 30 months (2 g/dL, p ≤ 0.001) in comparison with baseline. A total of 408 (76.7%) patients responded to thalidomide therapy (excellent responders 25.8%, good responders 31%, and partial responders 19.9%) and attained transfusion independence within 6 months of therapy. A significant decline in mean ferritin, LDH level, liver size, and spleen size was observed. No unfavorable effects were observed on kidney and liver functions. Mild adverse events were reported in 48 (9%) patients and serious adverse events, including cerebral vascular accident and portal vein thrombosis were reported in two patients each. This study concludes that thalidomide is an effective and well-tolerated drug that can improve Hb levels and reduce transfusion burden in hydroxyurea refractory TDT patients. Trial registration: This trial is registered at http://www.clinicaltrial.gov as # NCT03651102.

IntroductionType II Diabetes mellitus (T2DM) patients often do not achieve glycemic control with oral hypoglycemic agents (OHAs). There are two main approaches to address this challenge: transitioning to a triple OHA regimen, or adding Insulin to the existing dual OHA regimen.AimThis study aimed to compare the efficacy of adding Insulin to dual OHAs (Sitagliptin + Metformin) against adding a third OHA to Sitagliptin + Metformin in achieving glycemic control among patients with uncontrolled T2DM.MethodA pre-post study was conducted between 21 September 2023 and 21 December 2023 at Services Hospital Peshawar, Pakistan. Patients with uncontrolled T2DM with >7% HbA1c were divided into group 1 (Sitagliptin + Metformin plus a third OHA), and group 2 (Sitagliptin + Metformin plus pre-mixed Insulin 70/30). Glycemic control based on HbA1c values, fasting and random blood sugar levels, lipid profile, and body weight were evaluated after 3 months of therapy. The pre- and post- effect was compared by using a paired t-test.ResultsThe study included n = 80 patients with T2DM. Between groups 1 and 2, no significant difference was found in HbA1c values (9.1 vs. 9, with p = 0.724). However, BMI, cholesterol, and LDL significantly decreased in group 1 compared to group 2 (pConclusionThe triple OHA regimen improved BMI, cholesterol, and LDL levels, and reduced hypoglycemic episodes more effectively than dual OHA plus Insulin, despite similar HbA1c outcomes, suggesting it may be preferable for uncontrolled T2DM.

OBJECTIVE: To compare the radiological healing in elderly patients with hip fractures fixed with intramedullary versus extramedullary implants at 3 months by using Radiological Union Score for Hip (RUSH score). METHODS: This quasi-experimental study was conducted at Lady Reading Hospital, Peshawar from September 2020 to March 2021, in elderly patients (50-80 years) with hip fractures. Out of 238 patients, 119 were non-randomly assigned to Group-A undergoing intra- medullary implants and 119 to Group-B undergoing fixation with an extra-medullary implant. After the surgery, the patients were followed up periodically at 2nd week, 6th week and 12th week after surgery and assessed for radiological healing through RUSH score. The data was analyzed using SPSS version 23. RESULTS: Out of 238 patients, 96 were males and 142 were females. In Group-A, 51 (42.9%) were males and 68 (57.1%) were females. In Group-B, 45 (37.8%) were males and 74 (62.2%) were females. Majority (n=135/238: 56.72%) were aging from 50-60 years. Mean±SD of age was 63.1±8.8 years and 61.7±8.1 years in Group-A & Group-B respectively. Mean±SD of RUSH score in Group-A & Group-B was 19.50±6.92 and 22.51±5.60 respectively. Mean RUSH score for males in Group-A and Group-B was 21.52±6.39 and 22.33±6.99 (p=0.354) and for females in Group-A and Group-B was 19.36±7.33 and 22.18±5.75 (p=0.025) respectively. Median and IQR of RUSH score in Group-A & Group-B was 21±10 and 23±8 respectively (p=0.069). CONCLUSION: There was statistically insignificant difference in median RUSH score with use of either intramedullary or extramedullary implants in the management of hip fractures.

Background: Infantile haemangiomas (IHs) are widespread vascular tumours having incidence of 10% and most of them involute spontaneously. However, they are known to be located in proximity of vital organs and can have poor cosmetic and functional sequel if left untreated. The aim of the study is to assess the efficacy of oral propranolol and intraleisonal bleomycin in the treatment of infantile cutaneous haemangioma in terms of size regression. Materials and Methods: IH patients presenting in the outpatient department in PIMS were divided randomly by stratified random sampling in two groups. Out of 90 patients, 45 patients had treatment with oral propranolol and other 45 patients received intralesional bleomycin. Baseline size of haemangiomas was taken and regression in size was noted again at 3 and 6 months. Mean and standard deviation were calculated for the age and size of haemangioma in both groups. The mean size regression for both treatments was compared using independent t-test taking P < 0.05 as significant. Results: Out of 90 cases included in this study, the mean age of patients was 10.9 ± 6.1 months in Bleomycin group compared to 10.2 ± 6.9 months in propranolol group. The average size of haemangioma at baseline was 9.5 cm2 in bleomycin group compared to 8.9 cm2 in propranolol group. At 3 months after the intervention, the mean size regression was 3.5 cm2 in bleomycin group compared to 5.3 cm2 in propranolol group and after 6 months of treatment with bleomycin group the mean size of haemangioma was 0.45 cm2, whereas in the propranolol group, it was 2.8 cm2 and difference in the two was found statistically highly significant (P < 0.001). Conclusion: The present study concluded that treatment with intralesional injection Bleomycin for IHs helps in size reduction more efficiently with minimal side effects as compared to oral propranolol for comparable sized haemangiomas.

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.

OBJECTIVE: The current meta-analysis was carried out to identify the efficacy and safety of thalidomide in transfusion-dependent β-thalassemia (TDT) patients. METHODS: Six databases: PubMed, EMBASE, Scopus, Cochrane Library, EBSCOhost, and MEDLINE were searched until November 18, 2021, for studies that assessed the efficacy of thalidomide in TDT patients by using the following search terms: “Thalidomide”, “thalidomid”, “thalomid”, “N-phthaloylglutamimide”, and Thalassemia” using Boolean or wildcard operators. Original research publications in English with observational and/or experimental designs having a sample size ≥10, regardless of age and gender, used thalidomide for ≥3 months exploring the impact of thalidomide in ameliorating transfusion needs among TDT patients were included in this meta-analysis. Data were independently extracted by two reviewers using a data extraction form. The National Institutes of Health tool was used for quality assessment. RESULTS: Nine studies collectively involving 407 TDT patients fulfilled eligibility criteria. Thalidomide was associated with complete cessation of blood transfusion requirements with an overall response of 54% (95% CI, 34–75%) to a transfusion-independent state; heterogeneity was considered high with an I2 of 94.7%, p-value

Water ingress is a common and costly problem in tunnel construction, and understanding the hydrogeological characteristics of a site is crucial for mitigating its effects. This study presents a detailed analysis of the water ingress problems experienced during the construction and operation stages of the Lowari Tunnel in Khyber Pakhtunkhwa, Pakistan, and evaluates the suitability of the water for various purposes. The study found that the water quality varied significantly, depending on the geological conditions and water quantity, with the south portal of the tunnel dominated by Mg cations and bicarbonate anions. The water was found to be suitable for tunnel support systems, including concrete and steel installations, with negligible corrosion observed over the study period. However, the water coming out of the tunnel at the south portal was found to be unsuitable for drinking due to its low pH value. The Wilcox plot classified the water samples as excellent for irrigation, which could benefit local agriculture in the area. The findings of this study can provide valuable insights into the hydrogeological characteristics of the Lowari Tunnel, contributing to the design and construction of similar infrastructure projects in the region. Furthermore, these insights can help improve access to safe and reliable water sources for local communities.

BackgroundDengue fever has been responsible for around 12 countrywide large outbreaks in Pakistan, resulting in 286,262 morbidities and 1,108 deaths. Khyber Pakhtunkhwa (KP) is the most recently impacted province. This study aimed to investigate the molecular, epidemiological, and potential elements that contribute to increasing dengue transmission patterns, and knowledge, attitude, and practice (KAP) toward dengue in KP province.MethodThis cross-sectional community-based study was conducted (June-December, 2021) in two phases. Phase I involved the epidemiological (n = 5,242) and molecular analysis of DENV in 500 randomly collected blood samples of the 2021 dengue outbreak in KP. Phase II focused on assessing dengue-KAP levels in healthy communities (n = 14,745, aged >18 years), adopting a cross-sectional clustered multistage sampling in eight districts (dengue-hotspot vs. non-hotspot) of KP. Chi-square tests and logistic regression analysis were applied.ResultsPeshawar district had the highest dengue cases (60.0%) associated with the predominant co-circulation of DENV-2 (45.8%) and DENV-3 (50.4%) serotypes. A rise in cases was reported in October (41.8%) followed by September (27.9%) and August (14.4%; p < 0.001). Males (63.7%, p < 0.001) and individuals aged 16–30 years (37.0%, p < 0.001) were highly affected. General workers (18.0%), families with a monthly income of 10,000–20,000 Pak rupees (50.5%), unmarried (71.0%), uneducated (31%), families with higher human density (>10 individuals per household), and those (29.0%) who faced power outages for more than 7/24 h were the most affected. Moreover, co-morbidities like renal failure and bronchial asthma were associated with disease severity. A community survey on KAP revealed that an average of 74, 60, and 43% of the participants demonstrated good knowledge, attitudes, and dengue preventive practices, respectively.ConclusionMultiple poor socioeconomic elements are influencing dengue fever transmission in the province. Higher KAP levels may explain the low frequency of dengue in non-hotspot districts. Our study emphasizes the need for effective and long-term public health education, strengthened vector surveillance, and expanded laboratory capacity for better diagnosis and management of dengue cases to better predict the burden and seasonality of disease in the country.

Global Software Development (GSD) projects comprise several critical cost drivers that affect the overall project cost and budget overhead. Thus, there is a need to amplify the existing model in GSD context to reduce the risks associated with cost overhead. Motivated by this, the current work aims at amplifying the existing algorithmic model with GSD cost drivers to get efficient estimates in the context of GSD. To achieve the targeted research objective, current state-of-the-art cost estimation techniques and GSD models are reported. Furthermore, the current study has proposed a conceptual framework to amplify the algorithmic COCOMO-II model in the GSD domain to accommodate additional cost drivers empirically validated by a systematic review and industrial practitioners. The main phases of amplification include identifying cost drivers, categorizing cost drivers, forming metrics, assignment of values, and finally altering the base model equation. Moreover, the proposed conceptual model’s effectiveness is validated through expert judgment, case studies, and Magnitude of Relative Estimates (MRE). The obtained estimates are efficient, quantified, and cover additional GSD aspects than the existing models; hence we could overcome the GSD project’s overall risk by implementing the model. Finally, the results indicate that the model needs further calibration and validation.

The kidney is the most vulnerable organ in coronavirus disease-2019 (COVID-19) patients besides the lungs, with evidence of acute kidney injury (AKI). We aimed to find the prevalence of AKI among COVID-19 patients and further evaluate the association of between COVID-19 and AKI along with an understanding of mortality. A prospective observational study was conducted among COVID-19 patients admitted to a tertiary care hospital, Hayatabad Medical Complex, between March 2020 and June 2020. Chi-square test was applied for comparative analysis, whereas for predictors of mortality, odds ratios (OR) were calculated using logistic regression. A total of 606 patients with COVID-19 were admitted to the dedicated ward, of which 250 (41.3%) had AKI and 190 (31.4%) died, whereas, patients having AKI presented 62.1% of mortality. Our study revealed a statistically significant association between AKI and mortality (OR = 3.5; P

Software organization always aims at developing a quality software product using the estimated development resources, effort, and time. Global Software Development (GSD) has emerged as an essential tool to ensure optimal utilization of resources, which is performed in globally distributed settings in various geographical locations. Global software engineering focuses on reducing the cost, increasing the development speed, and accessing skilled developers worldwide. Estimating the required amount of resources and effort in the distributed development environment remains a challenging task. Thus, there is a need to focus on cost estimation models in the GSD context. We nevertheless acknowledge that several cost estimation techniques have been reported. However, to the best of our knowledge, the existing cost estimation techniques/models lack considering the additional cost drivers required to compute the accurate cost estimation in the GSD context. Motivated by this, the current work aims at identifying the other cost drivers that affect the cost estimation in the context of GSD. To achieve the targeted objectives, current state-of-the-art related to existing cost estimation techniques of GSD is reported. We adopted SLR and Empirical approach to address the formulated research questions. The current study also identifies the missing factors that would help the practitioners improve the cost estimation models. The results indicate that previously conducted work ignores the additional elements necessary for the cost estimation in the GSD context. Moreover, the current work proposes a conceptual cost estimation model tailored to fit the GSD context.

OBJECTIVE: To share our experience of laparoscopic assisted Swenson pull-through for classic Hirschsprung’s disease (HD) with sigmoid colostomy. METHODS: Thirty-one patients with HD and sigmoid colostomy operated in Pediatric Surgery department, Khyber Teaching Hospital, Peshawar, Pakistan, between June 2014 and June 2018 were included. Patients with long segment HD, and those operated elsewhere were excluded from the study. Demographic characteristics, intraoperative findings and post operative course were retrieved from files. Post-operative outcome at 3rd, 6th and 12th month follow ups were taken from follow up charts. RESULTS: Mean age and weight of patients were 13.23±1.76 months and 7.89±1.42 kg, respectively. Male to female ratio was 6.75:1. Mean operative time, duration of urinary catheterization and hospital stay were 171.87±15.76 min, 0.79±1.02 days and 5.91±1.01 days, respectively. After surgery, stool consistency was liquid in 12 (61.29% ) and loose in 12 (38.7 %) patients. However, stool frequency was >3 times/day in 10 (32.25%) cases, 2-3 times/day in 18 (58.06%) patients and 0-1 time/day in 3 (9.67% ) patients. Surgical site infection and perianal excoriation were seen in 2 (6.45%) and 11 (35.48%) patients, respectively. Progressive improvement in stool consistency and frequency was noticed at 12th month follow up. Perianal excoriation was seen 11 (35.48%) patients at 3rd month, 6 (19.35% ) patients at 6th and 1 (3.22%) patient at 12th month follow up. CONCLUSION: Laparoscopic assisted Swenson pull-through is a good treatment option for patient with recto-sigmoid HD and bears a predictable and acceptable stooling pattern, optimum hospital stay and minimal complications.

Abstract Background Glycine is the smallest nonessential amino acid and has previously unrecognized neurotherapeutic effects. In this study, we examined the mechanism underlying the neuroprotective effect of glycine (Gly) against neuroapoptosis, neuroinflammation, synaptic dysfunction, and memory impairment resulting from d-galactose-induced elevation of reactive oxygen species (ROS) during the onset of neurodegeneration in the brains of C57BL/6N mice. Methods After in vivo administration of d-galactose (d-gal; 100 mg/kg/day; intraperitoneally (i/p); for 60 days) alone or in combination with glycine (1 g/kg/day in saline solution; subcutaneously; for 60 days), all of the mice were sacrificed for further biochemical (ROS/lipid peroxidation (LPO) assay, Western blotting, and immunohistochemistry) after behavioral analyses. An in vitro study, in which mouse hippocampal neuronal HT22 cells were treated with or without a JNK-specific inhibitor (SP600125), and molecular docking analysis were used to confirm the underlying molecular mechanism and explore the related signaling pathway prior to molecular and histological analyses. Results Our findings indicated that glycine (an amino acid) inhibited d-gal-induced oxidative stress and significantly upregulated the expression and immunoreactivity of antioxidant proteins (Nrf2 and HO-1) that had been suppressed in the mouse brain. Both the in vitro and in vivo results indicated that d-gal induced oxidative stress-mediated neurodegeneration primarily by upregulating phospho-c-Jun N-terminal kinase (p-JNK) levels. However, d-gal + Gly cotreatment reversed the neurotoxic effects of d-gal by downregulating p-JNK levels, which had been elevated by d-gal. We also found that Gly reversed d-gal-induced neuroapoptosis by significantly reducing the protein expression levels of proapoptotic markers (Bax, cytochrome c, cleaved caspase-3, and cleaved PARP-1) and increasing the protein expression level of the antiapoptotic protein Bcl-2. Both the molecular docking approach and the in vitro study (in which the neuronal HT22 cells were treated with or without a p-JNK-specific inhibitor (SP600125)) further verified our in vivo findings that Gly bound to the p-JNK protein and inhibited its function and the JNK-mediated apoptotic pathway in the mouse brain and HT22 cells. Moreover, the addition of Gly alleviated d-gal-mediated neuroinflammation by inhibiting gliosis via attenuation of astrocytosis (GFAP) and microgliosis (Iba-1) in addition to reducing the protein expression levels of various inflammatory cytokines (IL-1βeta and TNFα). Finally, the addition of Gly reversed d-gal-induced synaptic dysfunction by upregulating the expression of memory-related presynaptic protein markers (synaptophysin (SYP), syntaxin (Syn), and a postsynaptic density protein (PSD95)) and markedly improved behavioral measures of cognitive deficits in d-gal-treated mice. Conclusion Our findings demonstrate that Gly-mediated deactivation of the JNK signaling pathway underlies the neuroprotective effect of Gly, which reverses d-gal-induced oxidative stress, apoptotic neurodegeneration, neuroinflammation, synaptic dysfunction, and memory impairment. Therefore, we suggest that Gly (an amino acid) is a safe and promising neurotherapeutic candidate that might be used for age-related neurodegenerative diseases.

Background: Kidneys are among the vital organs of the human body; therefore, damage from any exogenous/endogenous agent may put human life at risk. Arachis hypogaea (AH) contains different free radical scavenging flavonoids, stilbenes, and tannins. This research aimed to elucidate the possible nephroprotective mechanism of AH methanolic crude extract (AHcr) and n-hexane oil fraction (AHO) against gentamycin-induced nephrotoxicity. Methods: After the extraction of the crude oil of the plant, they were tested against a Gentamycin (GM)-treated group of Swiss Albino mice for their nephroprotective action. Animals were divided into six (6) equal groups with five (5) animals in each group. These groups were: control group (0.5 mL normal saline via intraperitoneal -i.p), gentamycin group (gentamycin 100 mg/kg i.p), Silymarin + gentamycin group (Silymarin 50 mg/kg and gentamycin 100 mg/kg i.p), plant extract (AHcr1) and gentamycin group (AHcr1 250 mg/kg and gentamycin 100 mg/kg i.p), AHcr2 + gentamycin group (AHcr2; 500 mg/kg and gentamycin 100 mg/kg i.p) and the hexane oil fraction (AHO) + gentamycin (AHO 1 mL/kg and GM 100 mg/kg i.p). After completion of doses, animals were sacrificed for the collection of blood to further investigate biochemical changes and histopathological changes in kidney tissues. Results: Serum creatinine, urea, and blood urea nitrogen significantly increased (p < 0.001) in the gentamycin-treated group as compared to the control group. The elevated level of serum creatinine, urea, and blood urea nitrogen was decreased significantly (p < 0.001) in groups treated with AHcr and AHO compared to the gentamycin group. Similarly, the histopathological study of kidney tissues from the gentamycin group showed tubular necrosis, vacuolation, and fibrosis. Conclusions: The effect of crude extract and hexane soluble fraction of AH caused a significant reversal of gentamycin-induced nephrotoxicity.

Abstract Background Chronic kidney disease-associated pruritus (CKD-aP) is a well-recognized, frequent and compromising complication among patients on hemodialysis. Despite advancement in basic medical sciences, CKD-aP is still a major complication and a challenge for both physicians and patients to manage. The aim of this study was to estimate the prevalence of CKD-aP among hemodialysis patients in Malaysia, to determine the impact of CKD-aP on sleep quality and any factors associated with CKD-aP. Method A multi-centered, cross-sectional study design was conducted from February 2017 to September 2017 at a tertiary hospital and its affiliated dialysis centers, in Kuala Lumpur, Malaysia. Included were patients > 18 years of age who were undergoing hemodialysis and could understand Malay. Participants were asked to fill the Malay 5D-itch scale and the Malay Pittsburgh sleep quality index (PSQI) upon recruitment. Results A total of 334/334 patients were recruited (response rate = 100%). The majority were male (59.6%) and Chinese (61.7%). A total of 61.3% had pruritus, of which most patients (63.4%) reported that their pruritus was mild. More than half (54.1%) reported that they slept > 6 h, and 93.2% experienced no sleep disturbances during the night. However; the overall PSQI median score [IQR] was 6.0 [5.0–9.0]. No significant association was found between demographic and clinical characteristics of patients with the severity of pruritus. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus. Conclusion In Malaysia, the prevalence of CKD-aP was 61.3%, of which the majority reported that their pruritus was mild. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus.

Nicotinamide (NAM) is the amide form of niacin and an important precursor of nicotinamide adenine dinucleotide (NAD), which is needed for energy metabolism and cellular functions. Additionally, it has shown neuroprotective properties in several neurodegenerative diseases. Herein, we sought to investigate the potential protective mechanisms of NAM in an intraperitoneal (i.p) 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinson’s disease (PD) mouse model (wild-type mice (C57BL/6N), eight weeks old, average body weight 25–30 g). The study had four groups (n = 10 per group): control, MPTP (30 mg/kg i.p. for 5 days), MPTP treated with NAM (500 mg/kg, i.p for 10 days) and control treated with NAM. Our study showed that MPTP increased the expression of α-synuclein 2.5-fold, decreased tyrosine hydroxylase (TH) 0.5-fold and dopamine transporters (DAT) levels up to 0.5-fold in the striatum and substantia nigra pars compacta (SNpc), and impaired motor function. However, NAM treatment significantly reversed these PD-like pathologies. Furthermore, NAM treatment reduced oxidative stress by increasing the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) between 0.5- and 1.0-fold. Lastly, NAM treatment regulated neuroinflammation by reducing Toll-like receptor 4 (TLR-4), phosphorylated nuclear factor-κB, tumor (p-NFκB), and cyclooxygenase-2 (COX-2) levels by 0.5- to 2-fold in the PD mouse brain. Overall, these findings suggest that NAM exhibits neuroprotective properties and may be an effective therapeutic agent for PD.

Leishmaniasis is affirmed as a category one disease (most emerging and unmanageable) by the World Health Organization (WHO), affecting 98 countries with an annual global incidence of ~1.2 million cases. Options for chemotherapeutic treatment are limited due to drug resistance and cytotoxicity. Thus, the search for new chemical compounds is instantly desirable. In this study, we used two compounds, i.e., 10-hydroxy chondrofoline and tafenoquine, for their antileishmanial activity against L. tropica (HTD7). First, the cytotoxicity assay of the test compounds against THP-1 cells was carried out, and these compounds were found safe. Intra-THP-1 amastigote activity (in vitro) was performed, which was then followed by the in vivo activity of 10-hydroxy chondrofoline in the murine cutaneous leishmaniasis (CL) model. A total of three concentrations were used, i.e., 25, 50, and 100 µM, to check the in vitro activity of the test compounds against the amastigotes. 10-hydroxy chondrofoline was found to be the most potent compound in vitro (and thus was selected for in vivo studies) with an LD50 value of 43.80 µM after 48 h incubation, whilst tafenoquine had an LD50 value of 53.57 µM. In vivo activity was conducted by injecting 10-hydroxy chondrofoline in the left hind foot of the infected BALB/c mice, where it caused a statistically significant 58.3% (F = 14.18; p = 0.002) reduction in lesion size (0.70 ± 0.03 mm) when compared with negative control (1.2 ± 0.3 mm).

Mirtazapine is a tetracyclic anti-depressant with poor water solubility. The aim of this study was to improve the dissolution rate of mirtazapine by delivering the drug as a liquisolid compact. Central composite design (CCD) was employed for the preparation of mirtazapine liquisolid compacts. In this, the impacts of two independent factors, i.e., excipient ratio (carrier:coating) and different drug concentration on the response of liquisolid system were optimized. Liquisolid compacts were prepared using propylene glycol as a solvent, microcrystalline cellulose as a carrier, and silicon dioxide (Aerosil) as the coating material. The crystallinity of the formulated drug and the interactions between the excipients were examined using X-ray powder diffraction (XRD) and Fourier-transform infrared spectroscopy (FTIR), respectively. The dissolution study for the liquisolid compact was carried out as per FDA guidelines. The results showed loss of crystallinity of the mirtazapine in the formulation and was completely solubilized in non-volatile solvent and equally dispersed throughout the powder system. Moreover, drug dissolution was found to be higher in liquisolid compacts than the direct compressed conventional tablets (of mirtazapine). The liquisolid technique appears to be a promising approach for improving the dissolution of poorly soluble drugs like mirtazapine.

Introduction: The patronage of online pharmacies is rapidly growing, driven by the convenience and cheaper costs of purchasing prescription drugs electronically, especially under the lockdown situation. However, there are issues regarding the quality of the prescription drugs sold online and the legitimacy of online pharmacies. The use of prescription drugs without the supervision of a licensed health care practitioner may potentially harm consumers. Objectives: This systematic review was conducted to improve the body of knowledge on three main aspects of online pharmacies: (1) type and characteristics of the online pharmacies selling drugs; (2) the quality of pharmaceutical drugs purchased online; and (3) the characteristics of consumers of online pharmacies. Methods: Based on a pre-defined search strategy, PubMed and Scopus were utilised to search articles written in the English language published between January 2009 and February 2020. Studies focusing on the sale of prescription drugs were included. The terms used for the literature search were “online pharmacy”, “internet pharmacy”, “e-pharmacy”, “prescription”, “quality”, “medication safety”, and “counterfeit medicine”. These terms were used alone and in combination with Boolean operators. The institutional webpages including the World Health Organization (WHO) and the United States Food and Drug Administration (USFDA) were also examined for any additional studies. No methodological limitations in terms of study design were applied. A standardised data collection form was used to compile the data. Results: Based on the inclusion and exclusion criteria, a total of 46 articles were eligible and included in the final analysis. There were 27 articles on types and characteristic of online pharmacies, 13 articles on the quality of prescription drugs sold from online pharmacies, and 11 articles on consumers purchasing prescription drugs from online pharmacies. Readers should note that five articles discussed both the types and characteristics of online pharmacies, and the quality of the drugs sold from the outlets. The response rate (products received out of the number of orders) ranged from 20% to 100%, whereas the proportion of consumers buying prescription drugs online ranged from 2.3% to 13%. Reasons for online purchase of prescription drugs include the difficulty of obtaining a prescription for certain medications such as opioid analgesics, cheaper cost, since the costs associated with seeing a physician to obtain a prescription are reduced, and the need to obtain drugs such as opioid analgesics and benzodiazepine for misuse. Conclusions: Almost half of the online pharmacies are not properly regulated and fraudulent issues were uncovered. To address this issue, stricter regulation by World Health Organization and implementation should be carried out together with frequent monitoring of the licensure system and pharmacy verification on every online pharmacy, this would reduce the number of illegal or illegitimate online pharmacy.

National immunization program of Pakistan does not include Influenza vaccines. The low rate of immunization might be attributed to the poor knowledge of influenza vaccination in Pakistan. Current study was aimed to assess the knowledge and attitude of influenza vaccination among parents. A questionnaire-based cross sectional study was conducted among randomly selected parents with at least one child aged >6 months. The responses were recorded against 27 items questionnaire assessing knowledge, perception, attitude and behaviours of parents. Data were analysed by using appropriate statistical methods. A total 532 responses were recorded with male gender preponderance (65%). Most of the parents (61.1%) reported that their children had received or planned to receive all recommended vaccines in Expanded Program on Immunization (EPI) of Pakistan. Only one third of the parents (24.4%) were aware of the availability of influenza vaccines in Pakistan, and very few (6.6%) reported vaccinating their child against influenza. Exploring the parents' attitudes regarding children vaccination, the top motivator was ‘immunization is important to keep my children healthy' (relative index = 0.93, p < 0.000). However, substantial number of parents believed that influenza is not a serious disease (18.5%) and vaccines are accompanied by several side effects (24.6%). A positive attitude was reflected among parents who were aware of influenza vaccines in Pakistan. About 35% participants believed that influenza vaccines are not required for healthy children. Current study demonstrated very low vaccination rate against influenza. Awareness and health literacy regarding influenza vaccine is poor among parents. These findings necessitate the need to appropriately structured awareness programs regarding influenza vaccination among parents.

Abstract Background Chronic kidney disease (CKD) has become a major public health issue worldwide in the past few years. Pruritus is a common, well-recognized complication often seen in patients with chronic renal failure. For assessment of pruritus, different tools are used but these tools are unable to identify the changes and variations in the severity of pruritus. The aim of our study was to validate the Urdu-version of the Urdu-version of the 5D itch scale among patients suffering from chronic kidney disease in Pakistan. Method The 5D itch scale was translated from English into Urdu following translation guidelines for translation. Face and content validity was determined by a panel of experts and piloted. For retest, the Urdu version of the 5D itch scale was administered at baseline and two weeks. Results A total of 50 participants with end stage renal disease were recruited, and of these, 64% were males. Exploratory factor analysis revealed that the 5D–IS had 2-factor loadings: “Pattern and activity” and “Distribution” with Kaiser–Mayer–Olkin (KMO) = 0.802, Bartlett’s test of sphericity was significant (df = 28, p

Abstract Background Vaccinating healthcare professionals against influenza is considered an effective infection control measure. However, there is a low uptake of influenza vaccine among healthcare professionals around the globe. Currently, it is unknown whether healthcare professionals in Sierra Leone are aware of, and have been vaccinated against influenza. Also, there is a paucity of research evidence on their level of knowledge and attitude toward influenza vaccination. This study assessed healthcare professionals’ current influenza vaccine uptake rate, reasons for not getting vaccinated as well as their awareness, knowledge of, and attitude towards influenza vaccination in Freetown Sierra Leone. Method A cross-sectional study was conducted between February and April 2016 among healthcare providers working in four public and two private health facilities in Freetown Sierra Leone. Linear regression analysis, one-way ANOVA and independent t-test were employed for data analysis. Results Among 706 respondents that participated in the study more than half were females 378 (53.6%), nurses 425 (60.4%), and the majority were between the age group of 20-39 years 600 (85.3%). Only 46 (6.5%) were vaccinated against influenza. Key reasons for not vaccinated against influenza were less awareness about influenza vaccination among HCPs 580 (82.73%) with (β = 0.154; CI 0.058–0.163), the high cost of influenza vaccines and therefore not normally purchased 392 (55.92%) having (β = 0.150; CI 0.063–0.186). More than half believed that HCPs are less susceptible to influenza infections than other people. Also, majority 585 (84.3%) of HCPs thought that influenza disease could be transmitted after symptoms appear. In addition, 579 (83.2%) of HCPs felt that symptoms usually appear 8–10 days after exposure. Close to half 321 (46.0%) of HCPs were not aware of the influenza immunisation guidelines published by the Advisory Committee on Immunization Practices and Centre for Disease Control. Conclusion Influenza vaccine coverage among healthcare professionals in Freetown Sierra Leone was low. High cost, inadequate knowledge about influenza and its vaccine as well as the lack of awareness of vaccine availability were key barriers. Increasing access to influenza vaccine and the use of appropriate educational interventions to increase knowledge and awareness are required to improve influenza vaccination coverage among HCPs.

OBJECTIVE: To compare needle assisted laparoscopic repair (NALR) of inguinal hernia in children with open hernia repair (OHR). METHODS: This randomized controlled trial was conducted at the Paediatric Surgery Unit of Khyber Teaching Hospital, Peshawar, Pakistan from Feburary 2017 to September 2018. Children aged upto 16 years and diagnosed with reducible inguinal hernia were randomized into two-groups; NALR and OHR. Obstructed inguinal hernia and cases which presented with recurrence were excluded from this study. Demographic and clinical data was collected and analysed using SPSS 20. RESULTS: One hundred and fifteen patient were included in the study with NALR (n=50) and OHR group (n=65). NALR group included unilateral (n=35), bilateral hernia (n=5), PPV (n=10). OHR group included unilateral (n=55), bilateral (n=10). The mean age for NALR was 2.96±2.5 years and OHR was 4.17±3.62 years. Mean weight for NALR group was 11±6kg and OHR was 7.6±3.7kg. Operating time for unilateral NALR was 12±2.4 minutes and OHR was 24±3.8 minutes while bilateral NALR was 18.3±3.1 minutes and OHR was 32±6.3 minutes. Hospital stay for NALR group was 40±6.8 hours and OHR was 30±7.7 hours. Analgesia doses for unilateral NALR (4.5±1.2) were less than OHR (6.96±1.8) (p=0.02) and same is the case for bilateral repair (p=0.03). OHR had a high rate of postoperative complications; surgical site edema (14%), wound infection (4%) and recurrence (2.8%). CONCLUSION: NALR is a safe and reliable substitute to OHR in terms of less operating time, minimum hospital stay, less doses of analgesia required and low rate of postoperative complications.

OBJECTIVES: To determine the prevalence of physical and verbal harassment in nurses and doctors and to evaluate the associated factors which lead to harassment in Teachings Hospitals in Peshawar district in 2018. METHODOLOGY: Nurses and doctors of three government and one private hospital of District Peshawar were included in this study. Sample size was 384. Simple random sampling was used and those nurses and doctors having experience less than 6 months were excluded. A self-administered questionnaire was implemented having both closed and open-ended questions and a written informed consent was taken. Data was analyzed using SPSS version 22. RESULTS: Out of 384 respondents 235 (61.3%) were harassed. Common type was verbal. Prevalence was more in nurses (69.5%) than doctors (52.2%), in non-pathan (73%), Muslim (62%), rural (67.2%), non-married (61.3%), younger age and in surgical and allied (65.5%) nurses and doctors. Main source of harassment were colleagues. More harassment occurs in wards and in night shift and among those nurses and doctors whose daily working hours are more than 8 hours (62.5%) and working experience is more than 4 years (64.6%). CONCLUSION: The prevalence of harassment in our study was 61.3% and significant associated factors of harassment in our study are ethnicity, daily working hours, duration of job, nature of duty, place of duty, religion, work specialty and assailant. KEYWORDS: Physical Harassment, Verbal Harassment, Prevalence, Risk Factors, Lady Doctors, Nurses

Substances at nanoscale, commonly known as “nanomaterials,” have always grabbed the attention of researchers for hundreds of years. Among these different types of nanomaterials, magnetic nanomaterials have been the focus of considerable attention during the last two decades as evidenced by an unprecedented increase in the number of research papers focusing these materials. Iron oxide magnetic nanoparticles have occupied a vital position in imaging phenomena; as drug vehicles, controlled/sustained release phenomena and hyperthermia; atherosclerosis diagnosis; prostate cancer. In fact, these are wonderful “theranostic” agents with some under clinical trials for human use. In this review, we have attempted to highlight the advances taking place in the field of magnetic nanoparticles as theranostic agents. Extensive progress has been made in the two most important parameters, namely, control over the size and shape which decide the importance of iron oxide magnetic nanoparticles by developing suitable procedures like precipitation, co-precipitation, thermal decomposition, hydrothermal synthesis, microemulsion synthesis and plant mediated synthesis. After using a suitable synthetic route, workers encounter the most daunting task linked with the materials at nanoscale i.e., the protection against corrosion. Only properly protected iron oxide magnetic nanoparticles can be further connected to different functional systems to make building blocks for application in catalysis, biology and medicines. Finally, “theranostics” which is a combined application of imaging and drug delivery has been discussed. With all the potential uses, toxicity of the of iron oxide magnetic nanoparticles has been discussed.

Alzheimer’s disease (AD) is the most predominant age-related neurodegenerative disease, pathologically characterized by the accumulation of aggregates of amyloid beta Aβ1–42 and tau hyperphosphorylation in the brain. It is considered to be the primary cause of cognitive dysfunction. The aggregation of Aβ1–42 leads to neuronal inflammation and apoptosis. Since vitamins are basic dietary nutrients that organisms need for their growth, survival, and other metabolic functions, in this study, the underlying neuroprotective mechanism of nicotinamide (NAM) Vitamin B3 against Aβ1–42 -induced neurotoxicity was investigated in mouse brains. Intracerebroventricular (i.c.v.) Aβ1–42 injection elicited neuronal dysfunctions that led to memory impairment and neurodegeneration in mouse brains. After 24 h after Aβ1–42 injection, the mice were treated with NAM (250 mg/kg intraperitoneally) for 1 week. For biochemical and Western blot studies, the mice were directly sacrificed, while for confocal and “immunohistochemical staining”, mice were perfused transcardially with 4% paraformaldehyde. Our biochemical, immunofluorescence, and immunohistochemical results showed that NAM can ameliorate neuronal inflammation and apoptosis by reducing oxidative stress through lowering malondialdehyde and 2,7-dichlorofluorescein levels in an Aβ1–42-injected mouse brains, where the regulation of p-JNK further regulated inflammatory marker proteins (TNF-α, IL-1β, transcription factor NF-kB) and apoptotic marker proteins (Bax, caspase 3, PARP1). Furthermore, NAM + Aβ treatment for 1 week increased the amount of survival neurons and reduced neuronal cell death in Nissl staining. We also analyzed memory dysfunction via behavioral studies and the analysis showed that NAM could prevent Aβ1–42 -induced memory deficits. Collectively, the results of this study suggest that NAM may be a potential preventive and therapeutic candidate for Aβ1–42 -induced reactive oxygen species (ROS)-mediated neuroinflammation, neurodegeneration, and neurotoxicity in an adult mouse model.

This cross-sectional study comprises a questionnaire-based survey regarding knowledge about human papillomavirus and its vaccine among students in different educational fields at public and private universities in the city of Lahore in Pakistan. A 26-item questionnaire was used to attain the objective of this study. The reliability of this tool was assessed using Cronbach's alpha (0.79) and the Kaiser-Meyer-Olkin value was 0.827. The response rate to the survey was 78.0%, of whom the majority (74.9%) were females and 308 (79%) were single (median age=23 years). While assessing the respondents' knowledge about HPV, 223(57%) students reported that they had already heard of HPV (human papillomavirus) and nearly 215 (55%) reported that HPV causes cervical cancer and can infect both men and women. Gender and field of study were two main factors found influencing the respondents' knowledge about HPV. Moreover, students' understanding about the mode of transmission of HPV was cursory: 40.51% said they did not know how HPV is transmitted, 133 (34.10%) stated that HPV spreads through the exchange of bodily fluids, and 22 (5.64%) selected cough/sneezing. In terms of prevention, 175 (44.87%) students stated that HPV can be prevented by vaccination, 30.0% reported sexual abstinence, 21.54% using condoms, and nearly 5.38% disclosed use of antibiotics. Addressing the knowledge of students regarding HPV vaccine, nearly 53% stated there is no vaccine against HPV and almost 64% rejected the statement that HPV vaccine prevents cervical cancer. In addition, students reported that they will be more than willing to get vaccinated for HPV if their physician recommend them (RII=0.74) followed by parents (RII=0.69). The results of this study revealed a poor understanding among respondents about the health problems associated with HPV, its prevention, modes of transmission and arability of HPV vaccine in Pakistan. Keywords: Human papillomavirus, Vaccine, Knowledge, Attitude, University students, Pakistan

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that represents 60–70% of all dementia cases. AD is characterized by the formation and accumulation of amyloid-beta (Aβ) plaques, neurofibrillary tangles, and neuronal cell loss. Further accumulation of Aβ 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 Aβ1–42 mouse model of AD. An Intracerebroventricular injection (i.c.v.) of Aβ (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 Aβ and beta-secretase-1 (BACE-1) expression and enhanced the memory and cognitive function in the Aβ-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 Aβ1–42-induced neurotoxicity. Our findings suggest that lupeol could serve as a novel, promising, and accessible neuroprotective agent against progressive neurodegenerative diseases such as AD.

OBJECTIVE: The aim of this study is to determine the trend of poisoning due to household substances in Peshawar. METHODOLOGY: This was a retrospective observational study. All the information related to poisoning including mode of transmission, duration of poisoning, demographic information, duration of hospital stay, name of poison, amount of poison ingested, inhaled and intension of poisoning was from the medical record room of Khyber Teaching Hospital (KTH) casualty department. The cases reported with a history of household poisoning were recorded for a period of one year from February 2016 to January 2017. RESULTS: Among the total 217 patients, males female ratio was 1.3:1 where male 114 (51%) whereas 104 (49%) females, whereas intensity to commit suicide is more in females. Tablet overdose cases were 73 (34%) and poisoning due to common household poisons such as mosquito repellant, rat killer poison, kerosene oil, detol and detergents were 87 (36%). Victims inhaled and ingested Organophosphorous accidently and intentionally were 62 (28%). Suicidal tendency was determined to be a hallmark among females. The age group between 18 to 31 year were found highly motivated to harm themselves. It was showed 196 (91%) patients consume with intention of suicide and only 20 (9%)were found accidental victims of poisoning. CONCLUSION: It was concluded that easy accesses to anti psychotic drugs without registered doctor’s prescription, self medication, over dosage and rat killing pills were found the most prevalent cause of poisoning among victims belonging to low socioeconomic status. It was also indicated in the study that most of the accidental incidents happed at home when victim was either alone or left unattended.

BackgroundThe prevalence of chronic kidney disease-associated pruritus (CKD-aP) varies from 22% to 84% among patients receiving hemodialysis. It occurs more frequently at night, and often affects patient's sleep quality. CKD-aP is often unreported by patients, and many do not receive effective treatment. There is, however, a paucity of available data on the prevalence and impact of CKD-aP on patients receiving hemodialysis in Pakistan.MethodsA multicenter cross-sectional study was undertaken from July 2016 to April 2017 at a tertiary care hospitals in Pakistan.Results354 patients undergoing hemodialysis were studied. 35.6% had CKD for 1-2 years, and 42.4% were receiving hemodialysis for 1-2 years. The prevalence of pruritus was 74%. The median [interquartile range] score for pruritus was 10.0 (out of possible 25) [8.0-12.0]; while the median [interquartile range] Pittsburgh Sleep Quality Index (PSQI) score was 8.0 (out of possible 21) [7.0-10.0]'. Pruritus was significantly correlated with the sleep score (r = 0.423, pConclusionsChronic kidney disease-associated pruritus is very common in patients receiving hemodialysis in Pakistan. Pruritus is significantly associated with poor sleep quality.

IntroductionSeveral tools have been developed to assess the severity of pruritus. In Malaysia, no tool has been validated to assess pruritus in patients with chronic kidney disease (CKD). Therefore, the aim of our study was to validate the Malay 5D itching scale (M5D-IS) among patients with CKD in Malaysia.MethodThe English version of the 5D-IS was translated into Malay according to International Guidelines. Face and content validity was determined by an expert panel and pilot tested in patients with end-stage renal disease (ESRD). The M5D-IS was then validated in a tertiary hospital in Malaysia from May to June 2016. We recruited patients with (i.e., patients with ESRD) and without pruritus (i.e., patients with stage 1–3 CKD) (to determine if the M5D-IS could discriminate between the two groups), and administered the M5D-IS at baseline and 2 weeks later. Exploratory factor analysis was used to examine the construct validity. Internal consistency was assessed using Cronbach’s alpha and intraclass correlation coefficient was calculated to assess the reliability of the instrument.ResultsA total of 70 participants were recruited (response rate = 100%). The majority were males (51.4%) and Malay (67.1%). Exploratory factor analysis revealed that the 5D-IS had 2-factor loadings: “daily routine activity” and “pattern of itching,” which explained 77.7% of the variance. The overall score of the M5D-IS, as well as for each domain, was significantly worse in participants with pruritus (9.83 ± 0.35), compared to those without pruritus (5.51 ± 0.93, p

Background and objectives: Chronic kidney disease (CKD)-associated pruritus is a common and disturbing condition which has a negative impact on sleep quality, as well as overall health-related quality of life of patients receiving hemodialysis. To date, no systematic review has been undertaken, and there is a lack of concise evidence that statistically quantifies the impact of pruritus based on published data. Materials and Methods: A systematic search was done for original articles published in peer-reviewed English journals from database inception on 20 December, 2018, in the following databases: PubMed, MEDLINE, EMBASE, Ovid, CINHAL, ProQuest, and Scopus. Results: A total of 9217 research articles were identified. After removal of duplicates and screening for titles and abstracts, 28 articles were selected. The prevalence of disturbed sleep was 4−94%, while the pooled proportion on random effect in the study was 40% (95% CI = 0.30 to 0.49); I2 = 99.8%. However, the prevalence of disturbed sleep quality and quantity due to pruritus was 9−76%, and the pooled proportion on random effect in the study was 50% (95% CI = 0.37 to 0.64); I2 = 99.8%. Conclusions: Patients undergoing hemodialysis who are affected by CKD-associated pruritus have a higher chance of experiencing sleep disturbances. The prevalence of disturbed sleep due to CKD-associated pruritus was found to be 9−76% in the included studies for patients receiving hemodialysis therapy.

Objective: To determine the outcome of the modified MAGPI procedure for primary repair of distal hypospadias. Methodology: This prospective descriptive study was performed in three hospitals of Bannu and Peshawar. A total of 24 cases with distal hypospedias were included in the study with coronal, subcoronal and glandular hypospadias. Those with chordee and more proximal forms where the MAGPI was not the procedure of choice were excluded from the study. The procedure of modified MAGPI included a modification of the original MAGPI (meatal advancement and glanuloplasty) by excision of a triangular shaped piece of glanular tissue or a vertical incision in the glans distal to the meatus. The patients were followed up for 6 months. Results: The total number of patients who underwent modified MAGPI procedure was 24. The age range was 2- 10 years. The average length of hospitalization was 24 hours. Complications observed in 4 (16.6 %) cases. We observed two (8.3%) patients with meatus retraction and one (4.2%) with glanular dehiscence or total disruption and one (4.2%) with wound infection. No case with fistula was observed. Straightening of penis, good micturating stream and cosmetic outlook as well as parents satisfaction was achieved in 83.3% (n=20/24) cases. Conclusion: Follow up of all the operated cases of the modified MAGPI procedure for primary repair of distal hypospadias showed good functional and cosmetic results. Complication rate was 16.7%. Key words: MAGPI procedure, Hypospadias, Coronal This article may be cited as: Rehman HU, Waheed T, Rehman IU, Imran M. Outcome of the modified Magpi procedure for primary repair of distal hypospadias. Khyber Med Univ J 2012; 4(4): 179-182.

Objective: To find out the efficacy of Bishop Koop procedure in terms of duration of hospital stay, postoperative complications and survival rate for jejunoileal atresias (JIA) in neonates in our setup. Material and Methods: This retrospective study was carried out at Pediatric unit, Khyber Teaching Hospital, Peshawar. Cases of JIA admitted from January 2009 to June 2010 were retrospectively analyzed. Patient’s age, sex, weight, type of delivery; gestational age, clinical presentation, associated anomalies, management and outcome were recorded from ward register. Nineteen neonates with age of 5 days and above , with a weight < 3 kg and cases having lower jejunal and ileal atresias were included in the study. Results: All 19 neonates (10 with jejunal atresia and 9 with ileal atresia) underwent Bishop Koop procedure. Type 3(a) was the most common (68.42%) atresia seen in the series. The mean age was 5.83 days and mean weight was 2.73kg. Postoperative hospital stay was 5-9 days (mean 5.78 days). Two patients (10.5%) died of postoperative leak from anastomotic site with septicemia while 17 (89.5%) patients survived. In 10 (52.6%) patients Bishop Koop chimney closed spontaneously, and in seven (36.8%) patients closure was done at the age of 1 year. Only one (5.3%) patient developed wound infection and one (5.3%) had adhesive intestinal obstruction; both were treated conservatively. Conclusion: Bishop Koop procedure is a safe technique with good outcome in terms of decrease morbidity, mortality and short hospital stay thus helping in improving the survival. However more efforts are recommended to improve our intensive care to achieve better outcome. Key Words: Jejunoileal Atresias, Bishop Koop Procedure, Neonates. This article may be cited as: Imran M, Rehman HU, Rehman IU, Waheed T, Khan I. Outcome of Bishop Koop procedure in neonatal jejunoileal atresias: A retrospective analysis. KUST Med J 2011; 3(2): 52-56.

Background: The irrational use, “over the counter supply„, and unregulated supply chains of antimicrobials are contributing toward antimicrobial resistance. Antimicrobial stewardship programs regulate antimicrobials usage to prevent resistance and reduce health care burden. Objective: To assess the knowledge and practice of pharmacists’ working in various healthcare settings toward antimicrobial stewardship in Pakistan. Method: A cross-sectional study was conducted among pharmacists working in different sectors between March to June 2017. Results: A total of 181 pharmacists participated, of whom (n = 145, 80.1%) were males. The majority of participants were in the 20⁻30 age group (n = 147, 81.2%) and hold Doctor of Pharmacy degrees. More than 80% of pharmacists agreed that “antimicrobial stewardship is essential to improve patient care„; while (n = 159, 87.8%) pharmacists agreed that “pharmacist should be trained on the use of antimicrobial„. Close to 90% of pharmacists agreed that “adequate training should be provided to pharmacists on antimicrobial use„. Regarding the practice of antimicrobial stewardship, (n = 72, 39.8%) pharmacists often/always “make efforts to prevent or reduce the transmission of infections within the community„; (n = 58, 32%) pharmacists never “dispense antimicrobials without a prescription„; and (n = 60, 32%) pharmacist often/always “communicate with prescribers if unsure about the appropriateness of an antibiotic prescription„. Conclusions: Increased antimicrobial stewardship efforts can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. Pharmacists in Pakistan have good knowledge and adopt positive practices toward antimicrobial stewardship. Pharmacist and other health care professionals should collaborate within multi-disciplinary teams to reduce the problem of antimicrobial resistance and improve the quality of life of patients.

Intestinal obstruction is common in neonates; however, Intestinal obstruction due to sigmoid atresia is very rare. We present a case of sigmoid atresia, suspected from clinical examination and radiological investigations on day two of life, and subsequently confirmed at surgery and histopathology. Sigmoid atresia Type 3(a) was noticed peroperatively. Resection and primary anastomosis was done with proximal covering stoma. The patient was discharged on 7th post operative day without any complications. Key words: Neonate, Intestinal atresia, Sigmoid colon. This article may be cited as: Imran N, Rehman IU, Waheed T. Sigmoid atresia: A rare cause of neonatal intestinal obstruction. KUST Med J 2009; 1(2): 71-72.