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Abdul Majeed,1 Iltaf Hussain,1 Imran Imran,2 Muhammad Usman Saleem,3 Hamid Saeed,4 Muhammad Asad Abrar,1 Muhammad Islam,4 Furqan K Hashmi,4 Muqarrab Akbar,5 Basit Ramzan,6 Muhammad Omer Chaudhry,7 Waseem Ashraf,2 Muhammad F Rasool1 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; 2Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; 3Department of Biosciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, Pakistan; 4University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, Pakistan; 5Department of Political Science, Bahauddin Zakariya University, Multan, Pakistan; 6Al Shifa Pharmacy, Multan, Pakistan; 7School of Economics, Bahauddin Zakariya University, Multan, PakistanCorrespondence: Muhammad F RasoolDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, PakistanTel +92 3008639046Email fawadrasool@bzu.edu.pkBackground: The COVID-19 pandemic is not only affecting public health, but it is also impairing the specialized surgical care services in the hospitals. The present study aimed to assess the barriers faced by the surgeons while performing surgical procedures during the COVID-19 pandemic.Methods: A cross-sectional, web-based survey was conducted from September 10 to October 14, 2020. The study population consisted of surgeons practicing in Kpk, Pakistan. Descriptive statistics and binary logistic regression analysis were used to analyze the data.Results: A total of 292, out of 543, surgeons participated in the study (response rate: 59.6%). The younger surgeons (25– 30 years) considered the lack of policies and practices regarding exposure to COVID-19 patients as a significant barrier to their practice. The surgeons practicing in private hospitals considered themselves at a higher risk while providing surgical care to the COVID-19 patients. The non-cooperation of the patients was the main barrier in delivering surgical care services.Conclusion and Recommendation: The current study highlighted the barriers to the surgeons while providing surgical care to patients in the current pandemic. The most pronounced barriers to the surgeons were the lack of policies regarding exposure to COVID-19 and practice and non-cooperation of the patient. To address these barriers, it is recommended that health regulatory agencies of Pakistan should implement strict infection control practices to ensure the safety of surgeons and allied healthcare staff during the COVID-19 pandemic.Keywords: COVID-19, nCoV-2, surgeons, barriers

Abdul Majeed,1 Muhammad Rehman,1 Iltaf Hussain,1 Imran Imran,2 Muhammad Usman Saleem,3 Hamid Saeed,4 Furqan K Hashmi,4 Muqarrab Akbar,5 Muhammad Asad Abrar,1 Basit Ramzan,6 Muhammad Omer Chaudhry,7 Muhammad Islam,4 Naveed Nisar,8 Muhammad Fawad Rasool1 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan; 2Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan; 3Department of Biosciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan; 4University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan; 5Department of Political Science, Bahauddin Zakariya University, Multan, 60800, Pakistan; 6Al Shifa Pharmacy, Multan, Pakistan; 7School of Economics, Bahauddin Zakariya University, Multan, 60800, Pakistan; 8Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, PakistanCorrespondence: Muhammad Fawad RasoolDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan, PakistanTel +923008639046Email fawadrasool@bzu.edu.pkAim: The current study was conducted to assess the factors contributing to treatment adherence and its impact on the quality of life (QoL) in type 2 diabetes mellitus (T2DM) patients.Methods: A cross-sectional study was conducted between January 2020 to March 2020 among T2DM patients. The data was collected from T2DM out-patient clinics. The participants were recruited by using a simple random sampling method. To assess the association of demographics with the level of adherence, binary logistics regression analysis was applied. Moreover, the Mann–Whitney U-test was used to evaluate the impact of adherence on QoL.Results: A total of 384 patients participated in this study. Amongst them, 60.2% were male and 39.8% were female. Low adherence was seen in illiterate patients and patients older than 40 years. The results showed that good QoL in T2DM patients was significantly associated with treatment adherence (p= 0.004).Conclusion: The finding of the current study showed that the non-adherence prevailed in illiterate strata of the study population and the medication adherence significantly affects the QoL in T2DM patients. These findings suggest that health regulatory agencies should focus on implementing disease-education interventions for improving the adherence to medications in patients with long-term conditions.Keywords: type 2 diabetes, drug adherence, quality of life

Muhammad Subhan Arshad,1 Iltaf Hussain,1 Muhammad Nafees,1 Abdul Majeed,1 Imran Imran,2 Hamid Saeed,3 Furqan K Hashmi,3 Muqarrab Akbar,4 Muhammad Asad Abrar,1 Basit Ramzan,5 Muhammad Omer Chaudhry,6 Muhammad Islam,3 Areeba Usman,7 Naveed Nisar,8 Muhammad Fawad Rasool1 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; 2Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; 3University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore 54000, Pakistan; 4Department of Political Science, Bahauddin Zakariya University, Multan 60800, Pakistan; 5Al Shifa Pharmacy, Multan, Pakistan; 6School of Economics, Bahauddin Zakariya University, Multan 60800, Pakistan; 7Nishter Medical Hospital, Multan, Pakistan; 8Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, PakistanCorrespondence: Muhammad Fawad RasoolDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, PakistanTel +92 3008639046Email fawadrasool@bzu.edu.pkPurpose: The COVID-19 (coronavirus disease-2019) has been associated with psychological distress during its rapid rise period in Pakistan. The present study aimed to assess the mental health of healthcare workers (HCWs) in the three metropolitan cities of Pakistan.Methods: A cross-sectional, web-based study was conducted in 276 HCWs from April 10, 2020, to June 5, 2020. Depression, anxiety, and stress scale (DASS-21) were used for the mental health assessment of the HCWs. Multivariable logistic regression analysis (MLRA) was performed to measure the association between the demographics and the occurrence of depression, anxiety, and stress (DAS).Results: The frequency of DAS in the HCWs was 10.1%, 25.4%, and 7.3%, respectively. The MLRA showed that the depression in HCWs was significantly associated with the profession (P< 0.001). The anxiety in HCWs was significantly associated with their age (P=0.005), profession (P< 0.05), and residence (P< 0.05). The stress in HCWs was significantly associated with their age (P< 0.05).Limitation: This study was conducted in the early phase of the COVID-19 pandemic, when the number of COVID-19 cases was on the rise in Pakistan and it only represents a definite period (April to June 2020).Conclusion: The symptoms of DAS are present in the HCWs of Pakistan and to manage the psychological health of HCWs, there is a need for the initiation of psychological well-being programs.Keywords: depression, anxiety, stress, pandemic, DASS-21

Iltaf Hussain,1 Muhammad Fawad Rasool,1 Imran Imran,2 Hamid Saeed,3 Furqan Hashmi,3 Muqarrab Akbar,4 Muhammad Asad Abrar,1 Basit Ramzan,5 Muhammad Omer Chaudhry,6 Muhammad Islam,3 Areeba Usman,7 Naveed Nisar,8 Abdul Majeed1 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; 2Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; 3University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore 54000, Pakistan; 4Department of Political Science, Bahauddin Zakariya University, Multan 60800, Pakistan; 5Al Shifa Pharmacy, Multan, Pakistan; 6School of Economics, Bahauddin Zakariya University, Multan 60800, Pakistan; 7Nishter Medical Hospital, Multan, Pakistan; 8Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, PakistanCorrespondence: Abdul MajeedDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, PakistanTel +92 3336139819Email abdulmajeed@bzu.edu.pkBackground and Purpose: Over the past few decades, the focus of pharmacy practice has been shifted from the classical role of drug dispenser to pharmacotherapy expert. Pharmacists now are more often involved in the patient care process by addressing the drug-related needs of the patients and this patient-centered approach is known as pharmaceutical care (PC). The present study was conducted to assess the attitude of pharmacy undergraduate students toward PC and various contributing factors that influence their preference towards it.Method and Instrument: A descriptive cross-sectional study was conducted in 422 undergraduate pharmacy students by using a simple random sampling method. A pre-validated and self-reported Pharmaceutical Care Attitude Scale (PCAS) was used for assessing a student’s attitude towards PC.Results: Amongst the 422 undergraduate students, the majority were males (68.2%) and 70.4% were between the age group of 20 and 25 years. The students studying in third, fourth, and fifth year (final year) were 140 (33.2%), 142 (33.6%), and 140 (33.2%), respectively. Overall participant showed a positive attitude toward the PC. Professional year showed significant influence on professional duties (PD) (p< 0.001) and age was significantly associated with return on efforts (ROE) (p< 0.001) and professional benefits (PB) (p< 0.001).Conclusion: Most of the participants showed a positive attitude toward PC and showed motivation to practice it. To promote PC practice in Pakistan, the government along with other professional bodies like Pakistan Pharmacists Association (PPA) should work together in collaboration with global health agencies to develop a well-structured advanced healthcare system in which there is a defined role of PC practice.Keywords: attitude, clinical pharmacy, pharmaceutical care, pharmacy practice

Over the last twin decades, significant advancements have occurred in global electricity grids due to the widespread adoption of renewable energy resources (RES). While these sources play an essential role in total generation cost reduction, transmission power loss minimization, and reduction of environmental hazards related to traditional power plants. Still, however, the optimal planning and operation of the power system in the presence RES is considered a primary challenge due to the their stochastic natural and intermittency. One of the most complex and motivating issues in a power system is optimal power flow (OPF), a constrained optimization problem characterized by non-linearity and non-convexity. From these specifications, researchers competed in the past decades to find optimal solutions to stochastic OPF problems while keeping system stability. To tackle this challenge, an effective optimization algorithm which mimics on the foraging behavior of dwarf mongooses’ in the nature is introduced. The objective function considers reserve cost for overestimation and penalty cost for underestimation of intermittent renewable sources. To show the robustness and efficacy of the recommended optimizer, case studies on the customized IEEE 30-bus system and a realistic power system DZA 26-bus (isolated grid) are undertaken. Numerical findings show that the proposed DMOA beats all previous published-results and performs better over a variety of objective functions while finding high-quality optimally viable solutions. The obtained results demonstrate that the DMOA realized exceptional performance for both the test networks, with total generation cost minimized values of 780.982 ${\$}$ /h and 8283.942 US ${\$}$ /h, respectively. These results highlight the precision and robustness of DMOA in effectively addressing various instances of the OPF problem Furthermore, the one-way analysis of variance (ANOVA) test, a statistical approach, was employed to evaluate the superiority of the proposed algorithm and to highlight a certain level of confidence to our study.

Objectives: The study aimed to assess the knowledge, attitude and practices (KAP) of HCPs regarding the use of probiotics in different health conditions and to identify various barriers that are associated with their use., Methods: A cross-sectional study was conducted on 405 HCPs by using a validated self- administered questionnaire for assessing their KAP towards probiotic use. The study data were analysed using descriptive statistics, χ 2 test and binary logistic regression (BLR)., Results: Among the 405 participants, only 15.1 % of HCPs had good knowledge, while 15.6% had acceptable practices and 89.1% had a positive attitude towards probiotics. The professional position of HCPs was significantly associated with knowledge (p=0.001) and practice (p=0.001). Among all the HCPs, the pharmacists showed a significant association with good knowledge (p=0.016) and good practices (p=0.024) by using BLR. The lack of knowledge about probiotics was a major barrier to the utilisation of probiotics., Conclusions: The poor knowledge and practices regarding the use of probiotics have been seen in the current study. While the participants showed a positive attitude towards the utilisation of probiotics. To transform HCPs' positive attitude to their practices and to create awareness regarding probiotic use focused training programmes should be initiated by professional health organisations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The current study aims to assess the beliefs of the general public in Pakistan towards conspiracy theories, acceptance, willingness to pay, and preference for the COVID-19 vaccine. A cross-sectional study was conducted through an online self-administered questionnaire during January 2021. The Chi-square test or Fisher exact test was utilized for statistical data analysis. A total of 2158 respondents completed the questionnaire, among them 1192 (55.2%) were male with 23.87 (SD: ±6.23) years as mean age. The conspiracy beliefs circulating regarding the COVID-19 vaccine were believed by 9.3% to 28.4% of the study participants. Among them, 1040 (48.2%) agreed to vaccinate on its availability while 934 (43.3%) reported the Chinese vaccine as their preference. The conspiracy beliefs of the participants were significantly associated with acceptance of the COVID-19 vaccine. The existence of conspiracy beliefs and low vaccine acceptance among the general population is a serious threat to successful COVID-19 vaccination.