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Aim: Various research was conducted during the last decade, with inconsistent findings regarding iron death anaemia (IDA) perils vis-à-vis utilization of proton-pump inhibitors (PPIs). Consequently, recent systematic review and meta-analysis were implemented to evaluate IDA-related perils concerning the utilization of proton-pump inhibitors. Methods: The databases of EBSCOhost, PubMed® and Cochrane Central were searched from the research outset until February 28, 2021 purposely to identify all research with objectives that align with the present research investigation. The Newcastle-Ottawa Scale (NOS) was utilized for the evaluation of the research investigation standard. The prime (1º) goal of the research was to gauge IDA peril among users of proton-pump inhibitors (PPI). For data processing, RevMan (Review Manager) version 5.4 was employed. Results: In total, fourteen investigations research was employed in this systematic review and metaanalysis. The combined relative risk of nine research exhibited a numerically consequential interrelation betwixt the utilization of proton-pump inhibitors and IDA peril (RR 2.56 [95% CI 1.43–4.61], p < 0.00001). Contemporary systematic review and meta-analysis examination posit that proton-pump inhibitor consumers are prone to greater peril of coming down with IDA in comparison to non-PPI users. Conclution: In keeping with the findings of my research, prescriber physicians should exercise caution when prescribing PPIs to individuals taking it for a long time to avoid the peril of IDA. Additionally, their serum iron level should be checked to ensure that proton-pump inhibitors are safe.

The purpose of the study is to identity and develops a comprehensive construct for the entrepreneurs in Pakistani context. The study has used qualitative review to highlight the reasons of entrepreneurship and issues faced by emerging entrepreneurs in Pakistan. The study intended to investigate the extant literature on Entrepreneurial Opportunity Recognition. The researchers focused on reputed and leading journals in order to contribute in a more objective manner. A comprehend review indicates that not just entrepreneurial factors but also shows how setups are branded. The study also highlights a comprehensive psychological model for quantitative testing. The previous studies only shows the importance and factors of entrepreneurship, however, this study also have highlighted the reasons for branding in emerging entrepreneurship. The study will impact to elaborate clearly on the information's about not only entrepreneurship but also the directions towards branding.

This is the first notice, edition, and translation of a royal order in Sanskrit, engraved on a set of three copper-plates kept in the permanent collection of the Philadelphia Museum of Art. The inscription is dated to the seventh year of the reign of Nannarāja I, king of the Pāṇḍuvaṃśin lineage active in Dakṣiṇa Kosala in the sixth and seventh centuries CE. The inscription provides important new information about a family of engravers, probably relocated from Śarabhapura to Sirpur, who served both the Śarabhapurīya and Pāṇḍuvaṃśin courts. The plates further suggest that Nannarāja I, as the first Pāṇḍuvaṃśin king of South Kosala, continued the epigraphic traditions of the Śarabhapurīyas, whom he may have served with his father Indrabala in his early career before the conflicts which brought him to power.

The development of several types of vaccines to avert COVID-19 has taken place. Despite several reports of undesirable reactions noted post-COVID-19 vaccine administration, later remains one of the best prevention and management tools in fighting the spread of the virus and its variants and reducing the harshness of this viral attack. The purpose of the current paper was to explore the side-effects experienced by the females in the Eastern Province of Saudi Arabia directly after receiving the booster dose of the Pfizer-BioNTech/BNT162b2 COVID-19 vaccine.A descriptive cross-sectional study among adults living in the East-ern Province, Saudi Arabia was applied. A survey link was, distributed through WhatsApp, SMS, or e-mail to community members. Respondent's demographic information was acquired, as well as information about any local and systemic side-effects reported following booster dose of BioNTech/BNT162b2 COVID-19 vaccine.A total of 72.36% (432/597) of the respondents who participated in this study reported at least one side-effect. Pain and redness at the injection site (75.93%), myalgia (71.99%), headache (53.24%), fever (33.56%), and fatigue (43.78%) were the highest frequently stated side-effects. Furthermore, 9.25% of the respondents had to see a physician due to side effects, plus merely four participants were admitted to the hospital. The respondents working in the non-healthcare-related sector had a 1.677-fold more possibility of side effects in comparison with the other respondents (adjusted odds ratio = 1.677; 95% CI = 1.363, 2.064).All reported side-effects were mild to moderate. These findings might persuade pessimists and refusers to get the COVID-19 vaccine. Myalgia and pain or redness at the site of injection were the most common reported side-effects in our study.

Background: Human papillomavirus (HPV) is one of the most widespread viral infections that affect the reproductive tract. The aim of this study is to assess the knowledge, attitude, and practice toward HPV amongst pharmacy students in Saudi Arabia. Methods: A cross-sectional prospective online survey-based study was conducted amongst all second year to final year students enrolled in the pharmacy programme. Results: Female students exhibited better awareness and knowledge (87.2%) compared to male students (12.8%). The majority of respondents (92.8%) had heard about the risk of cervical cancer, with fewer respondents had heard about the HPV vaccine (35.0%). There was high ratification that vaccines help in preventing cervical cancer (64.80%), which is a good response. Conclusion: The pharmacy students showed an average knowledge regarding HPV infection and HPV vaccination. Considerable HPV targeted initiatives related to the offered pharmacy curriculum should be planned and executed to equip future pharmacists with proper knowledge and soft skills to perform their effective role in the prevention of HPV infection.

IoT is a fundamental enabling technology for creating smart spaces, which can assist the effective face-to-face and online education systems. The transition to smart education (integrating IoT and AI into the education system) is appealing, which has a concrete impact on learners' engagement, motivation, attendance, and deep learning. Traditional education faces many challenges, including administration, pedagogy, assessment, and classroom supervision. Recent developments in ICT (e.g., IoT, AI and 5G, etc.) have yielded lots of smart solutions for various aspects of life; however, smart solutions are not well integrated into the education system. In particular, the COVID-19 pandemic situation had further emphasized the adoption of new smart solutions in education. This study reviews the related studies and addresses the (i) problems in the traditional education system with possible solutions, (ii) the transition towards smart education, and (iii) research challenges in the transition to smart education (i.e, computational and social resistance). Considering these studies, smart solutions (e.g., smart pedagogy, smart assessment, smart classroom, smart administration, etc.) are introduced to the problems of the traditional system. This exploratory study opens new trends for scholars and the market to integrate ICT, IoT, and AI into smart education., 30 pages, 16 tables, 6 figures. This article is accepted for publication in ACM Computing Surveys

Introduction: Self-medication can be described as the use of medications with therapeutic intent without prescription or supervision of the physician. The World Health Organization has considered Self- medications as one of self-care elements that comprise hygiene, nutrition, lifestyle, living condition, and income level. Self- Care is a practice that people do, to maintain wellness and prevent illness. Hence current study conducted to measure the prevalence of knowledge and attitude about self- medication practice among the communities of Eastern province, Saudi Arabia. Methods: A cross-sectional descriptive study was conducted among 532 participants via an online survey. Survey questionnaire was distributed over the Social media platform. Results: The results indicate that among the age group 15 to 25 years (43.42%) there’s a high incidence of self-medication practice. Gender comparison indicated that females demonstrated a high prevalence of self-medication than males. Analysis of information from the university graduate students indicated that self-medication was high (46.05%) related with the knowledge of the medications (68.6%). Major medicine that was being used to self-medicate was Analgesic/painkiller (80.26%). It is essential to mention that the use of antibiotic was slightly low (12%). Among the health problems that provoked self-medication, headache was the main health problem (58.83%). Conclusion: Self-medication was found to be alarmingly high among the population of Eastern Province, Saudi Arabia. So, it is imperative to increase the awareness among the population about the risk of this practice and how to practice self-medication more responsibly to avoid unwanted outcomes.

Objective: A prospective cross-sectional survey-based pilot study was conducted amongst final year pharmacy students at a private pharmacy college in Eastern Province, Saudi Arabia, to evaluate the knowledge and perception toward generic medicines. Methods: This online survey-based study was carried out amongst all final year students enrolled in the pharmacy programme between 1 February and 30 April 2020. Results: The response rate was 95.56%. Most participants (66.27%) agreed that generic products are therapeutically equivalent to the innovator brand product, and 75.57% reported the need for more information on how bioequivalence tests are conducted for generic medicines. Furthermore, 34.88% agreed that generic medicines are of inferior quality to brand drugs and 73.24% reported the need for more information on the issues pertaining to the safety and efficacy of generic medicines. Conclusion: This study showed that fifth-year pharmacy students had a basic knowledge of generic medicines, with an ambivalent perception of generics’ quality and safety standards. A number of collaborative initiatives should be planned and executed to equip future pharmacists with broad knowledge concerning generic medications.

This study assessed antimicrobial prescription at our institute to promote rational antimicrobial use and implement customized antimicrobial stewardship programs. This study is a cross sectional point-prevalence survey on antimicrobial utilisation conducted at HAH Centenary hospital, New Delhi in April, 2019, over a period of 3 days. All in-patients were included in the analysis. However, neonates, emergency room patients and palliative care patients, orders for anti-viral, anti-fungal, anti-tubercular and anti-parasitic medications were excluded. SPSS version 13.0 was planned to be used for analysis of the statistical data. The number of patients admitted at the point of time of our survey was 217, out of which 101 (46.54%) patients were receiving antimicrobial agents (AMA) with 160 (73.73%) AMAs prescribed. 50 patients (49.5%) were prescribed AMAs for infections, whereas, 49 patients (48.51%) were prescribed AMAs prophylactically and 2 (1.98%) patients received AMAs for reasons not defined. The intensive care units exhibited 93.33% patients receiving antimicrobials. The most common indication was intra-abdominal infections (32.40%). The most commonly used antibiotics were beta-lactam antibiotics (60.62%). The study suggests a high rate of antimicrobial use and highlights areas for intervention for rational antimicrobial use. We propose to sensitise the government on initiating a national antimicrobial stewardship program such as the Global Point Prevalence Survey and facilitate evidence-based antimicrobial practice.

Since forecasting future values is fundamental for researchers, investors, practitioners, etc., obtaining accurate predictions is critical in time series analysis. The accuracy is reliant on good modelling and good-quality data. The latter is affected by unusual observations, changes over time, missing data, and structural breaks among others. Economic crises are the major cause of data instability and therefore, this paper focuses on how structural breaks in conditional heteroscedastic financial and macroeconomic data affect forecasting accuracy on short and long-term horizons. More specifically, we are interested in the impact of the location of the structural break and break size on the predictive performance of two linear (ARIMA and Exponential Smoothing) forecasting models and two nonlinear (ARIMA – ARCH and Artificial Neural Network) models. We conducted Monte Carlo simulations and showed that the forecasting accuracy decreases as the structural break location approaches the end of the sample. In addition, break size and length of the horizon show the same impact on the forecasting accuracy as the forecasting error increases with the increase of break magnitude and length of the horizon. We also showed that ARIMA – ARCH model is the best performing in the absence of a structural break while the artificial neural network model outperforms all the competing models in the presence of structural break, especially in large break sizes and long horizons. Last, we applied the above techniques to forecasting daily close prices of brent oil and Turkish Lira – USD exchange rates out–of–sample, and similar results were found.

In 21st century, human resource is major and most valuable asset of organization. Human resource is one of the major tool for organization that will help to achieve competitive advantage in the age of competition. Without a good human resource, companies cannot establish a good team of professional for their jobs. Great human asset should have such qualities as high satisfaction with their employments, high responsibility towards the organization, high inspiration to serve general society and solid aims to work for the association eagerly and dependably. Organization can upgrade inside capacities to manage present or future difficulties to be looked by an organization through great Human Resource practices. Human Resource Practices is a hierarchical capacity assume a critical part in overseeing workforce through it proactive approach in lessening disparities and also to draw in, create, hold and propel workforces. In that capacity, when organization energizes value and decency, their representatives is anticipated to wind up more dedicated in their activity & job. In the field of HRM, employee turnover is a major problem. Employee turnover is a cause for concern when the best and efficient employees intend to switch towards another organization, and there may be something that organization could do to retain those employees. Most of the Telecom sector in Pakistan faces a serious problem of high employee turnover. Now employees are considered as a main source to achievement of competitive advantage and organizations should give more focus in order to compete in the market with competitors. Organizations higher performance will depend on their incomparable employees; employees would not only adequately perform their required job but exert efforts that are beyond necessities. Employee turnover expectation is the huge reason that gives guidance to hold the specific conduct. This investigation is investigating the effect of HR practices on representative turnover and OCB in Telecom part of Pakistan that is Warid and Mobilink. This exploration will add to the group of writing relating HR practices and effect of HR practices on representative turnover and OCB, in hypothetical casing work will depict the measurements of HR practices for estimation worker turnover aims and OCB. The examination will clarify of how HR rehearses influences worker maintenance and OCB in telecom associations of Pakistan. The investigation will inspect through experimental discoveries in which including descriptive examinations, and regression for finding the effect of HR hones on representative turnover and OCB. Data will be collected using standardized questionnaire administered. Data collected from the sample size of one hundred and fifty people. In this study one hundred and fifty questionnaires were distributed only eighty was returned included in sample size in which forty employees and forty supervisors are included from both the company.

This paper is a description of how marketing occurs in the forests of Malaysia, a focus made on the direct selling and relationship marketing in those jungles where marketers/sales people get access to their customers. These potential customers living in the shelter houses temporarily prepared in the jungles where the customers are employed for various assignments. An observation method for data and information gathering is acquired. Discussion/ unstructured interviews are made with the sales people and customers to understand the essence of direct selling and the relationship that the marketers have developed with the customers who live in the jungles. Also, pictures were drawn with a digital camera to reveal how the customers and the marketers relate while dealing with each other.

After making thorough on-ground observation it is observed that because of hazardous development of populace, evolving needs, financial rivalry and also inflation of the assets for social welfare administrations at the worldwide level are decreasing. Keeping in perspective the contracting position of assets for social welfare and group advancement the idea of investment rose in range of sociological areas and group improvement. Participatory approach gradually and steadily came into use in the group advancement discourse. It was trailed by a fast development in the advancement of techniques for including rustic individuals in looking at their own issues, setting their own objectives, and checking their own accomplishments. It is essential to note that an effectively included and enabled domestic populace is key for effective community development process. This paper deals with similar themes on community development and disaster management in Pakistan.It discusses the fundamental prologue to the worldview of involvement of local community; ontological transformation in disaster administration and procedure of community based disaster management in Pakistan.

This research tries to investigate the influence of organizational learning on innovation on one hand and the impact of innovation on performance on the other. Upon the review of literature, two hypotheses projected in pursuit of the research: the positive impact of organizational learning on innovation as well as the co relational effect of innovation with performance. Data was obtained distributing questionnaires in five public sector universities of Peshawar, Khyber Pakhtunkhwa, Pakistan. Conclusions substantiate hypotheses thus provided additional substantiation that organizational learning has a say in innovation capacity, and also the fact that innovation is positively associated to organization learning (R2 = 0.65) and coefficient β is 0.31 this clearly show that innovation leads to organization learning, on the other hand organization learning has positively associated to organization performance (R2 = 0.70) and coefficient β is 0.54 this means that organization learning leads to organization performance, and has positive significant effect on financial performance

Aim: Current study conducted with aims to assess general public knowledge, attitude and practice towards disposal of in-home medication among community in Eastern province, Saudi Arabia. Methods: A cross-sectional survey-based study was conducted from 1st September 2019 to 31st October 2019 among the community in Eastern province, Saudi Arabia. A validated self-administered questionnaire was distributed to easily approachable 1400 participants through social media in which 916 respondents were completely filled the survey form. Chi square test were used for the calculation of variance among the group. P-value less than and equal to 0.05 is considered statistically significant. Results: The response rate of survey was 65.42%.The mean age of the survey respondents was 30.34 ±9.95 years. Among all the respondents 225(24.56%) respondents were male and 691(75.43%) respondents were female from community of Eastern province, Saudi Arabia. The majority of the respondents 709 (77.4%) (p

This essay argues that the rise and circulation of large numbers of Sanskrit literary anthologies as well as story traditions about poets in the second millennium together index important changes in the ‘author-function’ within the Sanskrit literary tradition. While modern ‘empirical authorship’ and external referentiality in Sanskrit has long been deemed ‘elusive'by Western scholarship, the new forms of literary production in the second millennium suggest a distinct new interest in authorship among wider literary communities. This new ‘author-function’ indexed a shift in the perceptions of literary production and the literary tradition itself. Focusing on the famous sixteenth-century work known as the Bhojaprabandha as both an anthology as well as a storybook about poets, this essay further argues that the paradigmatic courts of kings like Vikramāditya and Bhoja (but particularly the latter), placed not in historical time but in an archaic temporality, became the mise en scène for the figure of the poet in the second-millennium literary imagination. They were courts where the finest poets of the tradition appeared and where their virtuosity could be savored and reflected upon by generations of readers.

The purpose of this study is to find out the impact of Terrorism on FDI inflow in Pakistan as well as other variables such as economic growth, market size, trade openness and infrastructure. Using a simple regression model to estimate time series, annual data from 2001 to 2016, the study concludes that market size, economic growth, and trade openness have a significant positive relationship with FDI. At the same time, the result shows that Terrorism and infrastructure has a significant negative relationship with FDI. This empirically builds up the way that Terrorism is a real threat to FDI and economic development of the economies of Pakistan. The empirical outcomes of the study of Terrorism confirmed the way that Terrorism based oppression has harmed the economic prosperity of Pakistan and has debilitated FDI inflows during the sample period. Therefore, Pakistan will take to measures the investment environment in this area. Government strategy makers should consider the situation of Terrorism, instability and lawfulness circumstance to decrease the risk of investors and to ensure their investment ability to host FDI.

The aim of the study is to find the impact of dividend policy on stock prices before the capital gains tax imposition (2006-2010) and after the capital gains tax imposition (2011-2015). This study uses Descriptive statistics, Correlation, and Panel Regression Analysis to investigate the impact of Dividend Policy on Stock Prices. The study is covering 10 years’ time period from 2006-15. This study investigated that before the imposition of capital gain tax there is no effect of Dividend Policy on Stock Prices. The reason whythe benefit in the said time period is greater is that there was no tax on capital gains. Investors were buying shares at low price and sell it at a higher price to earn capital gains. The first theory which is a dividend irrelevance theory supports the results of before capital gain tax imposition and the theory were presented by Miller and Modigliani (1961). The study also investigated thatafter the imposition of capital gain tax, Dividend Policy became the main tool of fluctuation in the prices of shares. The reason why people were unbiased to capital gains is that the tax on capital gains became higher than the tax imposed on dividend. So stockholders started to opt for those shares which yield a high dividend. This result of after capital gain tax imposition period is supported by “Bird in Hand” were presented by Lintner (1962) and Gorden (1963). The management of firms needs to follow a stable dividend policy to gain the confidence of investors for a long period of time. Investors may prefer stocks of those firms, which yield high dividend. Because high dividend payout ratio may indicate that the future of the firm is bright and its earnings may rise in the future. For the investor’s point of view, this research work recommends that investors need to opt for shares of those firms which pay high and stable dividend payout ratio. Because the stock prices of those firms affect much which follow a fluctuating dividend payout.

Reports of local and systemic side-effects of COVID-19 vaccination may play an important role in public confidence in the acceptance of the COVID-19 vaccine booster dose.We conducted a retrospective cross-sectional study among adults living in Eastern Province of Saudi Arabia. A link to the survey was distributed to community members via WhatsApp, SMS, or e-mail. Participants' general and demographic information was also collected, as well as information about any local and systemic side-effects reported following vaccination.A total of 370/390 (94.87%) of respondents reported one or more side-effects. Pain or redness at the site of injection (88.92%), fatigue (43.78%), body pain fever (37.84%), and headache (15.95%) were the most commonly reported side-effects. Moreover, 2.43% of the participants reported side-effects needed to see a physician; only four were admitted to the hospital. The non-healthcare respondents (n=273 (97.15%), OR (95% CI) = 5.22 (2.02, 13.48,According to this study, the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine was safe when given to Saudi Arabian adults. All reported side-effects were mild to moderate. The findings will likely persuade vaccine-hesitant individuals and pessimists to accept booster dose of COVID-19 vaccine.

Objective: The intent to prepare and evaluate Linezolid in-situ gel in the treatment of periodontitis. Methods: pH-sensitive in-situ gel was formed by the cold method using a varying concentration of the drug, carbopol 934P and hydroxypropyl methylcellulose (HPMC) and carbopol 934P and sodium carboxy methylcellulose (CMC) (1:1,1:1.5,1:2,1:2.5). An optimized batch was selected based on gelling time and gelling capacity. The prepared in-situ gels were evaluated for appearance, pH, gelling capacity, viscosity, in vitro release studies, rheological studies, and finally, was subjected to drug content estimation and antibacterial activity test. Results: FTIR study shows drug and physical mixture were compatible with each other. The rheology of formulated in-situ gel exhibited a pseudoplastic flow pattern. this may be because when polymer concentration was increased the prepared formulations become more viscous and in turn delayed the drug release and from the prepared formulation, LF4 and SF4 have polymer concentrations i. e, 0.9% carbopol and sodium CMC showed drug release up to 12 h. Conclusion: When carbopol is appropriately mixed with other suitable polymers it forms an in-situ gel-forming system that was substantiated by the property to transform into stiff gels when the pH is increased. The in-situ gel was prepared using a combination of carbopol-HPMC and carbopol-Na CMC The formulations LF1 to SF4 showed high linearity (R2 = 0.490-0.682), indicating that the drug was released from the prepared in-situ gel by the diffusion-controlled mechanism. Thus, the formulation of batches LF4 and SF4 containing carbopol: HPMC and carbopol: NaCMC in 1:2 ratios were considered as optimum formulation based on optimum viscosity, gelling capacity and to extend the in vitro drug release.

Highlights • Socio-economic status is very important in patient receiving DOT therapy. • Income influences disease occurrence as well as adverse events. • Occupation increases the risk of diseases and results increase risk of adverse events. • Low income results mal nutrition and increased risk of drug intolerance or adverse events. • DOTS is an effective treatment strategy for MTB patients., First-line antituberculosis (anti-TB) compounds have been considered as proven components of the Directly Observed Treatment-Short course (DOTS). Drug therapy against tuberculosis has been categorized as I, II, or III following the Revised National Tuberculosis Control Program guidelines. Anti-TB are drugs are quite common and show limited adverse effects. However, first-line anti-TB compounds mediated DOTS therapy and were found with several complications. Thus, those drugs have been discontinued. Therefore, the present study was designed to find out the possible impact of socioeconomic, income, and educational status on the adverse effects of drugs and their therapeutic episodes in patients targeted with a combination of tuberculosis intervention. This study found that an increased incidence of tuberculosis was found in patients who have finished high school, contributing to a high percentage of adverse effects. Notably, adverse events were shown maximally in poor patients compared with rich- or high-income patients. On the contrary, a high prevalence of adverse events was shown to be increased in partially skilled workers compared with full-skilled workers. Consequently, adversely considerable events were implicated to be raised in patients associated with minimal socioeconomic class. Such interesting factors would help in monitoring such events in experimental patients.

The birth of courtly emotions in early India was intimately linked to the proliferation of royal households across the subcontinent between the fourth and seventh centuries CE. Though earlier polit...

We report the synthesis of five proton-conducting ionic liquids (PCILs) by a neutralization reaction. The proton transfer from the corresponding Brønsted acid to the respective base was confirmed by FT-IR spectroscopy. The Karl-Fischer titration was used to measure the water contents of the PCILs exposed to air for different time intervals at a relative humidity of 36 ± 5% and 31 ± 5 °C. The rate of moisture uptake by the PCILs increased with the increase of their time of exposure to air and follows pseudo-first-order kinetics. The conductivity analysis reveals that the PCILs’ ionic conductivities further rise with increasing water contents and temperature. The conductivity data were fitted with the Arrhenius equation and activation energies (Ea) were deduced. The electrochemical analysis of the triethylammonium dihydrogen phosphate, TEADHP shows that the liquid has a wide (2.8 V) electrochemical window (EW) at the Pt electrode at 60 °C and 5% water. The EW becomes narrower as the temperature and water content of the TEADHP increase due to the increase in the rate of the water electrolysis. The data showed that during positive-going scans, Pt-oxides were formed due to the oxidation of water in the PCIL which plays an electrocatalytic role during formic acid oxidation in the medium.

There is high incidence of cervical cancer in Bihar, India. Vaccination for cervical cancer in developed countries has played a crucial role in limiting the incidence rate of cervical cancer worldwide. In consideration of debate on clinical efficacy of Human Papilloma Virus (HPV) vaccine in India, study on the prevalence of high risk HPV 16/18 strains in different regions of the nation becomes very crucial. Few individual states have started vaccination but centralised vaccination program does not exist due to lack of sufficient genotypic study of Human Papilloma Virus in different parts of India. Bihar is the third most populous state of India and HPV 16/18 distribution has not been reported yet. The nationwide data of HPV 16/18will help to develop a unified centralised vaccination program. We carried out a distribution study of high risk HPV type 16 and 18 in cervical cancer patients attending a tertiary care hospital of Bihar, India.HPV 16/18 types were analysed in cervical cancer tissues (n = 96) of patients attending the regional cancer hospital of Bihar. Tissue samples were analysed for HPV 16 and HPV 18 using a Real Time PCR technique. The results suggest very high prevalence of HPV 16/18. HPV was identified in all the samples (96/96). About, 74 (77.08%) samples presented with HPV 16 whereas, 16 (16.67%) of the samples presented with HPV 18. 6 Co-infection was presented in 6 (6.25%) of the samples of cervical cancer tissues. HPV 16/18 prevalence is more in the women aged between 41 to 61 years.We report 100% prevalence of HPV16/18 in the cervical cancer tissue samples. A way to minimise this gynaecological concern would be to introduce prophylactic vaccines and early screening in the state of Bihar. The data generated would be crucial in drafting for community screening of HPV. We strongly emphasize the prophylactic HPV Vaccination against HPV 16 to control the alarming rate of cervical cancer in one of the most populous state of India, Bihar.

Objectives Fungal infections in humans are superficial or systemic and are found to be life threatening. They are common among the middle age group and particularly in females and immunocompromised patients. Methods This study was conducted to evaluate the prescription pattern of antifungal drugs and their economic burden on patients. The study was designed as a single centered, cross-sectional retrospective pharmacy database study of utilization of antifungal drug therapy and their cost analysis. Data for the period from 1 January 2019 to 31 December 2019 were retrieved from the inpatients and outpatient electronic pharmacy records along with the unit dose prices of antifungal drug in the study hospital. Key findings Antifungals use was more among females (67.05%) compared with males (34.91%). The use was predominant among middle age group (31–45) with Clotrimazole being the most utilized lower cost topical drug and fluconazole the next preferred systemic drug with least toxicity. Variconazole is a novel drug utilized the least among all age groups due to its adverse effects and higher cost. Clotrimazole is the drug of choice topically due to low cost and lesser absorption orally. Fluconazole is the next preferred drug that can be given systemically and its use remain unchanged due to lower cost and least toxicity in immunocompromised patients. Conclusions Variconazole although have adverse effects and used rarely it is the drug preferred in invasive treatments when benefit outweighs the risk. Variconazole is highly expensive drug used in invasive treatments and its adverse drug reactions, and cost need to be monitored.

Objectives Inappropriate use of antibiotics is a matter of concern worldwide as that may lead to antimicrobial drug resistance. The objective of current study was to assess drug utilization pattern and cost-effectiveness. Studies are conducted to analyze the pattern of antibiotics prescribing their adherence to standard guidelines and economic impact on the patients in order to promote their rational use. Methods The study was designed as a single-centred, cross-sectional retrospective pharmacy database study of prescribing patterns and cost-utility analysis of five most common antibiotics used in Saudi Arabia. Data for the period from 1 January 2019 to 31 December 2019 were used in the study. Demographic characteristics were demonstrated as frequencies and percentages (with Wilson 95% confidence intervals for proportions). The chi-square test (for P-value calculation) was used to compare the adherence of National Antimicrobial Guidelines for prescribing antibiotics in Saudi Arabia. Key findings The maximum number of patients was recorded from the age group of 18–35 years (35.97%) and minimum from 72 to 88 years (1.82%). The number of units prescribed was highest for amoxicillin, clavulanic acid (22487) to 42.93% of patients and was lowest for ciprofloxacin (4215) with 8.04%. The longest duration of therapy was for Cefdenir (7.23 days) and lowest for azithromycin (3.58 days). The cost was highest for Cefdenir 38.66SR (10.31USD), and lowest cost was estimated for Cefuroxime 12.43SR (3.31USD). Conclusions Our study declared that (amoxicillin with clavulanic acid) was used the most as first-line agents in treating bacterial infections due to their broad coverage against different microbes. Conducting laboratory tests to identify the type of microbe before prescribing could prevent the development of drug resistance and save the antibiotic for future. The cost-to-benefit analysis studies of antibiotics must be conducted for each indication that may promote their rational use.

Objective This study is based on a retrospective cross-sectional study to assess the prescribing patterns and cost-utility analysis of management of childhood asthma in Saudi Arabia. Methods Prescription data were collected for 1 year from electronic records of pharmacy. The unit dose price was retrieved from pharmacy database and compared with daily price based on WHO Defined Daily Dose (DDD) and Saudi Initiative for Asthma (SINA). The cost of each drug is calculated from average prices of each unit dose of each prescription. Key findings In male children (57.98%), asthma was more common in comparison to female children (41.02%) at the studied hospital. Salbutamol (44.55%) was the most commonly prescribed medication followed by budesonide (30.97%) and montelukast (12.82%), whereas prednisolone (0.15%) was the least prescribed medication for the management of childhood asthma. It was found that fixed-dose combination of budesonide and formetrol prescribed for the longest duration of therapy (30 days) and imposed highest cost as well [197.10 SR (52.53 USD)] among all the prescribed medicine. Conclusion In this study, inhalation route is the most preferred one for management of asthma; this may be due to their fast therapeutic action. Salbutamol was the most popular drug for quick reliever therapy, while budesonide was the most favoured drug for childhood asthma management. Medication prescribed for the management of childhood asthma at the mentioned study centre adhere to SINA guideline.

We have carried out a survey among Healthcare professionals in the perceptions and attitude towards COVID-19 and also attempted to reach a few conclusions in the form of recommendations. A questionnaire based online survey was conducted between 1st April 2020 and 30th May 2020. 97.20% (p

Osmund Bopearachchi and Suchandra Ghosh, eds, Early Indian History and Beyond: Essays in Honour of B. D. Chattopadhyaya. New Delhi: Primus Books, 2019, 561pp.

Objective: The study was aimed to evaluate utilization and adherence to guidelines recommended in the use of statins for management of cholesterol and their cost utility analysis in a clinical setting in Saudi Arabia. Materials: A cross-sectional retrospective study was conducted in a private hospital in Saudi Arabia. World Health Organization (WHO) Defined Daily Dose (DDD) was used to compute the Daily price of each statins. Results: The utilization of statins is higher in males, Saudis and people with the age group 40-59 as compared to females or non-Saudis or other age groups. Over all, Atorvastatin was the most preferred statin therapy followed by Rosuvastatin, Simvastatin and Fluvastatin. The average cost unit wise was found to be highest for Atorvastatin SR 5.58 (USD 1.49) being lowest for Rosuvastatin SR 4.02 (USD1.07). Conclusion: The study aimed to evaluate the use of statins for management of cholesterol is found to be consistent with international guidelines given by ACC/AHS. Our study suggests having further research to fully understand the barriers to guideline adherence to have improved utilization and considerably neutral cost effects of statins for all.

Objective: Chief aim of the current study was to draw attention in the prescribing pattern and utilization of PPIs in one year at a single private hospital of Saudi Arabia. Methods: This is a cross-sectional, retrospective drug utilization research on Proton pump inhibitors (PPIs). The PPI usage pattern of in- and out- patients of Al-Mana Group of Hospital (AGH) Al-Khobar between January 1, 2019 and December 31, 2019 were investigated, including incidence, prevalence, and duration. Results: We observed 27229 items of PPI were dispensed in the inpatient and outpatient pharmacy department of AGH-Al-khobar. Among all the PPI user more than the half {(52.98%, n = 14426), 95%CI (52.0-53.5)} were male. Nearly equal number of PPI users belongs between 18-40 years {(39.22%, n =10680), 95%CI (38.64-39.80)} and 41-60 years {(39.15%, n =10662), 95%CI (38.6-39.75)}. Among all the PPI users 61.46% (n=16736) were from community of Saudi Arabia while 38.53% (n=10493) from Non-Saudi. Among all the dispensed PPIs drugs Pantoprazole is dispensed to the highest number of patients {79% (95%CI, 78.53-79.50) (n=21515), p

Objective: To evaluate the drug utilization of Angiotensin Receptor Blocker (ARB) along with their ADRs in a tertiary care hospital. And to monitor, report of adverse drug reaction and drug interactions, if any. Methods: The patients who meet the inclusion and exclusion criteria were enrolled into the study. The pertinent data such as demographic details, drug name, dose, frequency, and laboratory data were gathered from medical records of the patient and results were analyzed. Results: Total of 100 patients were included in this study, the maximum utilization of antihypertensive drug (ARB) was telmisartan (90%) and widely use of ARBs in the age group of 41-50 y. Total 32 ADRs were observed and most probable ADRs included headache (42.8%), Nausea (14.28%) and dizziness (12.5%). Conclusion: Telmisartan was the most prescribed and utilized drug than the other drugs of ARBs. Maximum ADRs were noted in females, the most frequent ADRs headache, nausea and dizziness were reported. The majority of reactions were probable on causality assessment done by WHO-UMC and Naranjo’s scale having mild severity. So it can be concluded that considering risk factors, prevention and management of ADRs can drastically improve the therapeutic outcomes of the patients.

Objective The study was aimed to evaluate the cost and drug utilization pattern of anticoagulant drugs in a clinical setting in Saudi Arabia. Method A cross-sectional retrospective study was conducted in a private hospital in Saudi Arabia. World Health Organization, defined daily dose, and American Society of Hematology methods were used to compute the daily price of each anticoagulant agent. Key findings Consumption of oral anticoagulants was very less as compared to the parenteral. Apixaban was the most prescribed oral drug, while enoxaparin sodium was the drug of choice among the parenteral. In oral anticoagulants, the unit-wise cost was found to be highest for Rivaroxaban (12.60 SR (3.36 USD) and less for Warfarin (0.82 SR (0.22 USD)). Heparin sodium cost (51.62 SR (13.76 USD) was found to be the most expensive parenteral agent while the least expensive was Phytomenadione (3.76 SR (1.00 USD)). Conclusion Apixaban was the preferred oral anticoagulant among all the studied anticoagulants, although Warfarin is the cheapest. Therapeutic drug monitoring was recommended for Warfarin. The study highlights the importance of more studies to measure the advantages and disadvantages of all types of anticoagulants.

Objective: In the given study, we have carried out a survey among general population of Delhi NCR (India) for the knowledge, perceptions, and attitude toward coronavirus disease (COVID-19) and also attempted to reach to a few conclusions in the form of recommendations. Methods: A cross-sectional questionnaire based online survey (using Google Forms) was conducted between April 2020 and May 2020 to investigative knowledge, perceptions, and attitude toward COVID-19. Chi-square test was used for the computation of p-value. Results: There were total 823 respondents, with 43.01% females and 56.98% males. Around 73.74% respondents believe that it has become a social stigma. About 75.09% were of the opinion that sneezing etiquettes can help in curbing the infection. About 93.43% of study population follows the personal hygiene, 24.78% wished to get insurance coverage. Similarly, interesting data were collected over different aspects of COVID-19. Conclusions: The current pandemic is the first exposure at such a large scale to the existing population but with the progression of time, authorities and general population are collating knowledge about the same. It is to be fought at all the fronts such as medical, social, economic, and psychological. Hence, this type of survey becomes an important tool in decision making.

Objectives Mentioned study is carried out to assess the prescription pattern, utilization of drug and cost analysis of antihypertensive medications used in the treatment of hypertension in a private hospital in Saudi Arabia. Methods A retrospective cohort study was carried out in a private hospital in Saudi Arabia. Cost analysis and patterns of outpatient and inpatient antihypertensive drugs used among hypertensive patients between 1 January 2019 and 31 December 2019 were investigated, including incidence, prevalence, duration of use of therapy, class of antihypertensive drugs and therapy for cost-effective use. Key findings Monotherapy (78.32%) was leading trends of antihypertensive therapy that followed fixed dose combination with or without multidrug therapy (21.68%). The most frequent antihypertensive class to be prescribed was nonselective beta-blockers (39.36%) followed by calcium channel blockers (16.51%). The status in terms of cost utilized average per unit was the highest for telmisartan (3.371 (0.90) SR (USD)). The propranolol was most cost-effective (average cost per unit 1.43 (0.38) SR) in relative to the other antihypertensive prescribed. Conclusion Our study suggested that the prescription pattern of drugs used for the treatment of hypertension adhered with the JNC 8 guidelines. Monotherapy was reliably more recommended in the initial stages of hypertension. Higher percentage of patients (78.32%) was found to be on monotherapy. The Saudi Food and Drug Authority (SFDA) has overwhelmed for fixation of prices of drugs.

Objective To evaluate the use of proton-pump inhibitors (PPIs) for treatment of different gastric disease in Saudi population and their related administration cost. Materials and methods It was a cross-sectional retrospective drug utilization study. The utilization rates and cost analysis of each PPIs class of drugs were compared. Study data were obtained from pharmacy database. Data between 1 January 2019 and 31 December 2019 were investigated, including incidence, prevalence and duration of use of proton-pump inhibitors among adults of Saudi Arabia. Key findings We observed 26 798 (4.27%) prescription of PPIs were dispensed in the in-patient and out-patient pharmacy department of Al-Mana Group of Hospital (AGH) Al khobar. Among all the PPIs user, more than the half ((53.01%, n = 14 208), 95% CI (52.42–53.62)) were male. 30–40 years age patients (24.57%, 95% CI (24.06–25.09) (n = 6585)) were highest number of PPI users. Nearly, equal number of PPI users belongs between 51–60 years ((20.88%, n = 5596), 95% CI (20.40–21.37)) and >60 years ((20.36%, n = 5456), 95% CI (19.8–20.85)). Among all the dispensed PPIs drugs, Pantoprazole is dispensed to the highest number of patients (79.09% (95% CI, 78.61–79.58) (n = 21 197)) while their average duration of therapy was 18.86 days. Among all PPIs, pantoprazole average unit wise cost was highest SR 8.83 (USD 2.35) in comparison to other PPIs. Conclusion In our study, among all the PPIs Pantoprazole was prescribed to the highest number of patients also it was costliest; hence, their safe and effective use must be warranted. Current study will also help in to develop nation database regarding utilization of proton-pump inhibitors.

Objectives: The current study aims to assess general public knowledge and perception toward ADR reporting systems in Eastern province, Saudi Arabia. Methods: A cross-sectional survey based study was conducted from 1st September 2019 to 31st October 2019 among the community in Eastern province, Saudi Arabia. A validated self-administered questionnaire were distributed among easily approachable 1500 participants through social media in which 1038 respondents were completely filled the survey form. Chi square test were used for the calculation of variance among the group. P-value less than and equal to 0.05 is considered statistically significant. Results: The response rate of survey was 69.20%. The mean age of the survey respondents were 30.5± 8.37years. Among all the respondents 335(32.27%) respondents were male and 703(67.72%) respondents were female from community of Eastern province, Saudi Arabia. Only, 7.61% of the respondents were familiar with the Saudi National Pharmacovigilance Centre (NPC) (p Key words: ADR (Adverse Drug Reaction), Saudi National Pharmacovigilance Centre (Saudi NPC), Eastern province, Knowledge, Perception, Saudi Arabia.

Objectives: In the current study, we have evaluated pharmacy undergraduate student’s knowledge and perceptions towards this class of drug products. Methods: A random survey of 349 pharmacy students of six different pharmacy colleges from north India was carried out on an online-based questionnaire system to investigative knowledge and attitude towards biological/biosimilar. Chi-square test was used for the computation of p-value. Results: Out of 349 students, 80.22% of students have good knowledge about the same. 44.12% responded that the products are generally safe while 60.74% responded that these products don’t produce any kind of adverse drug reaction. 62.18% students were not updated about ADR reporting system in India. But the students think that its knowledge is important but the educational training has been inadequate. Conclusion: Due to unawareness about biological products, there is a need to address the knowledge gap in graduating pharmacy students. Lack of knowledge could be overcome by upgrading the curriculum or through professional development courses. Key words: ADR (Adverse Drug reaction), Biosimilars, Perception, Pharmacy student.

Objectives: This study aimed is to identify treatment pattern and awareness of migraine in Eastern provinces of Saudi Arabia. Methods: The survey questionnaire used to assess the awareness and treatment pattern of migraine was adopted from previous study. The questionnaire contains three sections. The first section contained of items related to demographic information of the participants. The second section contains to assess the knowledge of participants towards migraine. The third part of questionnaire contains about different types of therapy used in treatment of migraine. Results: Overall awareness of migraine among participants from Eastern Provinces of Saudi Arabia is 81.81%. 98.60% participants have heard about the migraine. Nearly 40% of participants are suffering from migraine and main cause of it is stress and tension. Panadol and Brufen drugs were used by almost migraine patient. Although few migraine patient were also used Rapidus. Conclusion: There is higher occurrence of migraine in women than in men by ratio of 12:1. Despite of having good knowledge of migraine (81.81%), only 39.16% participants know about the causes of migraine and only 26.80% of participants know about the preventive measures of migraine. Thus educational and preventive health campaigns are needed all over the Saudi Kingdom.

Highlights • Monitoring of liver function tests is very important in patient receiving DOT therapy. • There was no significance difference reported in the differential leucocytes count. • We define mechanisms underlying the adverse drug reactions observed following DOTS. • The plasma INH concentration was reported to be high in slow acetylation. • Plasma INH concentration greater than the antimode are slow acetylator., Isoniazid is the most commonly used drug for treatment of tuberculosis, and is administered individually or in combination with other drugs as standard first line therapy. Offsetting its efficacy, severe adverse effects, especially peripheral neuropathy and hepatotoxicity, are associated with isoniazid therapy, limiting its use in tuberculosis. Isoniazid is acetylated in vivo producing hydrazine and acetyl hydrazine, which are responsible for hepatotoxicity. Marked pharmacogenetic differences in acetylation have been reported among different population across the globe. This study evaluates isoniazid acetylation patterns in tuberculosis patients receiving DOT therapy under the Revised National Tuberculosis Control Program (RNTCP) in a specialized tuberculosis hospital in north India. Of 351 patients from whom samples were taken for biochemical analysis of adverse events, 36 were assessed for acetylation patterns. Blood samples were taken 1 h after administration of a 600 mg dose of isoniazid, and plasma concentrations of isoniazid were determined using a validated HPLC method. Of these 36 patients, 20 (55.56%) were slow acetylators and 16 (44.44%) were fast acetylators. Our results are consistent with those of an earlier study conducted in a different region of India. Most biochemical changes produced during long-term isoniazid therapy resolve after therapy is terminated.

Objectives: The current study aims to assess community pharmacist’s knowledge, practice and barriers towards ADR reporting systems in the Dammam, Saudi Arabia. Methods: A cross-sectional study was conducted from 1st August 2019 to 31st October 2019 among the Community pharmacies in the Dammam, Saudi Arabia. 101 easily approachable community pharmacists participated in study. Results: The survey was sent to the 150 community pharmacists (CP), while only 101 surveys were received completely filled, the response rate of survey was 67.33%. The mean age of the survey respondents were 35.2±6.66 years. Among all the respondents 73(72.27%) were male and 28(27.73%) were female. Mean years of experience was 7.5±3.37. Overall, 90 (89.1%) respondents familiar with the term Pharmacovigilance (p Key words: ADR (Adverse Drug Reaction), Community pharmacist, Dammam, Knowledge, Saudi Arabia.

This study examines market efficiency in the light of the simple moving average technical trading rules on daily closing share prices of 100 companies listed on Pakistan Stock Exchange over ten years from 2006 to 2015. The results show strong support for simple moving average rules having both predictability and profitability for PSX. It refers that the returns from these rules are not same as investors earn from a naïve buy and hold strategy. The uses of these simple moving average rules produce abnormal returns to investors and hence nullify the weak form of efficiency on PSX.

Highlights • Tuberculosis (TB) treatment regimens can have serious adverse drug reactions that require monitoring. • This report describes adverse drug reactions associated with Directly Observed Treatment Strategy (DOTS) protocols. • We define some mechanisms underlying the adverse drug reactions observed following DOTS. • Although males are more likely to have TB, gender did not affect the development of adverse drug reactions. • Although DOTS therapy does require monitoring, it is a highly effective treatment for tuberculosis., Purpose Understanding the appearance of anti-tubercular drug-related adverse drug reactions (ADRs) in patients receiving tuberculosis (TB) treatment is important, and may be related to morbidity and mortality if not recognized early. Here, we aimed to characterize the mechanisms underlying adverse drug reactions due to combination anti-tuberculosis therapy of the Revised National Tuberculosis Control Program (RNTCP). Methods This was a prospective observational study conducted in 9 DOTS centers of New Delhi, India. All enrolled TB patients receiving first-line tuberculosis treatment as per RNTCP guidelines were monitored for ADRs. All ADRs that appeared during the treatment were recorded and analyzed. Results The study included 1011 TB patients on anti-TB treatment under DOTS. According to Naranjo’s probability scale, of a total 351 (34.72%) reported adverse events, 102 (10.09%) were definite, 59 (5.83%) probable, 123 (12.17%) possible, and 67 (6.63%) doubtful. On the Hartwig severity scale, of the 351 adverse drug events, 225 (22.26%) were mild, 105 (10.38%) were moderate, and 21 (2.08%) were severe. Out of 102 reported adverse drug reactions, 81 (79.41%) were moderate and 21 (20.59%), while 65.28% did not experience any ADRs. Conclusions Directly Observed Treatment (DOT) is effective and safe compared to daily treatment regimens. Patients receiving DOTS therapy needed close monitoring for adverse events. Therefore, a pharmacovigilance program should be added at the National level to accesses the adverse event incidence.

Rethinking Early Medieval India: A Reader. Edited by Upinder Singh. Delhi: Oxford University Press, 2011. Pp. xiv + 354. Rs. 1240.