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Background Community pharmacists' role in the primary health care, patient-centered services, beyond traditional dispensing services is well established in the developed world. However, this role is not fully established in low-middle-income countries including Pakistan. Objective To explore community pharmacists' perspectives and preparedness about practice change and associated facilitators and barriers to extended services. Setting A study was conducted involving community pharmacists of Lahore, Pakistan. Method Two phased studies were conducted using mixed-method sequential design. The first phase involved qualitative semi-structured face-to-face interviews with the community pharmacists, while the second phase constituted a questionnaire-based cross-sectional study. Main outcome measure Pharmacists' perspectives about extended pharmacy services, facilitators, barriers and preparedness for the practice change. Results For the first phase, pharmacists were purposively sampled and the saturation yielded a final sample size of fifteen pharmacists (N = 15). The thematic content analysis yielded four distinct themes; (1) current practices and familiarity with extended pharmacy services (2) practice gap between Pakistan and the developed countries (3) facilitators and the preparedness, and (4) barriers towards its implementation and provision. The second part was a questionnaire-based cross-sectional phase, where a total of 348 community pharmacists were approached, while only 242 responded, yielding a response rate of 69.5%. The triangulation of qualitative and quantitative data identified several barriers such as; shortage of pharmacists, lack of knowledge and skills, poor collaboration with general practitioners, failure of customers to pay for extended services. Facilitators and preparedness for the provision of extended pharmacy services were; access to patient notes, follow-up, separate counselling areas, accreditation of specific services and sufficient resources. Conclusion This study's findings call for the implementation and enforcement of Punjab Drug Sale Rules 2007 to facilitate the practice change and provision of comprehensive pharmacy services in Punjab, Pakistan. There is a need for additional laws to define community pharmacists' roles, uniform job description, training, new funding model, separate area, and accreditation of extended pharmacy services in Pakistan.

Breast cancer (BCa) has become the leading cause of death in women worldwide. Irrespective of advancement in cancer treatments, e.g., surgery, radiation, chemotherapy, hormonal therapy, immunotherapy, and targeted therapy, recurrence leading to metastasis poses the greatest threat in BCa management. BCa receptors estrogen (ER), progesterone (PR), and human epidermal growth factor receptor-2 (HER2) hold significant reputations as prognostic and predictive biomarkers in therapeutic decision-making. Under normal physiological conditions, these receptors modulate critical biological functions, e.g., cell migration, proliferation, and apoptosis events, etc. However, aberrant expression causes deviations, triggering signaling course to adapt permanent switching "ON" mode. The later events induce rapid and unrestrained proliferation leading to cancer. As conventional ways of cancer management ultimately lead to resistance; therefore, recently targeted therapies have been extensively studied to conquer resistance. Targeting various small molecules in downstream signaling has become an area of interest in scientific society. The severity of cancer converts many folds soon after it takes on a migratory approach that eventually commences metastasis. Cancer migration comprises protrusion of cytoplasm at the leading edge of the migration forward-facing, establishing adhesions with the basic cell-matrix, disassembly of the adhesions at the back end of the cell, and actin-myosin fiber contractions to pull the bulk of the cytoplasm forward. On the other hand, metastatic progression comprises a cascade of events, including invasion, migration, and establishment of tumor microenvironment. The progression of BCa from early stage to metastatic development causes remarkable heterogeneity. Interference at any explicit level could hamper the process, and it has thus become an area of interest for scientists. Metastasis is the ultimate cause of spreading tumor cells to invade distant organs. Recently small molecule inhibitors of protein tyrosine kinases, which can cross the blood-brain barrier, have become a center point of research for investigators in developing novel treatment strategies against BCa management.

Usman Rashid Malik,1– 3 Jie Chang,1– 3 Furqan Hashmi,4 Naveel Atif,1– 3 Hareem Basir,5 Khezar Hayat,1– 3,6 Faiz Ullah Khan,1– 3 John Alimamy Kabba,1– 3 Krizzia Lambojon,1– 3 Yu Fang1– 3 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China; 2Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China; 3Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China; 4University College of Pharmacy, University of the Punjab, Lahore, 54000, Pakistan; 5Royal Albert Edward Infirmary, Wigan, WN1 2NN, UK; 6Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, 54000, PakistanCorrespondence: Yu FangDepartment of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of ChinaTel +86-29-8265-5132Fax +86-29-8265-5424Email yufang@mail.xjtu.edu.cnIntroduction: The excessive consumption of antibiotics is a significant contributor to antimicrobial resistance, especially in children. Children are often advised antibiotics for viral infections. In developing countries, drugstores are a prime source of easy access to nonprescription antibiotics. Moreover, in Pakistan, their irrational use is an “everyday routine”. The study, therefore, aimed to evaluate the dispensing of nonprescription antibiotics to children.Methods: Using pediatric acute diarrhea and acute upper respiratory infection as disease scenarios, a simulated client, cross-sectional study was conducted in Lahore, Pakistan, to explore the antibiotics’ ease of availability at both categories of drugstores (pharmacies and medical stores) from November 1st, 2019 to January 31st, 2020. Chi-square (χ2) test was used to compare the differences in practices of different categorical variables. Multivariable logistic regression was applied to analyze the association of various factors with antibiotics dispensing.Results: Antibiotics were dispensed without prescription in 456 (59%) of 773 simulated visits out of which 425 (93.2%) were dispensed on the advice of the drugstore staff. A qualified pharmacist was available in only 164 (21.2%) cases. Of the 386 visits for acute diarrhea and 387 for acute upper respiratory infection, nonprescription antibiotic dispensing occurred in 259 (67.1%) and 197 (50.9%) visits, respectively. There were considerable differences (p-value < 0.05) in the practices and antibiotics dispensing between each disease scenario presented. Moreover, antibiotics were less commonly dispensed at pharmacist-supervised drugstores compared to unsupervised ones.Conclusion: Overall, inappropriate dispensing practices were prevalent to a large extent at the drugstores, and antibiotics were effortlessly obtainable without prescription. The quality of the services provided, especially by the non-pharmacist staff, was also not satisfactory. Therefore, the Drug Regulating Authority of Pakistan must enforce strict implementation of drug laws at the drugstores without delay, especially in major cities to help curb the felonious use of antibiotics.Keywords: antibiotics, nonprescription, drugstores, community pharmacies, simulated client, Pakistan

Background: The use of antimicrobials and their acquisition from pharmacies without prescription is on the rise in low-and middle-income countries contributing towards the emergence of antimicrobial resistance (AMR). The study aims to determine factors influencing the non-prescription dispensing of antibiotics from community pharmacies and implications in AMR.Methods: A questionnaire-based cross-sectional survey was conducted from January 2019 to September 2019 in Lahore city of Pakistan. The data were analyzed using a statistical package for social sciences (SPSS) version 22. The association of the knowledge, attitude, and practice with demographic parameters were determined using correlation and chi-square test.Results: The majority of the respondents were male pharmacists (84.5%) working as staff pharmacists (45.5%). Among the respondents, 75.9% considered AMR as a global health threat, however, 52.1% facilitated antimicrobial dispensing without prescriptions. Respondents stated that non-prescription antimicrobial dispensing was to make medical consultation easy (42%) and satisfy the demand of the patients (30.1%). Yet participants recognized the value of patient education concerning drug interactions 42.6%, culture and sensitivity test 31.5%, and full course of antimicrobials 40.8%. Participants were not agreed to dispense antimicrobials in cold and flu (58.1%), influenza (57.8%), abdominal pain (50%), and fever (60.7%). They practiced dispensing in diarrhea (62.2%), urinary tract infections (68.1%), ear infection (56.9%), and sore throat (64%). For qualification with all knowledge variables, a significant association was obtained. For marital status and qualification with practice variables, P-value was found significant.Conclusion: Interventions should be done to halt these irrational practices which have a negative impact on public health. Educational interventions are required for the public. Strict enforcement of rules and regulations, Drug Sale Rules 2007, and implementation of Pakistan’s National Action Plan on AMR is required.

Additional file 1. Supplementary data.

Additional file 1:. 1. Anti-inflammatory activity. 2. Analgesic activity (central). 3. Analgesic activity (central). 4. Analgesic activity (central). 5. Anti-Proliferative activity.

Background The excessive consumption of antibiotics is a major contributor to antimicrobial resistance, especially in children. Children are often being advised antibiotics for viral infections. In developing countries, the drugstores are a prime source of easy access to nonprescription antibiotics. Also, in Pakistan, their irrational use is an “everyday routine”. The study, therefore, aimed to evaluate the dispensing of nonprescription antibiotics for children at drugstores of Lahore, Pakistan.Methods Using the pediatric acute diarrhea and acute upper respiratory infection as disease scenarios, a simulated client, cross-sectional study was conducted in Lahore, Pakistan to explore the antibiotics’ ease of availability at both categories of drugstores (pharmacies and medical stores) from November 1st, 2019 to January 31st, 2020. Chi-square (x2) test was used to compare the differences in practices of different categorical variables. Multivariable logistic regression was applied to analyze the association of various factors with antibiotics dispensing.Results Antibiotics were dispensed without prescription in 456 (59%) of 773 simulated visits out of which 425 (93.2%) were dispensed on the advice of the drugstore staff. The qualified pharmacist was available in only 164 (21.2%) cases. Of 386 visits for acute diarrhea and 387 for acute upper respiratory infection, nonprescription antibiotic dispensing occurred in 259 (67.1%) and 197 (50.9%) visits respectively. The considerable differences (p-value < 0.05) were observed between the practices of the towns, disease scenario presented, categories of drugstores, and pharmacist-supervised drugstores. Conclusions The inappropriate dispensing practices were prevalent to a large extent at the drugstores and antibiotics were effortlessly obtainable without prescriptions. The quality of the services provided, especially by the non-pharmacist staff, was also not satisfactory. Therefore, the Drug Regulating Authority of Pakistan must enforce strict implementation of drug laws at the drugstores without delays especially in major cities to help curb the felonious use of antibiotics.

ObjectiveTo evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability.DesignTwo cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology.SettingFour districts of Lahore division, Pakistan.Participants16 public sector hospitals and 16 private sector retail pharmacies.MeasuresThe pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days’ wages required to get a standard treatment by the lowest paid unskilled government worker.ResultsThe overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%–58.3% and 20.3%–32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019.ConclusionsThe availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, the drug pricing policy must be reviewed to ensure access to essential medicines.

Background: Adverse drug reactions (ADRs) are one of the leading causes of mortality and morbidity. Avoiding adverse reactions requires comprehensive knowledge about how they can be monitored, controlled, and reported. Objectives: The current study aimed to evaluate the knowledge, attitude, practices, and perceptions of the health care professionals concerning the adverse drug reactions monitoring and reporting in Lahore, Pakistan. Methods: A prospective cross-sectional study was conducted in Lahore, Pakistan, from October 2018 to December 2018. Descriptive statistics were obtained and the Pearson chi-square test was used to analyze the association between categorical variables. Results: In total, 150 pharmacists, physicians, and nurses were approached, that 40, 39, and 46 of them responded, respectively. Almost 95% pharmacists, 17.3% of nurses, and 58.9% of physicians correctly defined the “pharmacovigilance”, while 70, 10, and 30.5%, respectively, defined ADRs correctly. The current study revealed that 87% of pharmacists, 82.5% of physicians, and 82.6% of nurses had a history of identifying ADR in patients. Out of which only 52, 41, and 19% of pharmacists, physicians, and nurses had a history of reporting adverse drug reactions, respectively. Conclusions: This study revealed inadequate knowledge of health care professionals. Most healthcare professionals were motivated to report identified ADRs. However, the responsibility lies with the governing authorities to provide them with a suitably efficient platform to practice proper ADR reporting and monitoring. Educational campaigns and training, financial incentives, and simplification of the reporting process might change the levels of knowledge and attitude.

In the current outbreak of novel coronavirus (COVID-19), healthcare professionals (HCPs) have a primary role in combating the epidemic threat. HCPs are at high risk of not only contracting the infection but also spreading it unknowingly. It is of utmost importance to evaluate their knowledge, attitudes, and practices (KAP) and the ability to assess the risks associated with the outbreak. A cross-sectional online survey involving physicians, pharmacists, and nurses was conducted. A 39-itemed questionnaire based on the World Health Organization (WHO)COVID-19 risk assessment tool was shared with healthcare professionals in three purposively selected key divisions of Punjab province. Out of 500 healthcare professionals, 385 responded to the survey. The majority (70%) were aged 22&ndash, 29 years, 144 (37.4%) physicians, 113 (29.4%) nurses, and 128 (33.2%) pharmacists completed the survey. Overall, 94.8% of healthcare professionals scored adequately (&gt, 14) for COVID-19-related knowledge, 97.9% displayed an optimistic attitude (&gt, 42) and 94.5% had an adequate practice score (&gt, 28). Kruskal&ndash, Wallis and Jonckheere&ndash, Terpstra tests showed significant differences (p &lt, 0.05) in KAP and risk assessment scores among groups, physicians and nurses scored higher as compared to pharmacists. Further research and follow-up investigations on disaster management and risk assessment can help policy-makers better tackle future epidemics.

Background: Developing countries, such as the Philippines, started implementing policies to improve access to medicines, which is a vital step toward universal healthcare coverage. This study aimed to evaluate the prices, availability and affordability of prescribed medicines for diabetes, hypercholesterolemia and hypertension with the exemption of 12% value-added tax in the Philippines. Methods: The prices and availability of 50 medicines were collected in August 2019 from 36 public and 42 private medicine outlets in six regions of the Philippines, following a modified methodology developed by the World Health Organization and Health Action International. Availability is reported as the percentage of outlets in which the surveyed medicine was found at the time of visit. Medicine prices are expressed as median unit prices (MUPs) in Philippine Peso. Affordability is calculated based on the number of days&rsquo, wages required for the lowest-paid unskilled government worker to purchase a monthly treatment. Results: The mean availability of surveyed medicines was low in both public and private sectors, with 1.3% for originator brands (OBs) and 25.0% for lowest-priced generics (LPGs) in public outlets, and 34.7% and 35.4% in private outlets, respectively. The MUP of medicines were higher in private outlets, and OBs have higher unit price compared to the generic equivalents. Treatments with OBs were unaffordable, except for gliclazide, but the affordability of most LPGs is generally good. Conclusion: Access to medicines in both sectors was affected by low availability. High prices of OBs influenced the affordability of medicines even with tax exemption. A review of policies and regulations should be initiated for a better access to medicines in the Philippines.

Objective: Inappropriate use of antibiotics is one of the main causes of antibiotic resistance around the globe. The present study was aimed to assess the knowledge, attitude, and practices toward antibiotics and antibiotic resistance among consumers. Methods: A cross-sectional study was conducted from April 2019 to September 2019. The participants visiting community pharmacies to buy the antibiotics were approached by data collectors. The descriptive analysis, Kruskal Wallis, and Mann-Whitney statistical tests were used for data analysis through SPSS. Results: 399 participants at three pharmacies with male (n = 352, 88.2%), age (years) group between 34 to 41(n = 138, 34.6%), uneducated (n = 128, 32.1%), and higher education (n = 76, 19.0%) level of the participants were noted. Poor to moderate knowledge were observed; participants were unaware of the risk and misuse of antibiotics at all three pharmacies. By some means, a positive attitude noted, but the storage of antibiotics at home (Median = 2, IQR = 2) was preferred to use when needed. Most of the respondents didn’t follow the actual dosage regimen as prescribed (n = 266, 66.7%, p Conclusion: A lack of knowledge and malpractices toward antibiotics use among consumers were observed. Education and awareness of the public about antibiotic resistance is the need of the hour.

BACKGROUND Hypertension is one of the leading risk factors for ischemic heart diseases, and high rates of hypertension prevalence have either remained the same or increased in developing countries in recent years. Unfortunately, about 20% to 50% of patients with chronic diseases have been nonadherent to their drug therapy. SMS text messaging and pharmacy student–led consultations have the potential to help patients manage their blood pressure (BP). OBJECTIVE The aim of this study was to assess the effectiveness, feasibility, and acceptability of SMS text messaging and consultation to manage the BP of Chinese patients with hypertension. METHODS We conducted a two-arm cluster randomized controlled trial among patients with hypertension in Xi’an City, Shaanxi Province, China, and recruited 384 patients from 8 community health care centers. Patients were randomized into an intervention group to receive SMS text messages and consultations or into a control group to receive usual care for 3 months. We sent SMS text messages at 3-day intervals and collected data at baseline (including demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge about hypertension, BP, and medication adherence) and the 3-month follow-up (including BP, medication adherence, and knowledge about hypertension). RESULTS We assessed 445 patients with hypertension and excluded 61 patients who were not eligible or who had not filled out their questionnaires. The mean age of the patients was 68.5 (SD 7.9) years in the intervention group and 69.4 (SD 9.7) years in the control group, and the sample was primarily female (265/384, 69.0%). Patients in the intervention group showed significant improvements in systolic BP (SBP; mean 134.5 mm Hg, SD 15.5 mm Hg vs mean 140.7 mm Hg, SD 15.2 mm Hg; P=.001), medication adherence (mean 7.4, SD 1.2 vs mean 7.0, SD 1.3; P=.04), and knowledge about hypertension (mean 6.3, SD 0.9 vs mean 5.9, SD 1.2; P=.004) compared with those in the control group. In measures of diastolic BP (DBP), the two arms showed nonsignificant improvements (mean 78.2 mm Hg, SD 9.0 mm Hg vs mean 77.2 mm Hg, SD 10.3 mm Hg; P=.06). In total, 176 patients had controlled BP at the 3-month follow-up (98 patients in the intervention group vs 78 patients in the control group), but it was nonsignificant (P=.08). CONCLUSIONS The use of SMS text messaging and consultation to manage SBP and improve medication adherence is effective, feasible, and acceptable among Chinese patients with hypertension, although a significant difference was not observed with regard to DBP. It is important to maximize the potential of SMS text messaging and consultation by increasing the feasibility and acceptance of mobile interventions and conduct a cost-effectiveness analysis on this method. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1900026862; http://www.chictr.org.cn/showproj.aspx?proj=42717.

Background Influenza-associated excess death occurred most in the elderly. We aimed to assess the cost-effectiveness of quadrivalent influenza vaccine (QIV) versus trivalent influenza vaccine (TIV) for prevention of influenza infection among elderly population in China. Methods A decision-analytic model was developed to compare 1-year clinical and economic outcomes of three influenza vaccination options (no vaccination, TIV, and QIV) in a hypothetical cohort of Chinese elderly aged 69 years. Outcome measures included cost, influenza infection rate, influenza-related mortality rate, quality-adjusted life-years (QALY) loss, and incremental cost-effectiveness ratio (ICER) from societal perspective. Sensitivity analyses were performed to examine the uncertainty of model inputs. Results Base-case results showed no vaccination was dominated (more costly at higher QALY loss) by TIV and QIV. QIV was more costly (USD56.29 versus USD54.28) with lower influenza infection rate (0.608 versus 0.623), mortality rate (0.00199 versus 0.00204), and QALY loss (0.01213 versus 0.01243) than TIV. QIV was cost-effective compared to TIV with ICER of 6,700 USD/QALY below the willingness-to-pay threshold (29,580 USD/QALY). One-way sensitivity analysis found the cost-effectiveness of QIV was subject to the relative risk of vaccine effectiveness of QIV versus TIV, and TIV would be cost-effective if the relative risk was below 1.05. In 10,000 Monte Carlo simulations, the probabilities of QIV, TIV, and no vaccination to be cost-effective were 86.3%, 13.7%, and 0%, respectively. Conclusion QIV appears to be a cost-effective option compared to TIV and no influenza vaccination for elderly population in China.

Purpose: Patient satisfaction can identify specific areas of improvement in community pharmacy services. Currently in Pakistan, no evidence exists in this regard. This study was conducted to determine the needs of patients and the current standards of pharmacies. Methods: A cross-sectional study was conducted between October 2016 and June 2017. A pilot tested questionnaire was used to collected the data from 1088 patients of 544 community pharmacies. Likert scale and one way ANOVA was used to analyze the data. Results: The response rate of community pharmacies was 80% and that of purchasers was 68.1%. The mean age of participants was 35.2 years. The mean overall satisfaction score of participants was 2.78/5.00. Many patients were dissatisfied (1.65/5.00) with parking facilities provided by pharmacies. Pharmacy service time fulfilled the requirements of most patients (4.16/5.00). The counseling person’s good attitude (3.99/5.00) was credited by purchasers. Level of patient satisfaction with the availability of medicines (3.19/5.00), safe storage of medicines in pharmacy stores (3.66/5.00), and quality of medicines (3.41/5.00) were almost moderate. Many patients were very satisfied (4.35/5.00) with readable instructions for their medications. Approximately half of the patients were dissatisfied with the waiting time. Many patients were also dissatisfied (2.28/5.00) with the knowledge of the counseling person. Patients perceived that staff interest in patient recovery (2.24/5.00) was low. No significant difference in level of satisfaction with regard to participant’s characteristics was found. Conclusions: The current study demonstrated a low level of patient satisfaction with regard to community pharmacy services in Pakistan. These services need improvement.

Background: Low knowledge about diabetes risk factors coupled with high disease prevalence is common in low-resource countries. This study evaluated diabetes-related knowledge, attitudes, and practices in the general population in Punjab (Pakistan). Methods: A cross-sectional study was conducted in five districts in Punjab from January to March 2017. Data were collected from 2019 adults aged 18&ndash, 90 years through face-to-face interviews using a semi-structured questionnaire. The total knowledge score ranged from 0&ndash, 9, a score &ge, 6 was considered adequate diabetes awareness. Descriptive statistics, chi-square tests, and linear and binary logistic regression were used for the analyses. Results: Respondents&rsquo, mean age was 32.92 &plusmn, 11.4 years. In total, 85.9% of respondents had heard of diabetes, and 30.1% knew about the glucose tolerance test. We found 2.3% of respondents scored zero for diabetes knowledge, 11.3% scored 9, and 47.4% scored &ge, 6 (adequate awareness). Being female (&beta, = 0.37, 95% confidence interval [CI]: 0.16, 0.05, p = 0.001), socioeconomic status (&beta, = 0.24, 95% CI: 0.12, 0.36, p &lt, 0.001), being diabetic (&beta, = 0.82, 95% CI: 0.53, 1.10, 0.001), and higher education (&beta, = 0.25, 95% CI: 0.17, 0.33, 0.001) were significantly associated with knowledge score. Respondents with high socioeconomic status showed significantly higher positive attitudes compared with those with low socioeconomic status (adjusted odds ratio 1.57, 95% CI: 1.12, 2.24). Only 8.7% (30/343) of those diagnosed with diabetes had never undergone blood glucose screening since diagnosis. Conclusions: Knowledge of diabetes risk factors, management, and care is low in Pakistan&rsquo, s general population. Targeted public education programs should be instigated at a national level to increase understanding of diabetes prevention and treatment.

Spinal anaesthesia is technique of choice for caesarean sections and hyperbaric bupivacaine is a recommended drug for this popular block. Although safe but few complications are haemodynamic changes, postdural puncture headache, cauda equina syndrome and radiculopathy. However, hypotension remains the common side effect which is believed to occur in 95% of patients resulting in reduction of uteroplacental perfusion causing foetal acid-base abnormalities. Various doses regimes are in safe anaesthesia practice for providing regional anaesthesia for such patients with least detrimental effects on foetal outcome. This study was carried out to find the effective dose of 0.5 % hyperbaric bupivacaine in caesarean section patients by comparing two different doses.After enrolling two hundred patients of C section (Caesarean section) for this study, 90 patients were selected to compare the effects of 0.5% hyperbaric bupivacaine. Group A (n=45) received 10 mg of drug while group B (n=45) received 12 mg for spinal anaesthesia. Onset of block, sensory and motor level, haemodynamic changes, surgery time, maternal satisfaction, Apgar score and incidence of complications were compared in two groups.Blood pressure decreases were less in Group A (p-0.074) but not statistically significant. Phenylephrine for hypotension was given to 17% vs 5% in group B. Maternal satisfaction was found to be better in group B 33 vs 17 but was statistically significant (p 0.034). 2% patients had bradycardia in group A which was treated by atropine. No complications were reported in either group.Doses of hyperbaric bupivacaine for spinal anaesthesia in caesarean sections must be at least 12 mg because it produces excellent anaesthesia and maternal satisfaction without complications.

Background: An adequate level of health literacy is related to positive treatment outcomes. The current study is aimed to examine factors associated with health literacy among cardiovascular patients in Karachi city, Pakistan. Method: The study was designed as a cross sectional, descriptive survey. A pre-validated questionnaire was used for data collection. One hundred and sixty three patients attending the Cardiology Outdoor Patients Department of a tertiary care hospital in Karachi were recruited for the study. Descriptive statistics were used for data elaboration. SPSS v 21.0 was used for data analysis. Results: Out of 163 patients, the cohort was almost equal in term of gender distribution. Sixty-one percent had urban residency of Karachi city and 62 (38.04%) were categorized as elderly patients. Overall, poor health literacy status was reported among the study respondents. Health literacy was evident with patient’s knowledge about medications; knowledge of adverse effects; language barriers and perception about role of exercise in improving quality of life. Conclusion: Poor health literacy was associated with multiple factors that adversely affect patient’s pharmacotherapy plans. Urgent measures by using a collaborative approach of physicians, pharmacist and nurses are required to improve health literacy of Pakistani population.