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Objective: The current research study aimed to access the relationship between obesity and asthma exacerbations and severity among adult patients at the outpatient section of a federal hospital (PIMS) in Islamabad, Pakistan. Methods: A cross‑sectional research study was carried out on 207 asthma adult patients belonging to different areas and ethnic groups from the country. The study setting was the PIMS hospital, which attracts patients from all over the country due to its facilities and cost‑effective treatments. The body mass index (BMI) of asthma patients was calculated using the heights and weights of the study subjects. However, the pulmonary functions were calculated using a computerized spirometer i‑e Spirolab III S/N 303681 in line with Winspiro PRO 7.1.version software. It presents the patient’s forced vital capacity that expires in the first second of expiration to full (FEV1) in comparison to forced vital capacity (FVC) ratio, that is, Tiffeneau–Pinelli index was also recorded to determine the asthma severity. Results: According to recent surveys, the overall prevalence of patients with overweight and obesity was 29.0% and 23.7%, respectively. A Chi‑square test was used, and a statistically significant relationship was observed between BMI and asthma severity (P < 0.001). The adult obese female patients presented poor pulmonary functions. The average FEV1/FVC ratio presented significant variance among four different categories of BMI with P < 0.05. This difference was due to the normal BMI category as the Tiffeneau–Pinelli index, that is, FEV1/FVC in the normal BMI group was significantly lower as compared to that in underweight and obese patients. Conclusion: The study subjects presented raised asthma severity in accordance with the raised BMI. Obese patients presented comparatively raised asthma exacerbations. Moreover, a statistically significant association of gender difference was observed between obesity and asthma severity. It was concluded that adult asthmatic women with obesity presented raised asthma severity as compared to adult asthmatic males. [ABSTRACT FROM AUTHOR]

Background: Asthma is a rapidly increasing chronic respiratory disease worldwide. Inhalation drug therapy plays a vital role in asthma management because of immediate pharmacological response. Currently, a wide range of inhaler devices are being used worldwide, among which Metered Dose Inhalers (MDIs) are most commonly prescribed. Adherence with therapy directly depends upon the patient’s satisfaction with inhalation therapy. The current study aimed to determine the asthma patient’s satisfaction with inhalers. As well as the influence of pharmacist led educational intervention upon inhaler satisfaction of asthma patients. Materials and Methods: The present cross-sectional study recruited 207 physician diagnosed adult asthmatics who were currently using MDI. The patient’s satisfaction with their inhaler was accessed through the study tool- FSI-10 questionnaire. After baseline observations, pharmacist led educational intervention was delivered to asthma patients. The pharmacist personally educated study subjects regarding the proper usage technique and importance of MDIs. Moreover, literature pamphlets containing inhaler technique were provided to patients at the end of intervention. Pre and post intervention satisfaction with inhaler was determined statistically. Results: Majority of the asthma patients (197) i.e., 95.2% were observed to have low satisfaction regarding their pressurized meter dose inhalers. Only 4.8% patients presented high satisfaction with inhaler at baseline. However, patients’ satisfaction with their inhalers was raised from 4.8% to 58.5% as the result of intervention. The univariate analysis of the FSI-10 questionnaire data demonstrates a noteworthy association of the intervention given to patients regarding inhaler usage with its effect on the patients' level of satisfaction with the inhaler. The current study showed p-value of 0.001 (p<0.05) which statistically proves that there is a significant effect of intervention on patients’ level of satisfaction with inhalers. Conclusion: During baseline survey, majority of the patients presented poor satisfaction with their inhaler. But post intervention evaluation presented an enhancement in patient’s satisfaction with inhalers. Concluding that pharmacist led educational intervention proved to be effective in improving the patient’s satisfaction with inhalers. [ABSTRACT FROM AUTHOR]

Introduction: Metered-dose inhalers are the most widely prescribed and dispensed inhaler devices worldwide for the management of asthma. The present study aimed to access the impact of educational intervention on the competency of community pharmacists of Islamabad, Pakistan regarding the pressurized metered-dose inhaler (MDI) technique. Materials and Methods: The intervention involved educating pharmacists practically through placebo inhalers and theoretically through literature brochures; based upon the "National Asthma Education and Preventive Program" inhaler technique. A total of 100 pharmacists were recruited from the rural and urban sectors of Islamabad. A covert simulated patient approach was used to evaluate the inhaler technique of pharmacists. Type of pharmacy, education status of pharmacists and the influence of already received training on the use of inhaler devices were the factors that demonstrated a significant positive association with the competency of pharmacists. Results: McNemar test was applied for pre and post-intervention intragroup comparisons to further access categorical variables. A p-values <0.05 were considered statistically significant. The competency of pharmacists increased significantly from 24% before intervention to 33% after intervention (p<0.001). Conclusion: Originally, the inhaler technique competency of the majority of pharmacy professionals was observed to be inappropriate. However, the educational intervention proved to be effective in substantially enhancing the skill of community pharmacists regarding the MDI technique. [ABSTRACT FROM AUTHOR]

Background: Asthma is rapidly increasing globally. Inhalation therapy is the backbone for asthma management due to localized delivery and rapid onset of action. Currently, metered dose inhalers (MDIs) are the most widely prescribed and dispensed inhaler devices worldwide due to the advantage of portability, multiple dose delivery and better efficacy. Objectives: The current study aimed to access the effect of educational intervention on asthma patients' competency regarding pressurized metered dose inhaler (pMDI) technique. Methods: Asthma patients were recruited from Pakistan Institute of Medical Sciences (PIMS) Islamabad, Pakistan. Inhaler technique steps based upon "National Asthma Education and Preventive Program" (NAEPP) criteria was set as evaluating tool to evaluate competency of asthma patients regarding MDI appropriate technique. Intervention involved educating study subjects (asthma patients) practically through placebo inhaler and theoretically through inhaler technique directed literature brochures. Pre intervention and post intervention inhaler technique competency was accessed and evaluated statistically. Results: Among 207 asthma patients, majority were never instructed by healthcare professional regarding inhaler technique (78.8%). However, most of the patients were observed to have inadequate inhaler technique (76.3%) at baseline. As the result of educational intervention, the competency of patients regarding inhaler technique was significantly enhanced from 11.6% pre-intervention to 34.8% post-intervention (p<0.001), statistically analyzed by McNemar testing. Conclusion: Originally, inhaler technique competency of majority of asthma patients was observed to be inappropriate. However, educational intervention proved to be effective in substantially enhancing the competency of study subjects regarding MDI technique. [ABSTRACT FROM AUTHOR]

Diabetes has become a critical challenge to the global health concerns. Cytotoxicity and development of resistance against available drugs for management of diabetes have shifted the focus of global scientific researchers from synthetic to herbal medications. Therefore, the current study was conducted to investigate the possible anti-hyperglycemic potential of Dryopteris stewartii using Swiss albino mice. To evaluate any possible toxic effect of the plant, acute oral toxicity test was performed while the anti-diabetic effects of aqueous and ethanol extracts at 500 mg/kg, positive, negative and normal control were assessed simultaneously. The anti-diabetic study revealed that aqueous extract has higher anti-diabetic potential than ethanol extract while lowered blood glucose level at second week reaching 150 mg/dL, exerting stronger anti-diabetic effects, compared to ethanol extract (190 mg/dL). Oral glucose tolerance findings revealed that aqueous extract decreased blood glucose level by −0.41-fold, compared to ethanol extract showing a decrease by only −0.29-folds. The histopathological evaluation of liver and pancreas of all groups revealed normal cell architecture with no morphological abnormalities. These results suggested the possible use of D. stewartii as anti-diabetic herbal drug in near future. However, these recommendations are conditioned by deep mechanistic studies. [ABSTRACT FROM AUTHOR]

Background: This meta‐analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) are limited by cost and availability. Methods: We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra‐cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random‐effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra‐cardiac sarcoidosis group as compared with controls, SMD −3.98, 95% confidence interval (CI): −5.32, −2.64, P <.001, also was significantly lower in patients who suffered major cardiac events (MCE), −3.89, 95% CI −6.14, −1.64, P <.001. GCS was significantly lower in the extra‐cardiac sarcoidosis group as compared with controls, SMD: −3.33, 95% CI −4.71, −1.95, P <.001. Conclusion: LVGLS and GCS were significantly lower in extra‐cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS. [ABSTRACT FROM AUTHOR]

Introduction: MINOCA (Myocardial Infarction in non-obstructive coronary artery disease) is a recently described infarct subtype. There are few data that examine CAD (Coronary artery disease), extent MI size and type, and treatment differences at hospital discharge compared to MIOCA (Myocardial Infarction in obstructive coronary artery disease), or sex-specific MINOCA attributes of coronary anatomy and infarct size. Hypothesis: CAD extent, MI size and type, and guideline recommended treatment at hospital discharge are similar in MINOCA and MIOCA pts. Clinical characteristics of MINOCA pts are similar in men and women. Method: Single tertiary-center cohort study of consecutive pts that had coronary angiography for acute MI between 2005 and 2015. MI type at presentation (STEMI vs NSTEMI), MI size (peak cardiac troponin value (cTn) and ejection fraction (EF)) and gender differences in the MINOCA pts were examined. MINOCA was defined by absence of obstructive CAD >50% (n=87) and MIOCA by presence of stenosis ≥50% (n=1611) Result: Among 1,698 cases with acute MI, 87 had MINOCA (5.1%). MINOCA pts were younger, more often had NSTEMI, lower peak cTn values, and greater EF than MIOCA pts. Interestingly, frequency of multi-vessel disease involvement was similar in both groups. At hospital discharge, MINOCA pts less frequently received beta blockers or angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) therapy; 30-day re-admission rates were similar (Table). Women with MINOCA (n=41) had smaller MI's (peak cTn 14 vs 72 ng/ml; p<0.001), higher EF (53% vs 46.5% p=0.002) than the women with MIOCA (n=358) and were significantly less likely to be diabetic, hypertensive or hyperlipidemic. When the 87 MINOCA pts were examined, sex comparisons revealed women were older than men (60 vs 52 yrs., p<0.001), had lower mean peak cTn values (14.2 vs 29 ng/ml, p<0.001), greater EF (56% vs 48%, p=0.02) and more single vessel disease than men (73.2% vs 10.6%, p<0.0001). Conclusion: On average, MI size is smaller in MINOCA than MIOCA pts, and there are sex-related differences in clinical presentation, CAD extent and MI size. Re-admission rates are similar but MINOCA pts are less likely to receive guideline recommended medical therapy at discharge. [ABSTRACT FROM AUTHOR]