Displaying publications 1 - 20 of 27 in total

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  1. Rehman IU, Bukhsh A, Khan TM
    Travel Med Infect Dis, 2017 Jul-Aug;18:67-69.
    PMID: 28842213 DOI: 10.1016/j.tmaid.2017.08.002
    World Health Organization (WHO) measles surveillance data report a reduction in cases of measles globally from 67,524 cases in 2015 to 16,846 in 2016, and a reduction in deaths from 546,800 to 114,900 during period of 2000-14. Pakistan is among the five nations where almost a million children did not receive their first dose of measles vaccination, and outbreaks of the disease resulted in 4386 cases in 2011, 14,687 cases in 2012 with 310 deaths. In 2013, about 25,401 cases of measles were reported and 321 affected children died. The measles vaccination coverage is very low in Pakistan for both 1st dose and booster dose. To prevent outbreaks of measles in Pakistan a national vaccination program should be launched side by side with a polio eradication program in each district and township and a campaign should be launched to educate parents on measles vaccination for childrens to reduce the measles case fatality rate.
  2. Mallhi TH, Khan YH, Tanveer N, Khan AH, Bukhsh A
    Travel Med Infect Dis, 2017 Jul-Aug;18:75-76.
    PMID: 28709958 DOI: 10.1016/j.tmaid.2017.07.005
  3. Rehman IU, Chohan TA, Bukhsh A, Khan TM
    Medicina (Kaunas), 2019 Oct 17;55(10).
    PMID: 31627446 DOI: 10.3390/medicina55100699
    : Chronic kidney disease (CKD)-associated pruritus is a common and disturbing condition which has a negative impact on sleep quality, as well as overall health-related quality of life of patients receiving hemodialysis. To date, no systematic review has been undertaken, and there is a lack of concise evidence that statistically quantifies the impact of pruritus based on published data. A systematic search was done for original articles published in peer-reviewed English journals from database inception on 20 December, 2018, in the following databases: PubMed, MEDLINE, EMBASE, Ovid, CINHAL, ProQuest, and Scopus. A total of 9217 research articles were identified. After removal of duplicates and screening for titles and abstracts, 28 articles were selected. The prevalence of disturbed sleep was 4-94%, while the pooled proportion on random effect in the study was 40% (95% CI = 0.30 to 0.49); I2 = 99.8%. However, the prevalence of disturbed sleep quality and quantity due to pruritus was 9-76%, and the pooled proportion on random effect in the study was 50% (95% CI = 0.37 to 0.64); I2 = 99.8%. Patients undergoing hemodialysis who are affected by CKD-associated pruritus have a higher chance of experiencing sleep disturbances. The prevalence of disturbed sleep due to CKD-associated pruritus was found to be 9-76% in the included studies for patients receiving hemodialysis therapy.
  4. Bukhsh A, Lee SWH, Pusparajah P, Schmitt A, Khan TM
    Health Qual Life Outcomes, 2017 Oct 12;15(1):200.
    PMID: 29025432 DOI: 10.1186/s12955-017-0776-8
    BACKGROUND: Numerous study tools on diabetes self-care have been introduced; however, most existing tools do not show expectable and meaningful correlations with patients' glycaemic control. The Diabetes Self-Management Questionnaire (DSMQ) was designed to appraise self-care activities which can predict glycaemic control outcomes. However, this tool has not been validated in Pakistan. Therefore, the aim of this study was to translate and examine the psychometric properties of the Urdu version of DSMQ among type 2 diabetes patients.

    METHOD: Standard forward-backward translation was used to translate the DSMQ into Urdu language. A convenience sample of 130 patients with type 2 diabetes was collected to assess the Urdu version's psychometric properties. Reliability was assessed by Cronbach's coefficient α and validity was assessed using confirmatory factor analysis and criterion-related correlations.

    RESULTS: High internal consistency was found for all DSMQ scales (Sum scale: α = 0.96, Glucose Management: 0.91; Dietary Control: 0.88; Physical Activity: 0.89; Health-Care Use: 0.73). The DSMQ subscales showed significant correlations with HbA1c (Glucose Management: -0.75; Dietary Control: -0.76; Physical Activity: -0.71; Health-Care Use: -0.64; Sum Scale: -0.78; all p  0.05). Adequate fit to the data was achieved for single factor model after successively modelling all significant correlations between the items' error terms, with Chi2 = 106.6, df = 84, p = 0.049; TLI = 0.98, CFI = 0.99 and RMSEA = 0.05 (90% CI 0.01-0.07). Whereas a comparatively lower fit indices to data were observed in case of four factor model.

    CONCLUSION: The findings support the Urdu version of the DSMQ as a reliable and valid instrument for assessing self-care activities associated with glycaemic control in type 2 diabetes patients.
  5. Bukhsh A, Nawaz MS, Ahmed HS, Khan TM
    Medicine (Baltimore), 2018 Mar;97(12):e9847.
    PMID: 29561461 DOI: 10.1097/MD.0000000000009847
    BACKGROUND: Diabetes self-care activities, like, healthy diet, regular exercise, self-monitoring of blood glucose, and rational use of medicines are considered to play a vital role in establishing euglycemia. Health literacy among type 2 diabetes mellitus (T2DM) patients in Pakistan is very low, which is the most likely cause for poor clinical outcomes. This study is designed to investigate the impact of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among T2DM patients in Pakistan.

    METHODS: In this randomized controlled trail, effectiveness of a 6-month pharmacist-led educational intervention will be examined on glycemic control, diabetes self-care activities and disease knowledge of 80 adult T2DM patients (age >30 years) with poorly controlled T2DM (HbA1c> 7%), after randomizing them into intervention and control groups, at diabetes care clinic of Capital Hospital Islamabad, Pakistan.

    RESULTS: The primary outcome is change in patients' HbA1c, whereas, changes in self-care activities and patients' disease knowledge are the secondary outcomes. After baseline assessment of their self-care activities and disease knowledge by using validated Urdu versions of Diabetes Self-management Questionnaire (DSMQ) and Diabetes Knowledge Questionnaire (DKQ), respectively, interventional group patients will be supplemented with a face-to-face pharmacist-led educational intervention, whereas, the control group will receive usual care. Intervention arm patients will be educated successively at their first follow-up visit (12th week) and telephonically after every 4 weeks. All assessments will be made at baseline and end of trail for both intervention and control groups. Multivariate general linear model will be applied to analyze the effects of the intervention.

    CONCLUSION: Glycemic control in T2DM patients requires optimum self-care activities. This study is an attempt to improve self-care behaviors among poorly controlled T2DM patients who are at higher risk of diabetes-associated late complications.
  6. Usman A, Makmor Bakry M, Mustafa N, Rehman IU, Bukhsh A, Lee SWH, et al.
    Diabetes Metab Syndr Obes, 2019;12:1323-1338.
    PMID: 31496770 DOI: 10.2147/DMSO.S208492
    Background: During the progress and resolution of a diabetic ketoacidosis (DKA) episode, potassium levels are significantly affected by the extent of acidosis. However, none of the current guidelines take into account acidosis during resuscitation of potassium level in DKA management, which may increase the risk of cardiovascular adverse events.

    Objective: To assess literature regarding the adjustment of potassium level using pH to calculate pH-adjusted corrected potassium level, and to observe the relationship of cardiovascular outcomes with reported potassium level and pH-adjusted corrected potassium in DKA.

    Methodology: Seven databases were searched from inception to January 2018 for studies which had reported people with diabetes developing diabetic ketoacidosis, in relation to prevalence or incidence, fluid resuscitation or potassium supplementation treatment, treatment or cardiovascular outcomes, and experimentation with DKA management or insulin. Quality of studies was evaluated using Cochrane Risk of Bias and Newcastle Ottawa Scale.

    Results: Forty-seven studies were included in qualitative synthesis out of a total of 10,292 retrieved studies. Forty-one studies discussed the potassium level and blood pH at the time of admission, ten studies discussed cardiovascular outcomes, and only four studies concurrently discussed potassium level, pH, and cardiovascular outcomes. Only two studies were graded as good on the Newcastle Ottawa Scale. The reported potassium level was well within normal range (5.8 mmol/L), whereas pH rendered patients to be moderately acidotic (7.13). Surprisingly, none of the included studies mentioned pH-adjusted corrected potassium level and, hence, this was calculated later. Although mean corrected potassium was within the normal range (3.56 mmol/L), 13 studies had corrected potassium below 3.5 mmol/L and five had it below 3.0 mmol/L. Nevertheless, with the exception of one study, none discussed cardiovascular outcomes in the context of potassium or pH-adjusted potassium level.

    Conclusion: The evidence surrounding cardiovascular outcomes during DKA episodes in light of a pH-adjusted corrected potassium level is scarce. A prospective observational, or preferably, an experimental study in this regard will ensure we can modify and enhance safety of existing DKA treatment protocols.
  7. Bukhsh A, Khan TM, Nawaz MS, Ahmed HS, Chan KG, Lee LH, et al.
    Patient Prefer Adherence, 2018;12:2377-2385.
    PMID: 30519003 DOI: 10.2147/PPA.S177314
    Objective: Association of various self-care activities on glycemic control of people with diabetes (PWD) in Pakistan is yet to be explored. The current study aimed to evaluate the association of various diabetes-related self-care activities with glycated hemoglobin (HbA1c) levels and to examine the predictive relationship of patients' demographic variables with their self-care activities.

    Patients and methods: A cross-sectional study was conducted on adult PWD (N=218) who were diagnosed with type 2 diabetes mellitus of at least 1 year duration. Self-care activities were examined by using the Urdu version of Diabetes Self-management Questionnaire. Linear regression analysis was conducted to examine the significant predictors for diabetes-related self-care activities and glycemic control.

    Results: Mean age of the patients was 50.77±13.3 years. Poor glycemic control (HbA1c $7%) was observed in majority of the patients (83%). Linear regression analysis revealed that glucose management (β=-0.44; 95% CI -0.438, -0.209; P<0.001) was the strongest predictor for low levels of patients' HbA1c, followed by dietary control (β=-0.19; 95% CI -0.248, -0.018; P=0.024) and physical activity (β=-0.17; 95% CI -0.165, -0.023; P=0.010), respectively. Linear regression analysis showed that use of oral hypoglycemic agents only (β=-0.218; 95% CI -0.956, -0.200; P=0.003) and higher education level (β=0.204; 95% CI 0.138, 0.777; P=0.005) were significant predictors for higher scores of patients' self-care activities.

    Conclusion: The findings support that PWD having better self-reported self-care activities achieve better glycemic control. Patients' self-care activities should be monitored on a regular basis, especially for those who are at risk of poor glycemic control.
  8. Khan TM, Kok YL, Bukhsh A, Lee LH, Chan KG, Goh BH
    Germs, 2018 Sep;8(3):113-125.
    PMID: 30250830 DOI: 10.18683/germs.2018.1138
    Background: Burn victims admitted in burn intensive care units (ICU) are at a high risk of nosocomial infections generated by methicillin resistant Staphylococcus aureus (MRSA). This systematic review aims to estimate the incidence of MRSA among burn patients admitted to the ICU setting, with an emphasis on the incidence rate and antibiotic resistance profile of the MRSA strains.

    Methods: A systematic literature search was performed in five electronic databases limited to publication dates from 1st January 2000 until 31st August 2017. After screening n=481 articles, n=21 were found to meet the inclusion criteria of this systematic review.

    Results: Results from the meta-analysis revealed that the risk for MRSA isolates in the burn ICU was 55.0% higher (OR 0.55, 95%CI 0.32-0.94). Therefore, timely testing, appropriate hygiene practice and suggested wound care must be practiced while handling such patients.

    Conclusion: Further studies are needed to identify the risk factors of MRSA infections among burn patients and to develop new antimicrobial agents for MRSA infections.

  9. Ahmed A, Saqlain M, Akhtar N, Hashmi F, Blebil A, Dujaili J, et al.
    Health Qual Life Outcomes, 2021 Feb 08;19(1):48.
    PMID: 33557861 DOI: 10.1186/s12955-021-01693-0
    BACKGROUND: Reliable Health-Related Quality of Life (HRQoL) assessment will be useful in identifying health issues and in identifying health care actions. Due to the lack of a psychometrically valid tool in Urdu, we aim to translate and examine the psychometric and cross-cultural adaptation of WHOQOL HIV Bref among people living with HIV/AIDS (PLWHA) in Pakistan.

    METHODS: The standard forward-backwards translation technique was used to convert English version of the WHOQOL HIV Bref into Urdu. After cognitive debriefing, final Urdu version of instrument was developed. Based on the principle of at least 5 subjects for each item, a sample of 182 patients was used using a universal random sampling technique from the Pakistan Institute of Medical Sciences, Islamabad. The Cronbach's alpha and intra-class correlation coefficients (ICC) were estimated to assess internal validity and reliability of the translated version. Exploratory factor analysis was carried out to determine the factor structure and independent associations between the instrument domains and CD-4T-cell count were assessed using multivariable linear regression RESULTS: High Cronbach alpha 0.93 was found for all WHOQOL HIV Bref facets. The test-retest reliability demonstrated a statistically significant ICC ranged from 0.88 to 0.98 (p 

  10. Bukhsh A, Tan XY, Chan KG, Lee LH, Goh BH, Khan TM
    Patient Prefer Adherence, 2018;12:2457-2474.
    PMID: 30538430 DOI: 10.2147/PPA.S180256
    Background: Effectiveness of pharmacist-led educational interventions on self-care activities and glycemic control of type 2 diabetes mellitus (T2DM) patients is vague. The purpose of this review is to appraise the effect of pharmacist-led educational interventions on self-care activities and levels of glycated hemoglobin of T2DM patients.

    Methods: Five electronic databases were searched from date of database inception to September 2017. Randomized clinical trials examining the effectiveness of pharmacist-led educational interventions, directed at T2DM patients only, were included for systematic review and meta-analysis. The protocol is available with PROSPERO (CRD42017078854).

    Results: Eleven studies, involving n=1,544 T2DM patients, were included in this systematic review. Meta-analysis demonstrated that pharmacist-led interventions had a significant effect on lowering of the levels of glycated hemoglobin (-0.66; 95% CI [-0.83, -0.50]; I2=58.3%; P=0.008), in comparison to usual care. Self-care activities were assessed by using Summary of Diabetes Self-care Activities tool in eight studies. Overall meta-analysis of self-care activities for included studies demonstrated a significant effect of pharmacist-led interventions on improvement of self-monitoring of blood glucose (1.62; 95% CI [0.92, 2.32]; I2=70.5%; P=0.005), foot care (1.20; 95% CI [0.49, 1.90]; I2=95.0%; P<0.001), and overall diet (1.16; 95% CI [0.38, 1.93]; I2=64.2%; P=0.094).

    Conclusion: The findings of this review demonstrate a significantly positive effect of pharmacist-led educational interventions on HbA1c levels and self-care practices among T2DM patients.
  11. Bukhsh A, Goh BH, Zimbudzi E, Lo C, Zoungas S, Chan KG, et al.
    PMID: 33329377 DOI: 10.3389/fendo.2020.534873
    Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.
  12. Bukhsh A, Khan TM, Lee SWH, Lee LH, Chan KG, Goh BH
    Front Pharmacol, 2018;9:339.
    PMID: 29692730 DOI: 10.3389/fphar.2018.00339
    Background: Comparative efficacy of different pharmacist based interventions on glycemic control of type 2 diabetes patients is unclear. This review aimed to evaluate and compare the efficacy of different pharmacist based interventions on clinical outcomes of type 2 diabetes patients. Methods: A systematic search was conducted across five databases from date of database inception to September 2017. All randomized clinical trials evaluating the efficacy of pharmacist based interventions on type 2 diabetes patients were included for network meta-analysis (NMA). The protocol is available with PROSPERO (CRD42017078854). Results: A total of 43 studies, involving 6259 type 2 diabetes patients, were included. NMA demonstrated that all interventions significantly lowered glycosylated hemoglobin (HbA1c) levels compared to usual care, but there was no statistical evidence from this study that one intervention was significantly better than the other for reducing HbA1c levels. Pharmacist based diabetes education plus pharmaceutical care showed maximum efficacy for reducing HbA1c levels [-0.86, 95% CI -0.983, -0.727; p < 0.001]. Pharmacist based diabetes education plus pharmaceutical care was observed to be statistically significant in lowering levels of systolic blood pressure [-4.94; 95%CI -8.65, -1.23] and triglycerides levels [-0.26, 95%CI -0.51, -0.01], as compared to the interventions which involved diabetes education by pharmacist, and for body mass index (BMI) [-0.57; 95%CI -1.25, -0.12] in comparison to diabetes education by health care team involving pharmacist as member. Conclusion: The findings of this review demonstrate that all interventions had a significantly positive effect on HbA1c, but there was no statistical evidence from this study that one intervention was significantly better than the other for achieving glycemic control.Pharmacist based diabetes education plus pharmaceutical care showed maximum efficacy on HbA1c and rest of the clinical outcomes.
  13. Rana B, Bukhsh A, Khan TM, Sarwar A, Omer MO, Jamshed SQ
    J Pharm Bioallied Sci, 2017 Apr-Jun;9(2):121-125.
    PMID: 28717335 DOI: 10.4103/jpbs.JPBS_29_17
    AIM: The present study was aimed to highlight the current prescribing pattern of oral hypoglycemia in type 2 diabetes mellitus and to evaluate the therapeutic effectiveness of these therapeutic categories in achieving target glycemic control.

    METHODS: This is a prospective, cross-sectional, observational study of 6 months' duration conducted in a tertiary care hospital of Lahore, Pakistan.

    RESULTS: The current research recruited 145 patients presented in diabetes management center of a tertiary care hospital in Lahore, Pakistan. Mean age of the participants was 50.2 (± 8.5) years. Out of the 145 patients, 63% were females and 37% were males. Most patients were diagnosed to have diabetes within the past 5 years. Diabetes-induced neuropathy was the most common complication (71.7%) among the patients. A large proportion of these patients (70.3%) were also suffering from other comorbidities among which the most common one is hypertension. The average number of prescribed medications was 1.31. Metformin was prescribed to a majority of patients (64%) as monotherapy while 28.96% received combination therapy. Mean glycated hemoglobin (HBA1c) before and after 3 months of treatment was 8.5 (± 2.3) and 8.04 (± 2.1), respectively. Inferential statistics show a strong association between HBA1c and life style modifications and adherence to medication therapy (P = 0.05). However, the correlation between HBA1c and Morisky score and duration of disease was inverse and weak (P = 0.6, 0.4). The t-test values show a small difference between HBA1c values before and after 3 months (t = 0.440 and 0.466, respectively).

    CONCLUSION: Optimization of medication regimen and continuous patient education regarding life style modification and adherence to medication therapy are necessitated to bring HBA1c values near to target.
  14. Rafique G, Bukhsh A, Gul A, Khiljee S, Ashraf M, Omer MO
    Pak J Pharm Sci, 2017 Jan;30(1):11-16.
    PMID: 28603106
    180 million people are affected by chronic Hepatitis C Virus infection globally and more than 50 million in South East Asia. Combination of Interferon and Ribavirin is the current anti-HCV therapy in practice and is associated with certain hematologic adverse effects. In this concurrent observational study the incidence rate of major hematologic adverse effects and efficacy outcomes of Interferon and Ribavirin combination therapy was evaluated in 288 chronic hepatitis C patients at Lahore General Hospital. Levels of Hb, TLC, and Platelets counts were monitored for hematologic adverse effects monitoring, whereas, ALT, AST and bilirubin levels were monitored for efficacy. PCR was done at week 4, 12 &36 for therapeutic success evaluation. A significant reduction in Hb levels (p<0.05) was observed after week 4, 8 and 12 of therapy. Frequency of anemia increased in both genders with body weight <65kg and platelet count <150,000/mm(3). End Treatment Response (ETR) was achieved in 64.5%. Anemia was the major side effect of the combination therapy particularly in the males. Higher ETR was observed in patients who achieved RVR and were <50 years of age.
  15. Bukhsh A, Khan TM, Sarfraz Nawaz M, Sajjad Ahmed H, Chan KG, Goh BH
    Diabetes Metab Syndr Obes, 2019;12:1409-1417.
    PMID: 31616171 DOI: 10.2147/DMSO.S209711
    Objective: This study explored the relationship of disease knowledge with glycemic control and self-care practices in adult Pakistani people diabetes (PWD).

    Methods: People diagnosed with type 2 diabetes (n=218) were selected from three health care centers, located in different cities of Pakistan. Disease knowledge and self-care practices were assessed by Urdu versions of Diabetes Knowledge Questionnaire (DKQ) and Diabetes Self-Management Questionnaire (DSMQ), using a cross-sectional design. Chi-square and correlation analysis were applied to explore the relationship of disease knowledge with glycemic control and self-care practices. Linear regression was used to explore the predictors for disease knowledge.

    Results: Majority of the sample was >45-60 years old (48.8%), suffering from type 2 diabetes mellitus for <5 years (49.5%) and had poor glycemic control (HbA1C≥7%; n=181 participants). Disease knowledge was significantly associated (p<0.05) with patient's gender, level of education, family history of diabetes, nature of euglycemic therapy, and glycemic control. Correlation matrix showed strongly inverse correlations of DKQ with glycated hemoglobin levels (r=-0.62; p<0.001) and strongly positive with DSMQ sum scale (r=0.63; p<0.001). PWD having university-level education (β=0.22; 95% Confidence Interval (CI) 0.189, 0.872; p<0.01), doing job (β=0.22; 95% CI 0.009, 0.908]; p=0.046), and use of oral hypoglycemic agents in combination with insulin (β=-0.16; 95% CI [-1.224, -0.071]; p=0.028) were the significant predictors for disease knowledge.

    Conclusion: Disease knowledge significantly correlated with glycated hemoglobin levels and self-care activities of PWD. These findings will help in designing patient-tailored diabetes educational interventions for yielding a higher probability of achieving target glycemic control.

  16. Ahmed A, Lee KS, Bukhsh A, Al-Worafi YM, Sarker MMR, Ming LC, et al.
    J Infect Public Health, 2017 10 04;11(2):153-155.
    PMID: 28988775 DOI: 10.1016/j.jiph.2017.09.007
    The increase in Muslim parents' refusal and hesitancy to accept childhood vaccination was identified as one of the contributing factors in the increase of vaccine-preventable diseases cases in countries such as Afghanistan, Malaysia and Pakistan. The spread of inaccurate and irresponsible information by the anti-vaccination movement may inflict more harm than good on Muslim communities. To curb this issue, health authorities in Pakistan and Malaysia have resorted to imposing strict punishments on parents who refuse to allow their children to be vaccinated. Information addressing religious concerns such as the halal issue must be made priority and communicated well to the general public, encouraging not only the acceptance of vaccinations but motivating communities to play an active role in promoting vaccination. Local government of the affected region need to work towards creating awareness among Muslim parents that vaccinations are a preventative public health strategy that has been practised and acknowledged by many doctors of all faiths.
  17. Bukhsh A, Rehman H, Mallhi TH, Ata H, Rehman IU, Lee LH, et al.
    Hum Vaccin Immunother, 2018 04 03;14(4):952-957.
    PMID: 29333939 DOI: 10.1080/21645515.2017.1415686
    National immunization program of Pakistan does not include Influenza vaccines. The low rate of immunization might be attributed to the poor knowledge of influenza vaccination in Pakistan. Current study was aimed to assess the knowledge and attitude of influenza vaccination among parents. A questionnaire-based cross sectional study was conducted among randomly selected parents with at least one child aged >6 months. The responses were recorded against 27 items questionnaire assessing knowledge, perception, attitude and behaviours of parents. Data were analysed by using appropriate statistical methods. A total 532 responses were recorded with male gender preponderance (65%). Most of the parents (61.1%) reported that their children had received or planned to receive all recommended vaccines in Expanded Program on Immunization (EPI) of Pakistan. Only one third of the parents (24.4%) were aware of the availability of influenza vaccines in Pakistan, and very few (6.6%) reported vaccinating their child against influenza. Exploring the parents' attitudes regarding children vaccination, the top motivator was 'immunization is important to keep my children healthy' (relative index = 0.93, p < 0.000). However, substantial number of parents believed that influenza is not a serious disease (18.5%) and vaccines are accompanied by several side effects (24.6%). A positive attitude was reflected among parents who were aware of influenza vaccines in Pakistan. About 35% participants believed that influenza vaccines are not required for healthy children. Current study demonstrated very low vaccination rate against influenza. Awareness and health literacy regarding influenza vaccine is poor among parents. These findings necessitate the need to appropriately structured awareness programs regarding influenza vaccination among parents.
  18. Shahid MN, Khan TM, Neoh CF, Lean QY, Bukhsh A, Karuppannan M
    Front Pharmacol, 2021;12:638628.
    PMID: 34483894 DOI: 10.3389/fphar.2021.638628
    Background. Infertility is an emerging health issue for men. Comparative efficacy of different pharmacological interventions on male infertility is not clear. The aim of this review is to investigate the efficacy of various pharmacological interventions among men with idiopathic male infertility. All randomized control trials evaluating the effectuality of interventions on male infertility were included for network meta-analysis (NMA) from inception to 31 April 2020, systematically performed using STATA through the random effect model. The protocol was registered at PROSPERO (CRD42020152891). Results. The outcomes of interest were semen and hormonal parameters. Treatment effects (p < 0.05) were estimated through WMD at the confidence interval of 95%. Upon applying exclusion criteria, n=28 RCTs were found eligible for NMA. Results from NMA indicated that consumption of supplements increases sperm concentration levels [6.26, 95% CI 3.32, 9.21] in comparison to SERMs [4.97, 95% CI 1.61, 8.32], hormones [4.14, 95% CI 1.83, 6.46], and vitamins [0.15, 95% CI -20.86, 21.15)] with placebo, whereas the use of SERMs increased percentage sperm motility [6.69, 95% CI 2.38, 10.99] in comparison to supplements [6.46, 95% CI 2.57, 10.06], hormones [3.47, 95% CI 0.40, 6.54], and vitamins [-1.24, 95% CI -11.84, 9.43] with placebo. Consumption of hormones increased the sperm morphology [3.71, 95% CI, 1.34, 6.07] in contrast to supplements [2.22, 95% CI 0.12, 4.55], SERMs [2.21, 95% CI -0.78, 5.20], and vitamins [0.51, 95% CI -3.60, 4.62] with placebo. Supplements boosted the total testosterone levels [2.70, 95% CI 1.34, 4.07] in comparison to SERMs [1.83, 95% CI 1.16, 2.50], hormones [0.40, 95% CI -0.49, 1.29], and vitamins [-0.70, 95% CI -6.71, 5.31] with placebo. SERMs increase the serum FSH levels [3.63, 95% CI 1.48, 5.79] better than hormones [1.29, 95% CI -0.79, 3.36], vitamins [0.03, 95% CI -2.69, 2.76], and supplements [-4.45, 95% CI -7.15, -1.76] in comparison with placebo. Conclusion. This review establishes that all interventions had a significantly positive effect on male infertility. Statistically significant increased sperm parameters were noted in combinations of zinc sulfate (220 mg BID), clomiphene citrate (50 mg BID), and testosterone undecanoate and CoQ10; tamoxifen citrate and FSH were shown to improve the hormonal profile in infertile males.
  19. Bukhsh A, Lee SWH, Pusparajah P, Khan AH, Khan TM
    Front Public Health, 2017;5:139.
    PMID: 28702453 DOI: 10.3389/fpubh.2017.00139
    OBJECTIVE: Patient education is a key element in the treatment of diabetes. Assessment of diabetes knowledge is important for optimum treatment. For the assessment of diabetes knowledge, validated tool is essential. None of such validated tool is available in Urdu language. Therefore, the aim of this study was to translate and examine the psychometric properties of the 24-item Urdu version of Diabetes Knowledge Questionnaire (DKQ) among type 2 diabetes patients.

    METHODS: Standard "forward-backward" process was used to translate DKQ into Urdu language. Later, it was validated on a convenience sample of 130 patients with type 2 diabetes, between July and September 2016. Internal consistency was assessed by reliability analysis, one-way analysis of variance was applied for known group validity and multivariate linear logistic regression was applied for identifying significant predictors for patients' DKQ score.

    RESULTS: Good internal consistency was observed for DKQ (Cronbach's α = 0.702). The mean HbA1c of the patients was 8.55% (±1.91). DKQ scores of patients' with "good glycemic control" (14.22 ± 2.4) were observed significantly higher (P 
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