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Fulltext Knowledge and perceptions of prescribers regarding adherence to standard treatment guidelines for malaria: a comparative cross-sectional study from Pakistan

Malik M, Hassali MA, Shafie AA, Hussain A

East Mediterr Health J, 2014 Apr;20(4):221-8.
PMID: 24952118

Despite the availability of standard treatment guidelines for malaria in Pakistan adherence to protocols by prescribers is poor. This descriptive, cross-sectional study aimed to explore the perceptions and knowledge of prescribers in Islamabad and Rawalpindi cities towards adherence to standard treatment guidelines for malaria. A questionnaire was distributed to a random sample of 360 prescribers; 64.7% were satisfied with the available antimalarial drugs and 41.3% agreed that antimalarial drugs should only be prescribed after diagnostic testing. Only half the prescribers had the guidelines available in their health facility. Almost all the prescribers (97.7%) agreed that there was a need for more educational programmes about the guidelines. Most prescribers were unaware of the correct standard treatment regimen for Plasmodium falciparum and P. vivax malaria. There were no differences in knowledge between males and females, but prescribers having more experience, practising as general practitioners and working in private health-care facilities possessed significantly better knowledge than their counterparts.
Fulltext Colorimetric-based detection of TNT explosives using functionalized silica nanoparticles

Idros N, Ho MY, Pivnenko M, Qasim MM, Xu H, Gu Z, et al.

Sensors (Basel), 2015;15(6):12891-905.
PMID: 26046595 DOI: 10.3390/s150612891

This proof-of-concept study proposes a novel sensing mechanism for selective and label-free detection of 2,4,6-trinitrotoluene (TNT). It is realized by surface chemistry functionalization of silica nanoparticles (NPs) with 3-aminopropyl-triethoxysilane (APTES). The primary amine anchored to the surface of the silica nanoparticles (SiO2-NH2) acts as a capturing probe for TNT target binding to form Meisenheimer amine-TNT complexes. A colorimetric change of the self-assembled (SAM) NP samples from the initial green of a SiO2-NH2 nanoparticle film towards red was observed after successful attachment of TNT, which was confirmed as a result of the increased separation between the nanoparticles. The shift in the peak wavelength of the reflected light normal to the film surface and the associated change of the peak width were measured, and a merit function taking into account their combined effect was proposed for the detection of TNT concentrations from 10-12 to 10-4 molar. The selectivity of our sensing approach is confirmed by using TNT-bound nanoparticles incubated in AptamerX, with 2,4-dinitrotoluene (DNT) and toluene used as control and baseline, respectively. Our results show the repeatable systematic color change with the TNT concentration and the possibility to develop a robust, easy-to-use, and low-cost TNT detection method for performing a sensitive, reliable, and semi-quantitative detection in a wide detection range.
Fulltext Why hospital pharmacists have failed to manage antimalarial drugs stock-outs in pakistan? A qualitative insight

Malik M, Hassali MA, Shafie AA, Hussain A

Malar Res Treat, 2013;2013:342843.
PMID: 24223321 DOI: 10.1155/2013/342843

Purpose. This study aimed to explore the perceptions of hospital pharmacists towards drug management and reasons underlying stock-outs of antimalarial drugs in Pakistan. Methods. A qualitative study was designed to explore the perceptions of hospital pharmacists regarding drug management and irrational use of antimalarial drugs in two major cities of Pakistan, namely, Islamabad (national capital) and Rawalpindi (twin city). Semistructured interviews were conducted with 16 hospital pharmacists using indepth interview guides at a place and time convenient for the respondents. Interviews, which were audiotaped and transcribed verbatim, were evaluated by thematic content analysis and by other authors' analysis. Results. Most of the respondents were of the view that financial constraints, inappropriate drug management, and inadequate funding were the factors contributing toward the problem of antimalarial drug stock-outs in healthcare facilities of Pakistan. The pharmacists anticipated that prescribing by nonproprietary names, training of health professionals, accepted role of hospital pharmacist in drug management, implementation of essential drug list and standard treatment guidelines for malaria in the healthcare system can minimize the problem of drug stock outs in healthcare system of Pakistan. Conclusion. The current study showed that all the respondents in the two cities agreed that hospital pharmacist has failed to play an effective role in efficient management of anti-malarial drugs stock-outs.
Fulltext Standard treatment guidelines for malaria: Challenges in its implementation in Islamabad (federal capital) and Rawalpindi (twin city), Pakistan

Malik M, Hussain A, Hassali MA, Shafie AA

Saudi Pharm J, 2013 Jan;21(1):123-4.
PMID: 23960827 DOI: 10.1016/j.jsps.2012.02.005
Fulltext Self-medication during Covid-19 pandemic: challenges and opportunities

Malik M, Tahir MJ, Jabbar R, Ahmed A, Hussain R

Drugs Ther Perspect, 2020;36(12):565-567.
PMID: 33041621 DOI: 10.1007/s40267-020-00785-z
Fulltext Geochemical and Organic Petrological Characteristics of the Bituminous Carbonate Succession (Upper Cretaceous Shu'ayb Formation) in Northern Jordan: Implications for Organic Matter Input and Paleosalinity, Paleoredox, and Paleoclimatic Conditions

Hakimi MH, Alqudah M, Momani MM, Zahir D, El Aal AA, El Nady MM, et al.

ACS Omega, 2024 Jun 25;9(25):27458-27479.
PMID: 38947829 DOI: 10.1021/acsomega.4c02582

Bituminous carbonate rocks of the Upper Cretaceous Shu'ayb Formation from the Ajloun outcrop in Northern Jordan were geochemically and petrologically analyzed in this study. This study integrates kerogen microscopy results with geochemical results (i.e., biomarker, stable carbon isotope, and major elemental compositions) to understand the organic matter (OM) inputs and to reveal the dispositional setting and its effect on the occurrence of OM. The Shu'ayb bituminous carbonate rocks have high total organic carbon (TOC) and sulfur (S) contents, with average values of 12.3 and 4.59 wt %, respectively, indicating redox conditions during their precipitation. The high abundance of alginite (i.e., lamalginite) in the Shu'ayb bituminous carbonate sediments is a further evidence for redox conditions. The finding of mainly marine-derived OM was also demonstrated by the biomarker distribution and carbon isotope composition. The biomarkers are represented by a narrow Pr/Ph ratio of up to 0.97, abundance of tricyclic terpanes, and high C27 regular sterane, indicating that the OM was primarily derived from phytoplankton algae, along with small amounts of land plant-derived materials, and were accumulated under reducing conditions. The studied Shu'ayb bituminous carbonate facies is composed of mainly calcium (CaO; average, 45.10 wt %), with significant amounts of silicon (Si2O3; avg., 9.35 wt %), aluminum (Al2O3; avg., 6.91 wt %), and phosphorus (P2O3; avg., 1.47 wt %) and low amounts of iron (Fe2O3) and titanium (TiO2) of less than 1 wt %, indicating that the detrital influx was low in an open water depth system with higher primary bioproductivity. The geochemical proxy suggests that the Shu'ayb bituminous carbonate facies was established in a saline water environment, with Ca/Ca + Fe and S/TOC values of more than 0.9 and 0.50, respectively, which could be attributed to the increase in reducing conditions of the water column. The chemical index of alteration values of more than 0.8 also indicate that the Shu'ayb bituminous carbonate facies formed during warm and humid climatic conditions, thereby resulting in intense subaerial weathering.
Fulltext Assessment of Parents' Perceptions of Childhood Immunization: A Cross-Sectional Study from Pakistan

Hussain A, Zahid A, Malik M, Ansari M, Vaismoradi M, Aslam A, et al.

Children (Basel), 2021 Nov 04;8(11).
PMID: 34828720 DOI: 10.3390/children8111007

Immunization is one of the most cost-effective public health interventions, with considerable impacts on people's health. Parents' perception of their knowledge, attitude, and satisfaction is an important factor, as they may be targeted by interventions for better immunization coverage. Therefore, this study aimed to assess parents' perceptions in terms of their knowledge, attitude, and satisfaction of the immunization of their children aged less than two years of age, in two cities of Pakistan. A descriptive cross-sectional study was conducted in the vicinity of Rawalpindi and Islamabad from March to August 2019. A semi-structured questionnaire was used for the data collection on a convenient sample of parents. The questionnaire was hand-delivered to the parents by data collectors. Descriptive and inferential statistics were used for data analysis via SPSS version 22. A total of n = 382 respondents were included in the data analysis. Statistically significant differences were found between the parents' knowledge scores and their education levels and monthly incomes (p < 0.05). Parents with master's education degrees and low monthly incomes had significantly better knowledge (p < 0.05). Additionally, 96.85% of the respondents believed that child immunization was important. In addition, more than half of the respondents (57.58%) thought that the affordability of vaccines was a principal factor for delays in immunization. Although the parents' knowledge regarding the immunization of their children was not adequate, they had positive perceptions toward it.
Fulltext Perceptions of community pharmacists regarding their role in antimicrobial stewardship in Pakistan: A way forward

Hashmi A, Ul Haq MI, Malik M, Hussain A, Gajdács M, Jamshed S

Heliyon, 2023 Apr;9(4):e14843.
PMID: 37025891 DOI: 10.1016/j.heliyon.2023.e14843

BACKGROUND: Antimicrobial resistance is one of the biggest challenges to healthcare resulting in increased morbidity and mortality, and associated with drug resistant infections. Community pharmacists (CPs) can play a key role in antimicrobial stewardship (AMS) programs to aid the prudent use of antibiotics, and in infection prevention and control.
OBJECTIVE: The aim of this study was to assess perceptions of CPs regarding their role, awareness, collaboration, facilitators and barriers towards effective AMS practices in Pakistan.
METHOD: ology: A descriptive, cross-sectional study design was adopted, where convenience and snowball sampling methods were applied to enroll respondents (pharmacists working at these community pharmacies in different cities of Pakistan) of the study. After sample size determination, n = 386 CPs were enrolled. A pre-validated questionnaire was used regarding CPs roles and perceptions in association with AMS. Statistical analysis was performed using SPSS v. 21.
RESULTS: The results of the study reported that 57.3% (n = 221) of CPs had strong familiarity with term AMS. 52.1% (n = 201) of CPs agreed that they require adequate training to undertake activities in AMS programmes in their setting. The results of the study showed that 92.7% (n = 358) of the pharmacists thought real time feedback would be helpful. Significant association was observed in AMS awareness, approach, collaboration and barriers with regards to the respondents' gender, age groups and levels of experience in a community pharmacy.
CONCLUSIONS: The study concluded that CPs were aware of AMS programmes, their relevance and necessity of AMS in their everyday practice, but had inadequate training and resources to implement it in Pakistan.
Fulltext Development of Magnesium Aluminate (MgAl2O4) Nanoparticles for refractory crucible application

Khan SA, Mohd Zain Z, Siddiqui Z, Khan W, Aabid A, Baig M, et al.

PLoS One, 2024;19(1):e0296793.
PMID: 38227597 DOI: 10.1371/journal.pone.0296793

Ceramics are the oxides of metals and nonmetals with excellent compressive strength. Ceramics usually exhibit inert behavior at high temperatures. Magnesium aluminate (MgAl2O4), a member of the ceramic family, possesses a high working temperature up to 2000°C, low thermal conductivity, high strength even at elevated temperatures, and good corrosion resistance. Moreover, Magnesium Aluminate Nanoparticles (MANPs) can be used in the making of refractory crucible applications. This study focuses on the thermal behavior of Magnesium Aluminate Nanoparticles (MANPs) and their application in the making of refractory crucibles. The molten salt method is used to obtain MANPs. The presence of MANPs is seen by XRD peaks ranging from 66° to 67°. The determination of the smallest crystallite size of the sample is achieved by utilizing the Scherrer formula and is found to be 15.3 nm. The SEM micrographs provided further information, indicating an average particle size of 91.2 nm. At 600°C, DSC curves show that only 0.05 W/g heat flows into the material, and the TGA curve shows only 3% weight loss, which is prominent for thermal insulation applications. To investigate the thermal properties, crucibles of pure MANPs and the different compositions of MANPs and pure alumina are prepared. During the sintering, cracks appear on the crucible of pure magnesium aluminate. To explore the reason for crack development, tablets of MgAl2O4 are made and sintered at 1150°C. Ceramography shows the crack-free surfaces of all the tablets. Results confirm the thermal stability of MANPs at high temperatures and their suitability for melting crucible applications.
Case management of malaria fever at community pharmacies in Pakistan: a threat to rational drug use

Malik M, Hassali MA, Shafie AA, Hussain A, Aljadhey H, Saleem F

Pharm Pract (Granada), 2013 Jan;11(1):8-16.
PMID: 24155844

OBJECTIVE: To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city).
METHODS: A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy's management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities.
RESULTS: The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities.
CONCLUSIONS: The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel's at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies.
Fulltext Sale of WHO AWaRe groups antibiotics without a prescription in Pakistan: a simulated client study

Saleem Z, Hassali MA, Godman B, Fatima M, Ahmad Z, Sajid A, et al.

J Pharm Policy Pract, 2020;13:26.
PMID: 32774870 DOI: 10.1186/s40545-020-00233-3

Introduction: Resistant strains of bacteria are rapidly emerging with increasing inappropriate use of antibiotics rendering them less efficacious. Self-purchasing of antibiotics particularly for viral infections is a key driver of inappropriate use, especially in lower- and middle-income countries. There is a particular issue in countries such as Pakistan. Consequently, there is a need to assess current rates of self-purchasing especially for reserve antibiotics to guide future policies.
Aims: Assess the extent of current antibiotic sales without a prescription in urban areas of Pakistan.
Methodology: A multicenter cross-sectional study was conducted in different areas of Punjab, Pakistan using Simulated Client technique. The investigators demanded different predefined antibiotics from WHO AWaRe groups without prescription. Three levels of demand were used to convince the pharmacy staff in order to dispense the antibiotic without a prescription. A data collection form was completed by simulated clients within 15 min of each visit.
Results: Overall 353 pharmacies and medical stores were visited out of which 96.9% pharmacies and medical stores dispensed antibiotics without demanding a prescription (82.7% at demand level 1 and 14.2% at demand level 2), with only 3.1% of pharmacies refusing to dispense antibiotics. The most frequently dispensed antibiotic was ciprofloxacin (22.1%). Surprisingly, even the reserve group antibiotics were also dispensed without a prescription. In only 25.2% visits, pharmacy staff guided patients about the use of antibiotics, and in only 11.0% pharmacists enquired about other medication history.
Conclusion: Currently, antibiotics are easily acquired without a legitimate prescription in Pakistan. There is a need for strict adherence to regulations combined with a multi-dimensional approach to enhance appropriate dispensing of antibiotics and limit any dispensing of WHO restricted antibiotics without a prescription.
International consensus on patient-centred outcomes in eating disorders

Austin A, De Silva U, Ilesanmi C, Likitabhorn T, Miller I, Sousa Fialho MDL, et al.

Lancet Psychiatry, 2023 Dec;10(12):966-973.
PMID: 37769672 DOI: 10.1016/S2215-0366(23)00265-1

The effectiveness of mental health care can be improved through coordinated and wide-scale outcome measurement. The International Consortium for Health Outcomes Measurement has produced collaborative sets of outcome measures for various mental health conditions, but no universal guideline exists for eating disorders. This Position Paper presents a set of outcomes and measures for eating disorders as determined by 24 international experts from professional and lived experience backgrounds. An adapted Delphi technique was used, and results were assessed through an open review survey. Final recommendations suggest outcomes should be tracked across four domains: eating disorder behaviours and cognitions, physical health, co-occurring mental health conditions, and quality of life and social functioning. Outcomes are collected using three to five patient-reported measures. For children aged between 6 years and 12 years, the measures include the Children's Eating Attitude Test (or, for those with avoidant restrictive food intake disorder, the Eating Disorder in Youth Questionnaire), the KIDSCREEN-10, and the Revised Children's Anxiety and Depression Screener-25. For adolescents aged between 13 years and 17 years, the measures include the Eating Disorder Examination Questionnaire (EDE-Q; or, for avoidant restrictive food intake disorder, the Nine-Item Avoidant Restrictive Food Intake Disorder Screener [NIAS]), the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), the two-item Generalised Anxiety Disorder (GAD-2), the seven-item Generalised Anxiety Disorder (GAD-7), and the KIDSCREEN-10. For adults older than 18 years, measures include the EDE-Q (or, for avoidant restrictive food intake disorder, the NIAS), the PHQ-2, the PHQ-9, the GAD-2, the GAD-7, the Clinical Impairment Assessment, and the 12-item WHO Disability Assessment Schedule 2.0. These questionnaires should be supplemented by information on patient characteristics and circumstances (ie, demographic, historical, and clinical factors). International adoption of these guidelines will allow comparison of research and clinical interventions to determine which settings and interventions work best, and for whom.

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