Pediatric pharmacotherapy aims to ensure safe and effective use of drugs in various population of children. However, due to varied pediatric pharmacokinetic drug profile and lack of pediatric drug data as compared to adults, it is difficult to achieve the optimal drug therapy in pediatrics. Studies regarding dosage errors, drug interactions, unlicensed and off label drug use in pediatric population will help the health care professionals in identification and management of drug interactions as well as unlicensed and off label drug use. Patient drug profiles of 4240 patients were evaluated using Micromedex Drug-Dex and Drug-Reax at pediatric department in four tertiary care hospitals of Pakistan (3 public and 1 private). The association between studied risk factors was analyzed using logistic regression to calculate the odds ratio (OR) and 95% confidence interval (CI). In pediatric surgical units, total of 895 patients drug profiles were analyzed which described mean number of drug was 3.51 ± 1.50. Of all the patients, 351 (39.21%) had sub-therapeutic doses and 67 (7.48%) had overdoses, while 148 (16.54%) patients were exposed to DDIs. A total of 11 drug combinations were observed that led to 160 DDIs. Overall, 3168 drugs were prescribed of which 1931 (64.89%) were unlicensed and 1542 (48.67%) were off labeled. Indication (38.71%) and dose (34.82%) were the most frequent off label categories in all the therapeutics classes. Chi square value revealed that unlicensed drug use was significantly associated with the type of hospital (p<0.0001). A significant association was also found between unlicensed (p<0.0001) and off label (p<0.031) drug prescribing with age groups. Multivariate binary logistic regression analysis revealed that infants (OR 4.092, 95%CI 2.272-7.370) and children (OR 2.691, 95%CL 1.581-4.581) age groups were 4 times and 2.6 times respectively more likely to receive unlicensed medicines, while they were significantly less likely, Abstract v (OR 0.270, 95%CI 0.109-0.667) and (OR 0.320, 95%CL 0.133-0.769), to receive off label medicines than adolescent group. Pediatric patients receiving less than 5 medications were significantly less likely to receive unlicensed drug (OR 0.105, 95%CL 0.051-0.213) and off-label drugs (OR 0.117, 95%CL 0.42-0.323) as compared to pediatric patients that received 5 or more medications. Male patients were 2.1 times more likely to receive unlicensed medicines (OR 2.103, 95%CL 1.507-2.937), while they received substantially less amount of off-label medicines (OR 0.685, 95%CL 0.458-1.024) as compared to females. Hospital stay of less than 5 days (OR 0.397, 95%CL 0.228-0.629) carried significantly less risk of off label prescription as compared to patients staying at hospital for more than 5 days. In the pediatric medical wards of all the hospitals 1375 patients were analyzed. The mean number of prescribed drugs per patient was 3.93 ± 1.85. Analysis of 1375 cases revealed sub-therapeutic doses in 571 (41.2%) cases while overdoses was observed in 136 (9.89%) cases. In 1375 medical ward patients, 239 (17.38%) had at least one DDI regardless of type of severity. A total of 101 interacting drug pairs were identified causing 417 drug-drug interactions, while 100 drugs were prescribed 5708 times, of which 65.66% prescriptions were unlicensed by FDA. The percentage of off label prescriptions were 52.99%. Evaluating off label drug categories showed that dose (35.7%) and age (19.4%) were the highest reason observed for off label prescriptions. Significant association was found between unlicensed drug use with type of hospitals (p<0.001). A significant association was also found between unlicensed (p<0.002) and off label (p<0.0001) use of drugs with age groups. Multivariate binary logistic regression revealed that pediatric patients receiving drugs 5 or less drugs were significantly less likely to receive unlicensed prescriptions (OR 0.112, CL95% 0.027- Abstract vi 0.461) and off label drugs (OR 0.180, CL95% 0.073-447) as compared to patients who received 5 or more drugs. Analysis of 250 patients in the cardiology ward of HMC revealed the mean number of prescribed drugs to be 4.67±2.07. Of all the patients, 59.69% had sub-therapeutic doses and 5.52% had overdoses while132 (52.8%) had at least one DDI regardless of type of severity. Out of total drug prescriptions (1231), 43.05% were unlicensed and 44.59% were off labeled. In multivariate analysis, occurrence of unlicensed prescriptions were significantly more likely associated with infants (OR 10.288, CL 1.839-57.547) and children (OR 12.822, CL 2.004-62.025) age group as compared to adolescent group, while infant (OR 5.850, CL 1.131-30.246) age group was significantly 5.8 times more likely to receive off label prescription as compared to adolescent group. Among 1300 neonatal patients, 192 (14.76%) were premature in all nurseries of four tertiary care hospitals. Mean number of prescribed drugs were 2.85±1.35, while 358 (27.5%) had sub-therapeutic doses and 50 (3.8%) had overdoses. At least one DDI was present in 7.38% patients and a total of 21 drug combinations attributed to 112 DDIs. A total of 52 drugs were prescribed 3448 times, of which 1150 (33.35%) were unlicensed and 1798 (52.14%) were off labeled. Dose (61.29%) and indication (13.68%) were the most frequent off label categories in all the therapeutics classes. Chi square value determine that unlicensed drug use was significantly associated with the type of hospital (p<0.0001) and age groups (p<0.0001). Off label drug prescribing was also significantly associated with age groups (p<0.001). Multivariate binary logistic regression analysis showed that neonatal patients of age 0 to 7 days (OR 1.355, 95% 1.021-1.799), were significantly less likely to receive off unlicensed prescriptions as compare to reference age group. Male patients (OR 1.355, 95%CL 1.021-1.799) were significantly 1.3 times more exposed to receive unlicensed medicines compared to Abstract vii females. Neonatal patients of age 0 to 7 days (OR 1.631 (1.048-2.536) were also significantly 1.6 times more likely to receive off label medication as compared to patients of age 22 and above days. Of 420 patients admitted in pediatric intensive care units, the mean number of prescription per child was 4.13 ± 2.19, while 175 (41.66%) had sub-therapeutic doses and 54 (12.85%) had overdoses. Moreover, 74 (17.61%) patients had at least one DDI regardless of type of severity which were due to 41 interacting drug combinations leading to 156 DDIs. A total of 96 different drugs were prescribed 2453 times. Of these, 29.8% prescriptions were unlicensed from FDA and 42.27% were off label prescriptions. Dose (340, 32.79%) and indication (26.13%) was the highest reason for off label prescriptions. Multivariate regression analysis showed that patients receiving medications less than 5 (OR 0.280, 95%CL 0.137-0.570) were significantly less likely to receive off label prescriptions as compared to patients received 6 or more medications. In conclusion, prevalence of dosage errors and drug interactions was found to be higher in pediatric cardiology unit. A high prevalence of unlicensed and off label prescriptions was also observed in the present study which showed poor pediatric pharmacotherapy of our region. Increased number of prescribed drugs and infant age group were found to be significant predictors for unlicensed as well as for off label drug use. Unlicensed and off label drug use can also lead to adverse drug events. Therefore, to avoid exposing pediatrics to unnecessary risks, activities of health regularity agencies and perhaps, extra incentives are required to encourage the proper evidence based pediatric prescribing.
مشفق خواجہ یہ خبر نہایت افسوس کے ساتھ سنی جائے گی کہ کراچی میں ۲۱، ۲۲؍ فروری کی درمیانی شب میں جناب مشفق خواجہ صاحب کا انتقال ہوگیا، وہ اردو کے ممتاز محقق، نقاد، کالم نویس اور مزاح نگار تھے، خواجہ صاحب کو دل کی بیماری تھی، گزشتہ برس اس کا کامیاب آپریشن ہوا تھا، مگر پھر گردے کی تکلیف شروع ہوگئی جو بڑھتی گئی، انتقال سے ۴-۳ روز قبل طبیعت زیادہ خراب ہوگئی تو وہ اسپتال میں داخل کیے گئے جہاں انتقال ہوگیا، خواجہ صاحب کو علم و ادب سے بڑا شغف تھا، انہوں نے اپنی ادبی، تنقیدی اور تحقیقی نگارشات سے اردو ادب میں اہم جگہ بنالی تھی، وہ بہت اچھے مزاح نگار بھی تھے۔ خامہ بگوش کے نام سے اس فن میں اپنا جوہر خوب دکھاتے تھے، مرحوم کو دارالمصنفین سے بڑا لگاؤ تھا، ابھی دو برس پہلے اس کی اکثر کتابیں منگائیں تھیں، معارف بھی برابر ان کے مطالعہ میں رہتا تھا، ہندوپاک میں زرمبادلہ کی دشواری سے اہل علم کو بڑی پریشانی ہوتی ہے، معارف نہ ملنے سے خواجہ صاحب بھی بہت پریشان رہتے، اس کا علم جناب عبدالوہاب خاں سلیم صاحب کو ہوا تو وہ ان کا چندہ بھیجنے لگے اور تاکید کی کہ پیسے کی وجہ سے ان کا معارف نہ بند کیا جائے، اﷲ تعالیٰ خواجہ صاحب کی مغفرت فرمائے۔ (ضیاء الدین اصلاحی، مارچ ۲۰۰۵ء)
کوئی دوسرا مشفق نہیں ہے (ڈاکٹر رفیع الدین ہاشمی) انسان اپنی خلقت اور سرشت میں گوناگوں آرزؤں، خواہشوں اور تمناؤں کا مرقع ہے اور اس کی پوری زندگی ان ہی تمناؤں اور آرزؤں کی تکمیل و تزئین میں گزر جاتی ہے، خاک کا یہ پتلا بالعموم خواہشات نفس کا اسیر رہتا ہے اور حیات مستعار کی پوری نقدی کھیل تماشوں میں صرف کردیتا ہے، زر و مال کی طلب اور...
COVID-19 is a disease that cause respiratory illness due to novel corona virus. It was reported to WHO on December 31,2019 for the first time. The outbreak of this disease started from Wuhan city, China. Now COVID-19 pandemic is spreading worldwide mostly in Europe and North America, these regions have high prevalence of obesity. In the pathogenesis of COVID-19 disease, obesity assumes a significant job. Theinsusceptible framework, which is official in the pathogenesis of COVID19, assumes asignificant job in weight instigated fat tissue aggravation. In the fat tissue the irritationbrings about metabolic brokenness conceivably prompting dyslipidemia, type 2diabetes mellitus, insulin obstruction, hypertension and cardiovascular sickness. Obesity has been expanded the vulnerability to contaminations. In this pandemic, a large number of obese individual with Covid-19 are reported. Infection rate in obese is greater due to poor immunity, comorbidity and inadequate nutritional needs. Statistical analysis showed that about 41.7% patients reported in New York city were obese. Whereas 40% obese have been reported in United State of America with Covid-19. A report from UK indicated that 38% obese were admitted in ICU with Covid-19. According to Chinese researchers, obese individuals are 3-timesmore prone toward the development of Covid-19. So recent analysis indicated that obesity is the major risk factor of Covid-19. In COVID-19, overweight and obese patients have high danger of metabolic difficultiesand eternal infections that stoutness works. More nutrition care is required for such patients. As nutrition is a key factor for keeping up human wellbeing, for example, denseimpervious framework and satisfactory admission of supplements and dietaryenhancements. Tolerant with COVID-19 create contamination from slight to seriousindications bound to the dietary status. Consequently, assessing wholesome status ofindividuals with contamination turns out to be increasingly significant. Through dietaryhelp, we can bring down the danger of oxidative pressure, infection contamination andexpands invulnerability framework among obese people especially.
Dengue is one of the most leading mosquito-borne viral infection, considered as one of the major health problem associated with high rate of morbidity and motility. The root cause of dengue infection are four distinct but serotypically related virus (DENV-1, 2, 3 and 4). WHO estimated about more than 50,000,000 dengue cases reported worldwide. Primarily, dengue leads to dengue fever (DF), an acute febrile illness, while Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS) are secondary infection to DF. To-date, there is no proper medical treatment available against dengue. Recent studies indicated a direct infection of the platelets by the dengue virus. Clinical severity associated with dengue is potentially due to thrombocytopenia while in DHF, thrombocytopenia is associated with increased vascular permeability, haemorrhagic manifestations and any further decrease in platelet counts leads to lethality. So, there is a need of a regimen that can not only improve the disease outcome but also linked with the least side effects. Investigations on the effects of fresh aqueous leaf extract of Carica papaya Linn on the thrombocytes count of DF, DHF and DSS patients has provided promising results because of the presence of alkaloids, saponins and other phenolic compounds in leaves. The use of the papaya aqueous leaf extracts is one of the most inexpensive, therapeutically effective herbal management particularly in the less privileged and dengue endemic under developing countries. The purpose of the present study was to establish the quality standard of male and female papaya leaves separately along with quantification of bioactive compounds as they are important in dengue fever management. A significant difference was observed among alkaloids, phenols and saponins in both the leaves (p<0.01). Phytoconstituents including alkaloids, phenolics and saponins were found to be significantly different (p<0.01) in both male and female aqueous and ethanolic leaf extracts. The results delineated that aqueous extracts from female plant is richer in alkaloids while male leaves are richer in phenols. Furthermore, the aqueous crude extract of both male and female plant was accessed for tablet formulation. Extracts were first accessed for microbial contamination test and were found to be negative. Pre formulation studies were performed on both male and female aqueous extracts as well as for excipients. Significant difference (p<0.01)was observed for male and female leaf extract powders relating to bulk density, tapped density and Hausner’s ratio while no significant difference is seen for angle of repose and carr’s index. FTIR analysis was done for male and female aqueous extracts and also for excipient’s compatibility. The Interferogram delineated no significant difference after the addition of excipient to both the dried aqueous extract. All the ingredient showed good flow properties so direct compression method of tablets was selected. Post formulation studies were done on the prepared aqueous male and female leaf extracts tablets including general appearance, weight variation, hardness testing, friability testing, disintegration and dissolution profiles. Significant difference (p<0.05) was observed for only in disintegration. Tablets were also tested for their stability during storage period of one month. Tablets stored at 40°C and 75% humidity failed to pass the test while at 25°C; normal humidity and 5°C; 0% humidity passed the test. Finally, both kinds of tablets were preliminary analyzed to evaluate their potential role. For the said, six dengue positive subjects (of both gender) were selected based on criteria and administered with the tablets along with the standard therapy. Their platelet count for the next five days were analyzed. Results showed significant potential of aqueous female leaf extracts tablets (p<0.05) as compared to aqueous male leaf extracts tablets in terms of increasing and stabilizing the platelet count during treatment. Previous literature reported in general that Carica papaya aqueous leaf extract can be used as a first aid oral treatment in dengue but the data did not report the difference in phytoconstituents of male and female leaves of the plant separately.The current research depicted this difference.Data from the current research would be useful in development of medication for dengue in future from female plant leaves. However, randomized clinical trials based on large scale are still needed in order to establish potentiating role of Carica papaya aqueous leaf extract, especially from female leaves, in the management and/or treatment of dengue and its associated complication.