Background
Health-related quality of life (HRQoL) is considered to be the fourth 90 of UNAIDS 90-90-90 target to monitor the effects of combination antiretroviral therapy (ART). ART has significantly ...increased the life expectancy of people living with HIV/AIDS (PLWHA). However, the impact of chronic infection on HRQoL remains unclear, while factors influencing the HRQoL may vary from one country to another. The current study aimed to assess HRQoL and its associated factors among PLWHA receiving ART in Pakistan.
Methods
A cross-sectional descriptive study was conducted among PLWHA attending an ART centre of a tertiary care hospital in Islamabad, Pakistan. HRQoL was assessed using a validated Urdu version of EuroQol 5 dimensions 3 level (EQ-5D-3L) and its Visual Analogue Scale (EQ-VAS).
Results
Of the 602 patients included in the analyses, 59.5% (
n
= 358) reported no impairment in self-care, while 63.1% (
n
= 380) were extremely anxious/depressed. The overall mean EQ-5D utility score and visual analogue scale (EQ-VAS) score were 0.388 (SD: 0.41) and 66.20 (SD: 17.22), respectively. Multivariate linear regression analysis revealed that the factors significantly associated with HRQoL were: female gender; age > 50 years; having primary and secondary education; > 1 year since HIV diagnosis; HIV serostatus AIDS-converted; higher CD 4 T lymphocytes count; detectable viral load; and increased time to ART.
Conclusions
The current findings have shown that PLWHA in Pakistan adherent to ART had a good overall HRQoL, though with significantly higher depression. Some of the factors identified are amenable to institution-based interventions while mitigating depression to enhance the HRQoL of PLWHA in Pakistan. The HRQoL determined in this study could be useful for future economic evaluation studies for ART and in designing future interventions.
Pharmacists play a significant role in the multidisciplinary care of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). However, there is less ...evidence to clarify the impact of pharmacist as an individual team member on HIV care.
This study aims to determine the effects of pharmacist intervention on improving adherence to antiretroviral therapy (ART), viral load (VL) suppression, and change in CD4-T lymphocytes in PLWHA.
We identified relevant records from six databases (Pubmed, EMBASE, ProQuest, Scopus, Cochrane, and EBSCOhost) from inception till June 2020. We included studies that evaluated the impact of pharmacist care activities on clinical outcomes in PLWHA. A random-effect model was used to estimate the overall effect odds ratio (OR) for dichotomous and mean difference (MD) for continuous data with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence.
The review protocol was published on PROSPERO (CRD42020167994).
Twenty-five studies involving 3206 PLWHA in which pharmacist-provided intervention either in the form of education with or without pharmaceutical-care either alone or as an interdisciplinary team member were included. Eight studies were randomized controlled trials (RCTs), while 17 studies were non-RCTs. Pooled-analyses showed a significant impact of pharmacist care compared to usual care group on adherence outcome (OR: 2.70 95%, CI 1.80, 4.05), VL suppression (OR: 4.13 95% CI 2.27, 7.50), and rise of CD4-T lymphocytes count (MD: 66.83 cells/mm3 95% CI 44.08, 89.57). The strength of evidence ranged from moderate, low to very low.
The findings suggest that pharmacist care improves adherence, VL suppression, and CD4-T lymphocyte improvement in PLWHA; however, it should be noted that the majority of the studies have a high risk of bias. More research with more rigorous designs is required to reaffirm the impact of pharmacist interventions on clinical and economic outcomes in PLWHA.
...they continue to work, exposing themselves and others to risk 4. ...they face increasing difficulties in earning or receiving sufficient funds to afford ART medication 4,9. Ensuring a migrants’ ...good health is critical for the countries in which they originate from and move to 10 However, reports globally show that migrants are often subject to health inequalities due to lack of access to adequate health care as a result of neglect, exclusion, discrimination, unfavourable employment conditions causing ill health, inadequate living conditions, financial constraints or lack of appropriate legal status 10.
Background
The use of cosmetics is growing among both male and female consumers due to the availability of different brands. While there is an increase in the usage of cosmetic products, it is ...concerning whether the consumers are aware of the safety of the products.
Aims
This study aimed to widely explore consumers’ perceptions and attitudes toward cosmetics within the context of the COVID‐19 pandemic.
Methods
A cross‐sectional study was carried out among adults in Selangor, Malaysia. Thirty‐three questions divided into three dimensions (socio‐demographic parameters, assessment of perception, and assessment of attitude) were developed and validated to be answered by cosmetics consumers. Descriptive and inferential statistical analysis was done using SPSS.
Results
A response rate of 87% was achieved, and the mean age of participants was 33 ± 7.2. The overall perception of consumers indicates low levels of perception and moderate level of attitude toward cosmetic products. There was a positive correlation and high relationship between participants’ perception and attitude (p = 0.001, r = 0.72). A significant association was observed between demographic data of respondents and their attitude and perception toward cosmetic products. Participants were unaware that sharing of cosmetic products could lead to bacterial infection and possibly increased the chance of contracting COVID‐19.
Conclusion
This study displayed a nonchalant perception and attitude of Malaysian adults toward cosmetic products by focusing on aesthetics rather than health safety. Therefore, it is recommended to raise awareness on the composition and effects of cosmetic products, increase the practice of hygiene and dissuade the sharing of cosmetics to reduce transmissions of COVID‐19.
The irrational use, "over the counter supply", and unregulated supply chains of antimicrobials are contributing toward antimicrobial resistance. Antimicrobial stewardship programs regulate ...antimicrobials usage to prevent resistance and reduce health care burden.
To assess the knowledge and practice of pharmacists' working in various healthcare settings toward antimicrobial stewardship in Pakistan.
A cross-sectional study was conducted among pharmacists working in different sectors between March to June 2017.
A total of 181 pharmacists participated, of whom (
= 145, 80.1%) were males. The majority of participants were in the 20⁻30 age group (
= 147, 81.2%) and hold Doctor of Pharmacy degrees. More than 80% of pharmacists agreed that "antimicrobial stewardship is essential to improve patient care"; while (
= 159, 87.8%) pharmacists agreed that "pharmacist should be trained on the use of antimicrobial". Close to 90% of pharmacists agreed that "adequate training should be provided to pharmacists on antimicrobial use". Regarding the practice of antimicrobial stewardship, (
= 72, 39.8%) pharmacists often/always "make efforts to prevent or reduce the transmission of infections within the community"; (
= 58, 32%) pharmacists never "dispense antimicrobials without a prescription"; and (
= 60, 32%) pharmacist often/always "communicate with prescribers if unsure about the appropriateness of an antibiotic prescription".
: Increased antimicrobial stewardship efforts can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. Pharmacists in Pakistan have good knowledge and adopt positive practices toward antimicrobial stewardship. Pharmacist and other health care professionals should collaborate within multi-disciplinary teams to reduce the problem of antimicrobial resistance and improve the quality of life of patients.
Background
Incidence of hypokalemia during the management of diabetic ketoacidosis (DKA) is high despite detailed potassium replacement guidelines in its treatment.
Aim
We aimed to find the role of ...pH‐adjusted potassium (pHK) in the development of hypokalemia, and their mutual impact on patient outcomes during DKA management.
Methodology
Adult DKA patient's admission data of preceding 3 years (2015‐2017) were retrospectively clerked. Outcomes of interest were time to develop hypokalemia and to terminate emergency department (ED) care (hours), severity of hypokalemia and hospitalisation length (days). Linear regression was used to determine significant associations/predictors.
Results
The study was concluded on 85 patients. Hypokalemia was observed in nearly 3/4th of all admissions and occurred by the time of ED care termination. Each 1 mmol/L increase in pHK significantly (a) reduced the degree of hypokalemia by 0.07 mmol/L, (b) delayed time to develop hypokalemia by 4.58 hours, (c) and reduced the ED care time by 1.28 hours. Arterial pH was the other factor significantly delaying time to develop hypokalemia (36.25 hours) and facilitating early discharge from ED (13.86 hours). Moreover, each 1 mmol/L reduction in the degree of hypokalemia increased hospitalisation length by 1.86 days. Though significant, acute kidney injury negligibly increased hospitalisation length by 0.01 days.
Conclusion
pH‐adjusted potassium shall be used as a marker for hypokalemia and to initiate potassium replacement instead of measured serum potassium in DKA. Utilising pHK will help to avoid hypokalemia, reduce its severity and shorten ED care which will subsequently reduce hospitalisation length. We expect pHK to improve pharmacoeconomics in the future.
The utilization of vitamins and dietary supplements (DSs) among consumers in Malaysia has seen a notable increase. However, there is limited research available on how pharmacists in Eastern countries ...manage the provision of these products.
This study aims to assess the knowledge, attitudes, and practices of community pharmacists in Malaysia regarding the provision of counselling services on vitamins and DSs. The findings will inform education strategies in this area.
A cross-sectional quantitative study was conducted from February to April 2022 using a validated online-based questionnaire. The survey was distributed to community pharmacists across Malaysia through social media channels. t-test and ANOVA test were used for data analysis.
Among the 260 participants, 73.5% were categorized as having average product knowledge. Key concerns included a lack of knowledge about the indications of new products and when to discontinue their use. Regarding dosing in specific patient groups, 33.5% of pharmacists only occasionally consulted references and primarily relied on product labels. Furthermore, 29% of pharmacists believed it was unnecessary to refer patients to doctors when they experienced ongoing symptoms while taking vitamins or DSs. Interestingly, 44.6% of pharmacists believed there was a correlation between the efficacy of vitamins and their price, often recommending more expensive brands despite similar content.
There is an opportunity to enhance the knowledge of pharmacists in Malaysia regarding vitamins and DSs. Education interventions should focus on areas such as dosing for specific patient groups, when to discontinue products, understanding new products, evidence-based efficacy of products for specific conditions, and providing a framework for appropriate referral to support pharmacists in their practice.
With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV ...(PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular.
Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis.
Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention.
Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.
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