Background: Drug stores in Pakistan are run by dispensers with varied knowledge, qualification, and experience. The current study was sought to explore the knowledge, qualification, experience, and dispensing practices among dispensers working in drugstores in South Karachi, Pakistan. Methods: A cross-sectional survey was carried out using a structured questionnaire. Data were collected from medical stores in South Karachi which were then categorized, coded, and analyzed using SPSS version 23. Relationship among different study variables with pharmacist’s availability and personal experience was assessed using statistical non-parametric Chi-square test. A total of 385 samples obtained using a simple random sampling method were included in the study. However, only 210 responses on questionnaire were complete which were then selected for study analysis between October and December 2018. Results: Of the 210 surveyed drugstores, 9% of their staff had studied only till primary school, 5.7% till the eighth grade, 25.2% up to secondary school level, 26.7% till higher secondary school level, 15.7% had non-professional education, and 8.1% were professional graduate. Only 9% of them had a degree in Pharm. D or B. Pharm, while 0.5% had a post-graduation qualification. Furthermore, 44.8% of pharmacies had a valid pharmacy license but the pharmacist was physically absent in 91% of the drugstores. Majority of pharmacies did not maintain appropriate temperature (refrigerator and/or room temperature). Majority of dispensers did not review prescription particulars before dispensing medications and also dispensed medications on older prescriptions as well as without prescription. Conclusion: In conclusion, the overall knowledge and practices of dispensers working in drugstores was poor. However, the presence of pharmacist was associated with good dispensing practices to a certain extent.
Endoscopic retrograde cholangiopancreatography is an advanced investigation both diagnostically and therapeutically. It does need expertise and simultaneously a complete setup with the appropriate equipment, staff and radiological backup.1 The choice of the patients has to be spot on as the procedure does come up with complications like any other one including post-ERCP pancreatitis that can be bothersome to treat and challenging even for experienced gastroenterologists.2 The hospital stay is much longer sometimes with patients needing more scrutiny by the attending physician as resultant cholangitis is very troublesome and agonising for the patient needing antibiotics. 2The rising fever and increase in inflammatory markers take days to settle. . So prevention is better than cure in a sense that misery of both the patient and doctor can be avoided. It’s a common observation that most young gastroenterologists are more inclined towards learning ERCP.3 This is very encouraging keeping in mind there is a deficiency of skills, especially in peripheries. The problem is that eagerness to learn such advanced procedures has kept them out of the loop and rather deviated them from the basics of gastroenterology and hepatology because they tend to forget the theoretical knowledge and core concepts which are inevitably essential prerequisites for an emerging expert.2 Most ERCPS is done after a detailed workup and as a follow-up the investigation after magnetic resonance pancreatography, (MRCP) which is a non-invasive investigation for finding the cause of deranged liver function and dilated common bile duct on ultrasound abdomen for gallstones.4 Its better not to rely on a single US abdomen report if the clinical picture is different. It’s more appropriate to repeat it and go for an ERCP if the situation demands .This all comes with experience after seeing so many patients presenting with different forms and manifestations. The biggest dilemma is that most of the specialists do ERCPs directly without doing non-invasive investigations and that is when the clinical judgement of a physician is compromised and there is an increased risk of complications such as pancreatitis and perforation. The overall risk of PEP risk is 9.7% which can rise to over 14.7% in high-risk patients especially those with sphincter of Oddi dysfunction and a previous history of pancreatitis.5 It’s a better and safer approach to weigh the benefits vs. complications. Merely complications and giving reasons aren’t enough. One needs to own them as well by managing on time and counselling the patients why did they happen in the first place as there is element of colossal trust between the patient and attending physician that need to be kept As gastroenterologists we struggle with simple interpretation of deranged liver function tests rarely making wrong diagnosis by going for fancy investigations acquired from the books. There is lack of thought and wisdom at same time resulting in wastage of time and resources. The thing which arouses our curiosity is therapeutics and interventional endoscopies all the time. That shouldn’t be the aim all the time though necessary for progression of our careers. There are so many other aspects of gastroenterology that we need to focus. EASL guidelines of management of hepatitis B and C are published quite frequently. 6Every year there is an update on other diseases as well such as Barret Esophagus and Gastroesophageal Reflux Disease.7 There are innovative articles reflecting the latest trends in gastroenterology published all the time. One needs to focus on reading them and acquire the basics of subject before advancing and applying them in real clinical scenarios. These scenarios are quite tricky when it comes to diagnosis and same is the case in post graduate exams with trainees failing them quite frequently .There has to be more emphasis on ward rounds and learning from scenarios in case based discussions. Simulation is a powerful learning method in medical education that can be used in clinical settings.8Similarly one has to observe the procedures,assist,perform under supervision and then doing them independently once your mentor is confident enough about the skills acquired over the period of time. There are many areas of our subject on which we need to focus ranging from acute hepatitis to hepatocellular carcinoma.9 What we need to realise is that ERCP and EUS are advanced aspects of gastroenterology but that isn’t the end of the journey or the road. The eyes can’t see what the mind doesn’t know. There needs to be greater emphasis on the basics of gastroenterology enabling us to diagnose the patients promptly and refer the right ones for endoscopy, colonoscopy, endoscopic ultrasound, fibro scan, liver biopsy and even ERCP.10 Learning skills in a state of art of facility is must but one has to have a solid theoretical knowledge and application of it into appropriate clinical situation requiring sound clinical reasoning, critical thinking and problem solving skill.11 There are no shortcuts to experience and no stop to learning as well. It’s worth learning in a good setup with compassionate seniors and letting the time teach you the best. Hard work is the key to success and learning can’t be overnight. One has to be devoted to a cause as that is always rewarded and people working strenuously and continuous are winners eventually .The important thing is patience which most of us lack. All excellent clinicians were not made in a single day. They too went through the process of learning just like us .Some of us learn faster than others which shouldn’t matter as slow and steady wins the race. No book or can teach you practical skills and vice versa. The skills have to be learnt properly as today you are a trainee and in future a fully fledged supervisor training so many residents. There is always a ray of hope and lightening at the end of the tunnel. As long as there is a desire and eagerness to learn from others, it will bear fruits of learning in the long run. It’s wiser not to get disappointed on a single mistake in any procedure including ERCP as long you learn from that by analysing it carefully with an intention and a strong will not to repeat in future.
Objective: To find out the frequency of anemia, agranulocytosis and thrombocytopenia in hyperthyroid patients after the use of propylthiouracil. Study Design: Cross sectional study. Place and Duration of Study: Out Door Patients Department and Pathology Laboratory in Liaquat University Medical & Health Sciences, Hospital Hyderabad/Jamshoro, from May 2016 to Apr 2017. Methodology: Two hundred cases, comprising of adult patients were categorized into five groups, age group 15-30 years 79 (39.5%) patients presenting the highest out of total, age group 31-45 years 68 (34%) patients, age group 46-60 years 36 (18%), age group 61-75 years 14 (7%) patients, age group >75 years 3 (1.5) patients. Complete blood count was analyzed on Sysmex Kx21 and thyroid profiles were analyzed on Elecysis 2010 from the Pathology Department. SPSS version 22 was used for data analysis. Result: Out of total patients, 32 (16%) were males and 168 (84%) were females with mean age of 37.44 ± 14.82 years. Majority of patients 68 (34%) were anemic, while 4 (2%) had agranulocytosis and 11 (5.5%) had thrombocytopenia. Headache was reported in 111 (55.5%), exophthalmos in 106 (53%), sore throat in 172 (86%), fever in 136 (68%) and weight loss in 95 (47.5%) patients. Conclusion: Propylthiouracil causes defective hematopoiesis in hyperthyroid patients because propylthiouracil has adverse suppressive effects on bone marrow.
Objective: Aim was to evaluate the sensitivity and specificity of Mentzer index in differentiating beta thalassemia minor from anemia of Iron deficiency. Materials and Methods: A cross-sectional study conducted in Hematology unit of Hayatabad Medical Complex .Sampling was done non-consecutively. A total of 860 cases with value of Hemoglobin less than 11 Gm/DL were counted. In all the selected cases full blood count were checked and Mentzer Index mean corpuscular volume [MCV] per RBCs count )was calculated. Value of <13 suggests the diagnosis of β Thalassemia minor/trait while more than 13 value is more indicative of Iron deficiency anemia (IDA). Confirmation of diagnoses was made by hemoglobin study using HPLC. Values for specificity and sensitivity for Mentzer Index were calculated for the two differentials of microcytic hypochromic anemia presenting with microcytosis and hypochromia. Results: Mean hemoglobin level of patients was 9.01±1.85. Minimum and maximum hemoglobin value was 2.90 and 11 g/dl. Mean RCB count was 4.66±4.59 minimum and maximum RCB count was 1.07 and 136. Mean MCV value was 63.89±9.01. Minimum and maximum MCV value was 39.40 and 92.10 respectively. Men Mentzer index was 15.70±7.68. Minimum and maximum Mentzer index value was 7.80 and 10.7 respectively. Based on Mentzer index criteria 489(56.86%) patients had iron deficiency anemia and 371(43.14%) patients had higher suspicion of beta thalassemia. Conclusion: It was concluded that for differentiation among Beta thalassemia minor and anemia of iron deficiency , Mentzer Index can be beneficial to discriminate with a high sensitivity as well as specificity percentage and thus through a cost effective way, only suspected cases of beta thalassemia trait/minor can be further confirmed by Hb Electrophoreses. Keywords: Mentzer Index, iron deficiency Anemia, beta Thalassemia minor
Background: Dengue is the most common disease that has caused mortality throughout Pakistan as it can cause diversified complications ranging from slightly deranged liver function tests to acute hepatitis and liver failure. Objective: To determine the prevalence of acute hepatitis in dengue patients. Methods: We conducted a cross-sectional study from September to November 2022 at department of Medicine of MMC General Hospital a tertiary-care hospital of Kabir Medical College Peshawar. A proper approval was taken from research ethical committee of the hospital. The inclusion criteria were patients of dengue and exclusion was all patients having deranged liver function tests due to other causes such drug induced liver injury and acute viral hepatitis. The total sample size was 81 patients and non probability convenient sampling technique was used. The data was analyzed by using SPSS latest version. Results: ALT, ALP and Bilirubin was compared in age groups of patients. Results showed no significant difference for ALT, ALP and Bilirubin at baseline and at 3rd day of admission in all age groups as seen in above table.
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