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ObjectivePotentially inappropriate prescribing is a global health issue with catastrophic consequences in the elderly population. Healthcare providers play a critical role in medication optimisation in elderly patients. The present study aims to explore the perceptions of healthcare professionals (prescribers) regarding the complexities of inappropriate prescribing practices in the elderly population.DesignA qualitative study using semistructured interviews was conducted. All the data were transcribed verbatim and analysed via Braun and Clarke’s thematic analysis approach.SettingPrescribers working in a tertiary care hospital in Karachi, Pakistan.ParticipantsPrescribers having more than 5 years of experience in elderly prescribing. Participants were selected using purposive sampling, and recruitment continued until the point of data saturation, meaning no new major themes emerged.Results13 prescribers, five females and eight males with an average experience of 15.3 years, were interviewed. The interviews lasted for an average of 15 min. The analysis revealed three primary themes: (1) inappropriate prescribing, characterised by knowledge and awareness of inappropriate prescribing and its assessment tools; (2) complexities in elderly prescribing, highlighting patient factors such as comorbidities, polypharmacy, psychological issues and socioeconomic challenges, as well as prescriber factors; and (3) interventions to improve prescribing, emphasising the role of pharmacists in enhancing medication safety, the importance of effective patient–prescriber relationships through counselling and the need for regulatory measures to monitor prescribing behaviours. Inadequate knowledge of standardised assessment tools such as the Screening Tool to Alert to Right Treatment/Screening Tool of Older Persons’ Prescriptions criteria, time constraints faced by prescribers and fragmented healthcare systems were some of the barriers identified by the respondents in medication optimisation for elderly individuals.ConclusionThe findings highlight the need for enhanced education on standardised assessment tools and the implementation of targeted interventions. A key recommendation is the integration of clinical pharmacists into care teams to optimise prescribing practices.

Green synthesis of nanoparticles is becoming a method of choice for biological research due to its environmentally benign outcomes, stability and ease of synthesis. In this study, silver nanoparticles (AgNPs) were synthesized using stem (S-AgNPs), root (R-AgNPs) and mixture of stem and root (RS-AgNPs) of Delphinium uncinatum . The synthesized nanoparticles were characterized by standardized techniques and evaluated for their antioxidant, enzyme inhibition, cytotoxic and antimicrobial potentials. The AgNPs exhibited efficient antioxidant activities and considerable enzyme inhibition potential against alpha amylase, acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) enzymes. S-AgNPs showed strong cytotoxicity against human hepato-cellular carcinoma cells (HepG2) and high enzyme inhibitory effect (IC50 values 27.5μg/ml for AChE and 22.60 μg/ml for BChE) compared to R-AgNPs and RS-AgNPs. RS-AgNPs showed significant inhibition of Klebsiella pneumoniae and Aspergillus flavus and exhibited higher biocompatibility (<2% hemolysis) in human red blood cells hemolytic assays. The present study showed that biologically synthesized AgNPs using the extract of various parts of D. uncinatum have strong antioxidant and cytotoxic potentials.

The prevalence of potentially inappropriate medications (PIMs) in older adults populations is a significant concern, often leading to adverse drug events and increased health-care utilization. In the present study, we aim to evaluate the prevalence of PIMs among hospitalized older adults patients in Pakistan using STOPP (Screening Tool of Older Persons' Prescriptions) criteria version 3. A prospective observational study was conducted at a tertiary-care hospital in Karachi over 1 year from March 2023 to March 2024. Patients aged 60 years and above, prescribed at least one medication, were included. Data on demographics, comorbidities, and medications were collected and analyzed using the STOPP criteria to identify PIMs. Statistical analysis was performed using IBM SPSS Statistics version 21. To find the variables linked to PIM use, multivariable logistic regression analysis was used. The 95% CI and adjusted odds ratio (aOR) were used to measure the statistical association's strength. A p-value of less than 0.05 was deemed statistically significant. Among 450 participants, the median age was 67 years, with a predominance of male patients (55.3%). The prevalence of PIM use was 56.6%, and a total of 388 instances of PIM use were identified according to STOPP criteria version 3. Acetylsalicylic acid (18%) and pheniramine (11%) were the most frequent inappropriately prescribed medications. The multivariable logistic regression analysis revealed that polypharmacy and the presence of one or more comorbidities primarily influence the PIM use. The findings highlight a critical need for improved prescribing practices in the older adults population in Pakistan. Utilizing screening tools like the STOPP criteria can significantly enhance medication safety and optimize pharmacotherapy in this vulnerable group.

In an evolutionary era of medical education, “Artificial intelligence” (AI) is applied to replicate human intellect, encompassing abilities, logical reasoning and effective problem-solving skills. Previous research has explored the attitude of medical and dental students, toward the assimilation of AI in medicine; however, a significant gap exists in appraising the understanding and concerns of pharmacy students. Therefore, the current study was designed to explore undergraduate pharmacy students’ perceptions of integrating AI into education and practice. Methods : A cross-sectional study was conducted among final-year pharmacy students from different public and private sector universities in Karachi. The sample size on 60% anticipated response rate and 99% CI was calculated to be 390. Data was collected after acquiring ethical approval using convenient sampling. Frequency and percentage of the socio-demographic features were analyzed and then goodness of fit and Pearson’s chi-squared test of correlation was applied. Results were considered significant when p < 0.05. Results : The overall response rate of the study was 67%. More than 80% of the respondents were female. The students 35% (n = 202) strongly agreed and 59% (n = 334) agreed that AI plays an important role in healthcare, (χ2 = 505.6, p < 0.001). Around 79% (n = 453, χ2 = 384.3, p < 0.001) of students agreed on the replacement of patient care specialties with AI in the future, whereas 495 students (87%, χ2 = 682.3, p < 0.001) stated that they possess a strong comprehension of the fundamental principles governing the operation of AI. More than 80% of the students were comfortable in using AI terminologies (n = 475, χ2 = 598, p < 0.001) and 93% (n = 529, χ2 = 290, p < 0.001) were sure that AI inclusion in pharmacy education will develop a positive influence into the pharmacy curriculum (95%, n = 549, χ2 = 566.9, p < 0.001). A high and positive correlation was observed between the perception and willingness of students to adopt the AI changes in teaching undergraduate students (ρ = 0.491, p < 0.001). Furthermore, the outcomes showed students at private-sector universities stood out in computer literacy compared to public-sector universities (χ2 = 6.546, p < 0.05). Conclusion: The current outcomes revealed the higher willingness of pharmacy students towards AI-infused learning. They understood the prerequisite of having both formal and informal learning experiences on the clinical application, technological constraints, and ethical considerations of the AI tools to be successful in this endeavor. The policymakers must take action to ensure that future pharmacists have a strong foundation of AI literacy and take initiatives to foster the interests and abilities of imminent pharmacists who will spearhead innovation in the field.

Public involvement in reporting adverse drug reactions (ADRs) generates a broader database on drug safety. Underreporting remains a hindrance to implementing an effective pharmacovigilance system that ultimately affects public health. Hence, it is critical to appraise the public's awareness of ADR reporting and pharmacovigilance to address the gaps for the enhancement of ADR reporting rate. The current study explored public knowledge and attitudes toward ADR reporting in Karachi, Pakistan. A quantitative cross-sectional study was conducted from 3rd Jan 2022 to 30th Nov 2022 using a forty-item questionnaire to evaluate public insights regarding the ADR and its reporting. Descriptive analysis was executed to determine frequencies and percentages for the respondents' baseline characteristics and the responses toward ADR reporting. The chi-square test (χ2) was applied to determine the association between the dependent and independent variables considering a p-value < 0.05 as statistically significant. The response rate of the present study was 78.3%. More than 80% of the respondents deemed that ADR occurs only with high doses of medicines and over-the-counter medications do not cause any ADR. More than 75% of the respondents did not know that the ADR reporting form is available on the Drug Regulatory Authority of Pakistan (DRAP) website; the response varied significantly with the education (p = 0.002) and social status (p = 0.0001) of the respondents. More than 50% of the participants refused to ever report an ADR to health professionals. Physicians (n = 364; 47.7%) and pharmacists (n = 253; 33.1%) were the respondents' professed most reliable sources to whom ADR can be reported; responses varied significantly with their education (p = 0.003) and age (p = 0.001). The study has provided insight into the challenges and gaps needed to improve ADR reporting in Pakistan. The outcomes revealed that the public is aware of the benefits of reporting ADRs; however, they do not realize their role and the potentially significant impact on the healthcare system by contributing to ADR reporting. Therefore, it is a need of time to educate the public on the value of reporting ADRs and implement user-friendly and accessible ADR reporting systems in patient care areas to facilitate easier reporting.

Pharmacists being the drug experts need to be well aware of the applied handling of biosimilar medicines (BSMs). They are an integral educator, trailblazer, and advocate of biosimilar integration across all clinical settings. Therefore, the current study was conducted to assess the pharmacists' knowledge, attitude, and practices of integrating BSMs into clinical practice. The cross-sectional study was conducted from August 2019 to November 2019. The community pharmacies, clinical and academic settings in Karachi were approached for gathering the responses of pharmacists towards BSMs and interchangeable products using a 30-item survey form. Pearson correlation and independent sample -test were used to identify the relationship among independent variables and the responses, considering p values <0.05 as statistically significant. Overall, there were 305 survey forms used with a response rate of 87.14%. More than 80% of the respondents have good knowledge about the definition, characteristics, safety and efficacy, compatibility, cost issues, and utilization of BSMs. Around half of the respondents (48.9%, [95% CI 46.6-51.2]) were confident in using BSMs in clinical practice. However, they were concerned about the BSM's safety profile (45.2%, [95% CI 42.1-48.3]), quality (30.2%, [95% CI 28.3-32.1]), and efficacy issues (32.3%, [95% CI 31.2-37.5]). The findings revealed that pharmacists were well informed about the BSMs. However, some of the responses to the attitude demonstrated a lack of understanding of the application of that knowledge. The respondents persuaded that advanced patterns of diseases, product marketing stipulations, and need for better patient care drives higher demand for developing BSMs and were enthusiastic about gaining more insight to integrate BSMs into routine clinical practice.

Introduction: With the increase in the incidence rate of COVID-19, healthcare professionals (HCPs) being at the frontline of the outbreak response are at higher risk of getting exposure and suffering from the infection. The present study aimed to evaluate the knowledge, attitude, and precautionary practices of HCPs towards COVID-19. Methodology: The current study was a descriptive, cross-sectional, online study directed to the HCPs working in a metropolitan city of Karachi, during February 2020 and March 2020 using a self-administered questionnaire. A systematic random sampling approach was adopted. Results: A total of 286 completed surveys were incorporated in the investigation with a response rate of 74.28%. The median (interquartile range, IQR) knowledge score was 18.79 (17.64-19.57). Physicians were found to be more knowledgeable (OR: 1.32, 95% CI: 0.17-4.26, p = 0.003) as compared to other HCPs. Similarly, the HCPs working in private work settings (OR: 1.94, 95% CI: 1.54-2.79, p=0.001), having more experience (OR = 1.82; 95% CI = 1.64-2.78; p < 0.005) were found to be more well-informed than HCPs working in public sector (OR = 0.81; 95% CI = 0.63–0.72; p = 0.004). The correlation between the knowledge and attitude of respondents was found to be significantly correlated (correlation coefficient: 0.13, p < 0.005). Conclusions: The findings of the study revealed that HCPs were well conversant and have an optimistic attitude towards COVID-19. Further contemplates are required to evaluate the understanding of HCPs at a national level so that viable mediations could be planned to combat this pandemic.

Many pathogens colonize different anatomical sites, but the selective pressures contributing to survival in the diverse niches are poorly understood. Group A Streptococcus (GAS) is a humanadapted bacterium that causes a range of infections. Much effort has been expended to dissect the molecular basis of invasive (sterilesite) infections, but little is known about the genomes of strains causing pharyngitis (streptococcal \"sore throat\"). Additionally, there is essentially nothing known about the genetic relationships between populations of invasive and pharyngitis strains. In particular, it is unclear if invasive strains represent a distinct genetic subpopulation of strains that cause pharyngitis. We compared the genomes of 86 serotype M3 GAS pharyngitis strains with those of 215 invasive M3 strains from the same geographical location. The pharyngitis and invasive groups were highly related to each other and had virtually identical phylogenetic structures, indicating they belong to the same genetic pool. Despite the overall high degree of genetic similarity, we discovered that strains from different host environments (i.e., throat, normally sterile sites) have distinct patterns of diversifying selection at the nucleotide level. In particular, the pattern of polymorphisms in the hyaluronic acid capsule synthesis operon was especially different between the two strain populations. This finding was mirrored by data obtained from fullgenome analysis of strains sequentially cultured from nonhuman primates. Our results answer the long-standing question of the genetic relationship between GAS pharyngitis and invasive strains. The data provide previously undescribed information about the evolutionary history of pathogenic microbes that cause disease in different anatomical sites.

Growing antibiotic resistance complicates H. pylori eradication, posing a public health challenge. Inconclusive research on sociodemographic and clinical factors emphasizes the necessity for further investigations. Hence, this study aims to evaluate the correlation between demographic and clinical factors and the success rates of H. pylori eradication. A group of 162 H. pylori-positive patients were allocated randomly to receive either a ten-day moxifloxacin-based triple therapy or a levofloxacin-based sequential therapy. Eradication success was determined through the stool antigen test. Logistic regression analysis was utilized to figure out potential factors that contribute to H. pylori eradication success. Significantly higher H. pylori eradication rates were observed in the middle age group (COR: 3.671, p = 0.007), among females (p = 0.035), those with BMI ≥ 25 (COR: 2.011, p = 0.045), and non-smokers (COR: 2.718, p = 0.018). In multivariate analysis, age and smoking emerged as significant predictors (p < 0.05). Patients with comorbidities, excluding diabetes and hypertension (COR: 4.432, p = 0.019), dyspepsia (COR: 0.178, p < 0.001), and moxifloxacin triple therapy (COR: 0.194, p = 0.000), exhibited higher chances of eradication (p < 0.05). Further research is vital for tailored approaches to enhance eradication success.

Web-based pharmacy apps facilitate the electronic exchange of health-related supplies. They are digital platforms that run on websites and smartphones. Pakistan is experiencing significant progress in smartphone integration and digital services, leading to the expansion of the online pharmacy business. However, concerns remain over the legitimacy and precision of these apps. The aim of this study was to undertake a thorough assessment of digital pharmacy apps accessible in Pakistan. Specifically, our focus was on apps accessible via the Google Play Store and the iOS App Store. To fulfill this objective, an evaluation of these apps was performed using the Mobile App Rating Scale (MARS). A research investigation was conducted to analyze the online pharmacy apps in Pakistan. Initially, 50 apps were identified, but 10 were excluded for not meeting pre-established criteria, 10 were excluded for being in languages other than English, and 7 could not be downloaded. All paid and non-English apps were also excluded. A total of 23 apps were selected for the study, acquired via the Google Play Store and iOS App Store. The evaluation was conducted by 2 researchers who maintained independence from one another by using the MARS. Initially, 50 apps were identified, of which 27 were excluded for not meeting the predetermined criteria. A total of 23 apps were selected for the study, acquired via the Google Play Store and iOS App Store. Strong positive correlations between higher user engagement and better app functionality and information quality were observed. The average rating of the 23 apps ranged between 2.64 and 4.00 on a scale up to 5. The aesthetics dimension had the highest mean score of 3.6, while the information dimension had the lowest mean score of 3.2. For credibility and reliability, different tests (intraclass correlation, Cohen κ, Krippendorff α, and Cronbach α) on each dimension of the MARS were performed by using SPSS Statistics 27. The intraclass correlation of all MARS dimensions ranged from 0.702-0.913 (95% CI 0.521-0.943), the Cohen κ of all MARS dimensions ranged from 0.388-0.907 (95% CI 0.151-0.994), the Krippendorff α of all MARS dimensions ranged from 0.705-0.979 (95% CI 0.657-0.923), and Cronbach α had a lower score of 0.821 in the information dimension and a higher score of .911 in the subjective quality dimension of the MARS. This study evaluated online pharmacy apps in Pakistan by using the MARS. It is the first study on online pharmacy apps in Pakistan. The findings of the evaluation have provided insights into the reliability and efficacy of these apps.