Background: Lack of appropriate treatment for COVID-19 infection led the general population of Pakistan toward self-medication and symptomatic treatment; almost 80% of the population collected medications for future use during pandemic. Thus, the current study aimed to assess the use of medication as symptomatic treatment preventive strategy. Methods: This descriptive cross–sectional study was conducted on a local population of Hyderabad and Karachi, Sindh, Pakistan. The study duration was six months (April– September 2020). A total of 698 responders were selected via random sampling method. The number of participants were recruited based on 95% confidence interval with 5% margin error. Data were transferred into analysis sheet descriptively. Results: Most participants responded to the use of different over-the-counter (OTC) products for headache. The use of antibiotics with prescription due to allergic conditions, cough, respiratory tract infections including sore throat, and urinary tract infections was also found among the majority. Few respondents had self-medication practice with sedatives due to difficulty in falling asleep, and 9.5% had self-medication practice due to pain. About 20.8% of the population agreed that lockdown was a contributing factor in the self-medication practice. Conclusion: Pharmacists and healthcare professionals are advised to counsel the general public regarding the use of medication. A close collaboration is required at this stage to fight against COVID-19 and preventing the situation from worsening. Keywords: self-medication, covid-19, Hyderabad, Karachi, Pakistan

Objectives The persistence pattern of anti-migraine drugs’ use among migraineurs is very low in the United States and different European countries. However, the cost and persistence of antimigraine drugs in Asian countries have not been well-studied. Hence, the present study aimed to evaluate the treatment cost and persistence among migraineurs in Pakistan. Methods Data from prescriptions collected from migraineurs who visited the Outpatient Department (OPD) of different public and private sector tertiary-care hospitals of Karachi, Pakistan were used to conduct this retrospective cohort study from 2017 to 2019. The minimum follow up period for each migraineur was about 12 months for persistence analysis while dropped-out patients data were also included in survival analysis as right censored data. Pairwise comparisons from Cox regression/hazards ratio were used to assess the predictors of persistence with the reference category of non-binary variables i.e. hazard ratio = 1 for low frequency migraineurs and NSAIDs users. Persistence with anti-migraine drugs was estimated using the Kaplan-Meier curve along with the Log Rank test. Results A total of 1597 patients were included in this study, 729 (45.6%) were male and 868 (54.3%) were female. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most prescribed class of drug initially for all classes of migraineurs (26.1%). Of them, 57.3% of migraineurs discontinued their treatment, 28.5% continued while 14.8% were switched to other treatment approaches. Persistence with initial treatment was more profound in female (58.8%) patients compared to males while the median age of continuers was 31 years. The total cost of migraine treatment in the entire study cohort was 297532.5 Pakistani Rupees ($1901.1). By estimating the hazard ratios (HR) using the Cox regression analysis, it can be observed that patients with high frequency (HR, 1.628; 95%CI, 1.221–2.179; p<0.0001) migraine, depression (HR, 1.268; 95%CI, 1.084–1.458; p<0.0001), increasing age (HR, 1.293; 95%CI, 1.092–1.458; p<0.0001), combination analgesics (HR, 1.817; 95%CI, 0.841–2.725; p = 0.0004) and prophylaxis drugs (HR, 1.314; 95%CI, 0.958–1.424; p<0.0001) users were at a higher risk of treatment discontinuation. However, patients with chronic migraine (HR, 0.881; 95%CI, 0.762–0.912; p = 0.0002), epileptic seizure (HR, 0.922; 95%CI, 0.654–1.206; p = 0.0002), other comorbidities (HR, 0.671; 95%CI, 0.352–1.011; p = 0.0003) and users of triptan(s) (HR, 0.701; 95%CI, 0.182–1.414; p = 0.0005) and triptan(s) with NSAIDs (HR, 0.758; 95%CI, 0.501–1.289; p<0.0001) had more chances to continue their initial therapy. Conclusion Similar to western countries, the majority of migraineurs exhibited poor persistence to migraine treatments. Various factors of improved persistence were identified in this study.

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.

Objectives: Antibiotics widely used now a day in dental practice for treatment of acute odontogenic, non-odontogenic infections and as a prophylactic purpose for focal infections in patients at possibility for infective endocarditis development as well as prevention of surgical infection of wound and controlling of orofacial infections. Studies of prescribing trends provide information about the quality & pattern of use causes of drug use, and their outcomes. The main objective of this study was to assist trends and the rational utilization of antibiotics in dental practice. Study Design: Descriptive study. Settings: The current study was conducted among the different private dental clinical settings of Sialkot. Period: Eight months study (Jan-Aug 2018). Material and Methods: Sample size was 700 prescriptions which were gathered during. A purposive sampling was used for collection of prescription. A proforma was used for recording all required demographic & prescribing data was designed to collect all information associated to antibiotic prescribing trend. The data was collected, compiled, & analysed on MS Excel and descriptive statistics was used for analysing the result of the study. Results: A total of 700 prescriptions were collected from various Dental clinics. Among the study, 58.7% patients were male and 41.3 % females and more frequent age group was 51-68 (37%). Mostly patients have pervious medication history (38.8%) and most common diagnosis was periodontal abscess (16.6%) observed during our study followed by pulpitis (15.9%). The trend observed was that majority 35.3% would prescribe antibiotics for patients who presented with elevated body temperature. Commonly 5 drugs per prescription prescribed (26.7%) least numbers of drugs prescribed per prescription is 2(5.9%). Total 3445 drugs were prescribed in 700 prescriptions. Analgesics are frequently prescribed drug category (22.3%) followed by antibiotics (21.8%) Amoxicillin and clavulanic acid was mostly used (31.9%) in these dental centres. Conclusion: This study show that most prevalent dental disease for which doctors prescribed antibacterial was periapical or periodontal abscess and Amoxicillin and clavulanic acid used as a 1st choice for oral infections.

Objectives: Oral health performs a central part in general health which is associated with good oral hygiene. Teeth and their supporting (periodontal) structures are considered most important to oral health. Therefore, Most prevalent oral diseases such as odontogenic infections (dental caries, gingivitis, periodontal disease) gum disease, oral mucosal and congenital dental problems are foremost oral health dilemma in general population. Objective: The main objective of current study was to find out the Prevalence of odontogenic infections and their risk factors among the general population. Study Design: This is a descriptive cross sectional study. Setting: Dental patients who came to different dental clinical settings of Hyderabad, Pakistan. Period: August to December 2018. Material and Methods: A total of 300 patient’s data were collected. In current study, the variables of interest are microbial odontogenic infections such as dental caries, gingivitis and periodontal disease were included in study. Following risk factors were explored: gender, age, residence, education level, disease duration, smoking, family history, and tooth paste habit. All information/data were personally collected by interview technique and oral cavity examination. The observational data were reported in the specific form and used descriptive statistics to find out the results. Results: A total of 300 dental patients having various infections such as gingivitis (47%), dental caries (20.7%) and periodontal infection (32.3%) were reported in this study. Of these, 162(54%) were females and 138(46%) of males. The most common age of patients i.e. 41.7% were from 41 to 60 years. Education status showed that 86% of the dental patients had education and 35.3% had family history of dental diseases. Factors such as mostly duration of diseases were > 6 months(33.7%) and almost 66% patients has habit of cleaning the teeths, However, Calculus and tarta deposited in 62.7% patients teeth. Smoking (21.3%) and 46.6% patients used sweet foods on daily purpose. Moreover, amoxicillin most frequently prescribed antimicrobial agent 39% followed by metronidazole 32.7%. Conclusion: Dental diseases are common public health problem among our society, poor oral hygiene & dietary habits and deposition of calculus are associated factors for odontogenic infections. Moreover, prescribing pattern shows that Amoxicillin and Metronidazole has been considered as first-line treatment for oral infections. Therefore, oral hygiene education, dietary and proper cleaning of teeth habits and dental visit at early stage of disease should be recommended for patients to avoid and cure dental odontogenic infections.