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OBJECTIVES: Nocardia is an opportunistic infection among renal transplant recipients with an incidence of <1% but high mortality. Data from Pakistan are scarce. Our aim was to find the risk factors, clinical and radiographic findings, antimicrobial sensitivity, and outcomes of Nocardia infection among renal transplant recipients in Pakistan. MATERIALS AND METHODS: All adult renal transplant recipients diagnosed with nocardiosis between 2013 and 2020 were included. The cases were matched 1:2 with controls based on sex, age (±1 year), and transplant date (±1 year). Risk factors, clinical features, antibiotic sensitivities and outcomes were analyzed. RESULTS: A total of 48 patients developed nocardiosis. Around 25% of patients presented with disseminated disease. Median time from transplant to disease development was 2.68 years. High-dose methylprednisolone and presence of cytomegalovirus infection within 90 days of disease development were independent risk factors for Nocardia infection. The mortality rate was 20%. Central nervous system disease and cytomegalovirus infection within 90 days were significantly associated with mortality. The most susceptible drugs were co-trimoxazole and linezolid. Imipenem susceptibility was only 20%. CONCLUSIONS: High-dose methylprednisolone and cytomegalovirus infection were independent risk factors for Nocardia infection. Central nervous system disease was associated with mortality. Nocardia species were highly resistant to ceftriaxone and imipenem in our patient population.
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Antibacterianos , Huésped Inmunocomprometido , Trasplante de Riñón , Nocardiosis , Infecciones Oportunistas , Humanos , Nocardiosis/diagnóstico , Nocardiosis/mortalidad , Nocardiosis/epidemiología , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/mortalidad , Factores de Riesgo , Pakistán/epidemiología , Masculino , Femenino , Adulto , Infecciones Oportunistas/mortalidad , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/tratamiento farmacológico , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Resultado del Tratamiento , Factores de Tiempo , Estudios Retrospectivos , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/mortalidad , Infecciones por Citomegalovirus/epidemiología , Medición de Riesgo , Metilprednisolona/administración & dosificación , Inmunosupresores/efectos adversosRESUMEN
Cutaneous leishmaniasis (CL) stands out as a significant vector-borne endemic in Pakistan. Despite the rising incidence of CL, the genetic diversity of Leishmania species in the country's endemic regions remains insufficiently explored. This study aims to uncover the genetic diversity and molecular characteristics of Leishmania species in CL-endemic areas of Baluchistan, Khyber Pakhtunkhwa (KPK), and Punjab in Pakistan. Clinical samples from 300 CL patients were put to microscopic examination, real-time ITS-1 PCR, and sequencing. Predominantly affecting males between 16 to 30 years of age, with lesions primarily on hands and faces, the majority presented with nodular and plaque types. Microscopic analysis revealed a positivity rate of 67.8%, while real-time PCR identified 60.98% positive cases, mainly L. tropica, followed by L. infantum and L. major. Leishmania major (p = 0.009) showed substantially greater variation in nucleotide sequences than L. tropica (p = 0.07) and L. infantum (p = 0.03). Nucleotide diversity analysis indicated higher diversity in L. major and L. infantum compared to L. tropica. This study enhances our understanding of CL epidemiology in Pakistan, stressing the crucial role of molecular techniques in accurate species identification. The foundational data provided here emphasizes the necessity for future research to investigate deeper into genetic diversity and its implications for CL control at both individual and community levels.
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Variación Genética , Leishmaniasis Cutánea , Leishmaniasis Cutánea/epidemiología , Leishmaniasis Cutánea/parasitología , Pakistán/epidemiología , Humanos , Masculino , Adolescente , Adulto , Femenino , Adulto Joven , Niño , Persona de Mediana Edad , Leishmania/genética , Leishmania/clasificación , Leishmania/aislamiento & purificación , Preescolar , Análisis de Secuencia de ADN , Leishmania tropica/genética , Leishmania tropica/aislamiento & purificación , Leishmania tropica/clasificación , Leishmania major/genética , Leishmania major/clasificación , Leishmania major/aislamiento & purificación , ADN Protozoario/genética , Filogenia , Epidemiología Molecular , Anciano , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
Anaplasma is an intracellular alphaproteobacteria that infects diverse blood cell types in animal hosts including small ruminants. Epidemiological and risk factors information on zoonotic anaplasmosis with respect to anaplasmosis in sheep and goats are scarce. Therefore, the objective of the current study was to estimate the prevalence, risk factors of anaplasmosis and phylogenetic investigation of A. capra in sheep and goats from Faisalabad district, Pakistan. Briefly, 384 blood samples were randomly collected from sheep and goats of Faisalabad district, Pakistan, during January to May 2022. The samples were processed for the detection of Anaplasma targeting 16S rRNA gene using PCR. The data regarding disease determinants were collected using a predesigned questionnaire. Out of 384 samples, 131 samples were found positive for Anaplasma spp. with a prevalence rate of 34.11%. The results indicated a significantly higher prevalence of anaplasmosis in goats (41.88%) compared to sheep (22.00%). In addition, the chi square indicated that housing type, tick infestation, gender, tick control practices, age, mix farming, and hygiene were significantly associated with the occurrence of disease. The analysis of multivariate logistic regression expressed gender as the significant risk factor (p = 0.0001, OR = 1.757, CI = 1.305-2.366). The acquired sequences revealed four novel isolates of A. capra (Genbank accession numbers ON834323, ON838209, ON838210, and ON838211). The phylogenetic analysis of the 16S rRNA gene of A. capra revealed three distinct clusters with 99-100% homology with other isolates from different countries. Our isolates showed higher similarity with isolates from China (KM206273, KP314237, MT799937), Pakistan (ON238129, ON238130, ON238131), Angola (MT898988), India (MZ558066), Iran (MW692362), and Turkey (MT632469) isolated from human, sheep, ticks, goats, cattle, Gaddi goat, Persian Onager (Equus hemionus onager), and Turkish goats, respectively. In conclusion, A. capra is endemic in Punjab, Pakistan, there is a need to conduct large scale surveillance studies to assess the status of this pathogen at human-animal interface as well as to develop effective preventive and control strategies to reduce the economic losses associated with anaplasmosis in small ruminants.
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Anaplasma , Anaplasmosis , Enfermedades de las Cabras , Cabras , Filogenia , ARN Ribosómico 16S , Enfermedades de las Ovejas , Animales , Pakistán/epidemiología , Anaplasmosis/epidemiología , Anaplasmosis/microbiología , Cabras/microbiología , Ovinos , Anaplasma/genética , Anaplasma/aislamiento & purificación , Enfermedades de las Ovejas/epidemiología , Enfermedades de las Ovejas/microbiología , ARN Ribosómico 16S/genética , Enfermedades de las Cabras/epidemiología , Enfermedades de las Cabras/microbiología , Masculino , Femenino , Prevalencia , Factores de Riesgo , Zoonosis/epidemiología , Zoonosis/microbiología , HumanosRESUMEN
Plasmodium vivax variant interspersed repeats (vir) refer to the key protein used for escaping the host immune system. Knowledge in the genetic variation of vir genes can be used for the development of vaccines or diagnostic methods. Therefore, we evaluated the genetic diversity of the vir genes of P. vivax populations of several Asian countries, including Pakistan, which is a malaria-endemic country experiencing a significant rise in malaria cases in recent years. We analyzed the genetic diversity and population structure of 4 vir genes (vir 4, vir 12, vir 21, and vir 27) in the Pakistan P. vivax population and compared these features to those of the corresponding vir genes in other Asian countries. In Pakistan, vir 4 (S=198, H=9, Hd=0.889, Tajima's D value=1.12321) was the most genetically heterogenous, while the features of vir 21 (S=8, H=7, Hd=0.664, Tajima's D value =-0.63763) and vir 27 (S =25, H =11, Hd =0.682, Tajima's D value=-2.10836) were relatively conserved. Additionally, vir 4 was the most genetically diverse among Asian P. vivax populations, although within population diversity was low. Meanwhile, vir 21 and vir 27 among all Asian populations were closely related genetically. Our findings on the genetic diversity of vir genes and its relationships between populations in diverse geographical locations contribute toward a better understanding of the genetic characteristics of vir. The high level of genetic diversity of vir 4 suggests that this gene can be a useful genetic marker for understanding the P. vivax population structure. Longitudinal genetic diversity studies of vir genes in P. vivax isolates obtained from more diverse geographical areas are needed to better understand the function of vir genes and their use for the development of malaria control measures, such as vaccines.
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Variación Genética , Malaria Vivax , Plasmodium vivax , Plasmodium vivax/genética , Pakistán/epidemiología , Variación Genética/genética , Humanos , Malaria Vivax/epidemiología , Malaria Vivax/parasitología , Malaria Vivax/genética , Genética de Población , Proteínas Protozoarias/genéticaRESUMEN
Spatial cluster analyses of health events are useful for enabling targeted interventions. Spatial scan statistic is the stateof- the-art method for this kind of analysis and the Poisson Generalized Linear Model (GLM) approach to the spatial scan statistic can be used for count data for spatial cluster detection with covariate adjustment. However, its use for modelling is limited due to data over-dispersion. A Generalized Linear Mixed Model (GLMM) has recently been proposed for modelling this kind of over-dispersion by incorporating random effects to model area-specific intrinsic variation not explained by other covariates in the model. However, these random effects may exhibit a geographical correlation, which may lead to a potential spatial cluster being undetected. To handle the over-dispersion in the count data, this study aimed to evaluate the performance of a negative binomial- GLM in spatial scan statistic on real-world data of low birth weights in Khyber-Pakhtunkhwa Province, Pakistan, 2019. The results were compared with the Poisson-GLM and GLMM, showing that the negative binomial-GLM is an ideal choice for spatial scan statistic in the presence of over-dispersed data. With a covariate (maternal anaemia) adjustment, the negative binomial-GLMbased spatial scan statistic detected one significant cluster covering Dir lower district. Without the covariate adjustment, it detected two clusters, each covering one district. The district of Peshawar was seen as the most likely cluster and Battagram as the secondary cluster. However, none of the clusters were detected by GLMM spatial scan statistic, which might be due to the spatial correlation of the random effects in GLMM.
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Recién Nacido de Bajo Peso , Análisis Espacial , Humanos , Pakistán/epidemiología , Análisis por Conglomerados , Recién Nacido , Femenino , Modelos Lineales , Distribución de PoissonRESUMEN
OBJECTIVES: Living donor kidney transplant is the preferred method of renal transplant in Pakistan as deceased donor transplant has not yet been estab-lished. However, many patients who are dialysis-dependent, particularly younger patients, lack suitable living related donors. We aimed to determine factors contributing to nonselection of donors for living related renal transplant in Pakistan. MATERIALS AND METHODS: For this cross-sectional study, we included patients seen at the Sindh Institute of Urology & Transplantation Karachi, Pakistan) from March to November 2019. Potential donors were adult family members who accompanied patients with end-stage kidney disease to the clinic. Demographic and clinical information were recorded on predesigned proforma. After workup and baseline investigations had been completed, potential living related donors were selected. Factors leading to nonselection of donors were noted for those who did not qualify for donation. We used SPSS version 20 for analysis. RESULTS: During the study period, 253 potential donors (151 males, 102 females) with mean age of 35.68 ± 6.14 years were found to be ineligible for kidney donation. ABO incompatibility was the most common factor leading to nonselection (n = 101; 39.92%), followed by diabetes mellitus (n = 71; 28.06%), hypertension (n= 50; 19.76%), renal disease (n = 15; 5.92%), liver disease (n = 8; 3.16%), crossmatch positive (n = 5; 1.97%), and ischemic heart disease (n = 3; 1.18%). No differences were shown between potential male and female donors regarding factors leading to nonselection; diabetes was significantly more prevalent among those <40 years of age (P = .025). CONCLUSIONS: ABO incompatibility, diabetes mellitus, and hypertension were the most common factors leading to nonselection of potential donors in living related kidney transplant. More efforts are needed to expand the donor pool by considering second- or third-degree relatives to tackle the scarcity of organs for transplantation.
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Selección de Donante , Trasplante de Riñón , Donadores Vivos , Humanos , Trasplante de Riñón/efectos adversos , Femenino , Masculino , Estudios Transversales , Adulto , Pakistán/epidemiología , Factores de Riesgo , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/epidemiología , Incompatibilidad de Grupos Sanguíneos/inmunología , Persona de Mediana Edad , Medición de Riesgo , Resultado del Tratamiento , Sistema del Grupo Sanguíneo ABO/inmunología , Adulto Joven , HistocompatibilidadRESUMEN
Climate anxiety has a negative impact on the mental health and psychological wellbeing of the vulnerable population. The goal is to assess many factors that affect mental health and psychological wellbeing, as well as how climate change affects mental health in Pakistan's vulnerable population. This study provides evidence-based insights on the long- and medium-term impacts of extreme weather events on mental health. We conducted semi-structured interviews with a sample of 72 students aged 10-16 years, employing an exploratory qualitative design. The resulting process identified themes and questions for future research on climate change and its psychological effects on children's mental health. As a result, positive emotions embedded in children's climate strategic actions in parent and community contexts helped to mitigate children's perceptions of negative emotions (such as climate anxiety, phobias, fear, sleep disorders, depression, sadness, and substance abuse). Climate change's effects can have a significant impact on mental health. We will be discussing effective strategies to address the expected mental health issues among children caused by climate change. The discussion paper offers a set of recommendations for addressing the mental health impacts of climate change, including improving mental health support systems, integrating climate change education into services, and developing targeted interventions for vulnerable populations.
L'anxiété climatique a un impact négatif sur la santé mentale et le bien-être psychologique de la population vulnérable. L'objectif est d'évaluer de nombreux facteurs qui affectent la santé mentale et le bien-être psychologique, ainsi que la manière dont le changement climatique affecte la santé mentale de la population vulnérable du Pakistan. Cette étude fournit des informations fondées sur des données probantes sur les impacts à long et moyen terme des événements météorologiques extrêmes sur la santé mentale. Nous avons mené des entretiens semi-structurés avec un échantillon de 72 étudiants âgés de 10 à 16 ans, en utilisant une conception qualitative exploratoire. Le processus qui en a résulté a identifié des thèmes et des questions pour de futures recherches sur le changement climatique et ses effets psychologiques sur la santé mentale des enfants. En conséquence, les émotions positives intégrées dans les actions stratégiques climatiques des enfants dans les contextes parental et communautaire ont contribué à atténuer les perceptions des enfants concernant les émotions négatives (telles que l'anxiété climatique, les phobies, la peur, les troubles du sommeil, la dépression, la tristesse et la toxicomanie). Les effets du changement climatique peuvent avoir un impact significatif sur la santé mentale. Nous discuterons de stratégies efficaces pour résoudre les problèmes de santé mentale attendus chez les enfants causés par le changement climatique. Le document de travail propose un ensemble de recommandations pour faire face aux impacts du changement climatique sur la santé mentale, notamment en améliorant les systèmes de soutien en santé mentale, en intégrant l'éducation au changement climatique dans les services et en développant des interventions ciblées pour les populations vulnérables.
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Ansiedad , Cambio Climático , Salud Mental , Investigación Cualitativa , Poblaciones Vulnerables , Humanos , Femenino , Adolescente , Niño , Masculino , Poblaciones Vulnerables/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Pakistán/epidemiología , Entrevistas como Asunto , Estudiantes/psicologíaRESUMEN
Tick-borne pathogens are significant for human, veterinary, and wildlife health. Coxiella burnetii is an example that is widely distributed across various hosts and can cross species boundaries. In Pakistan, there is a scarcity of data regarding C. burnetii at the intersection of wildlife and livestock. Ticks were collected from ruminants and wildlife from the districts of Kasur, Pakpattan, and Okara in Pakistan. Five tick species totaling 571 ticks were collected, with the following distribution: 56.4% Hyalomma anatolicum, 22.4% Rhipicephalus microplus, 10.5% Hyalomma marginatum, 7.9% Rhipicephalus sanguineus, and 2.8% Rhipicephalus turanicus. Fifty tick pools were screened for C. burnetii to amplify a segment of the IS1111 using real-time PCR assays. Ticks collected from sheep and goats had a greater rate of positivity for C. burnetii (40% and 38%, respectively) compared to Indian long-eared hedgehogs with a prevalence of 2%. Coxiella burnetii was prominent in Rhipicephalus microplus (92.3%) and Hyalomma anatolicum (88.9%), followed by Rhipicephalus turanicus (66.6%), Rhipicephalus sanguineus (33.3%), and Hyalomma marginatum (25.0%). Ticks from Pakpattan district displayed the highest prevalence of C. burnetii (88.9%), whereas the lowest was observed in ticks from Kasur district (77.3%). There was no significant association between tick gender and C. burnetii infection. Female host animals were more likely to harbor ticks containing C. burnetii, with a prevalence rate of 81.8%. The research underscores the urgent need for comprehensive studies on C. burnetii in Pakistan, especially at the interface of wildlife and livestock. The high prevalence rates observed in certain tick species and geographic regions emphasize the importance of targeted public health interventions. Future research should focus on elucidating the transmission dynamics and implementing effective control measures to mitigate the impact of these pathogens on human, veterinary, and wildlife health in the region.
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Animales Salvajes , Coxiella burnetii , Cabras , Ixodidae , Fiebre Q , Infestaciones por Garrapatas , Animales , Coxiella burnetii/aislamiento & purificación , Coxiella burnetii/genética , Pakistán/epidemiología , Infestaciones por Garrapatas/veterinaria , Infestaciones por Garrapatas/epidemiología , Femenino , Fiebre Q/veterinaria , Fiebre Q/epidemiología , Fiebre Q/microbiología , Ixodidae/microbiología , Masculino , Ovinos , Prevalencia , Erizos/microbiología , Erizos/parasitología , Reacción en Cadena en Tiempo Real de la Polimerasa/veterinaria , Enfermedades de las Ovejas/epidemiología , Enfermedades de las Ovejas/microbiología , Enfermedades de las Cabras/epidemiología , Enfermedades de las Cabras/microbiología , Animales DomésticosRESUMEN
Anaplasma spp. and Rickettsia spp. are intracellular vector-borne pathogens and harbored by a wide range of ticks and vertebrate hosts. Aim of this study was to molecularly characterize Anaplasma spp. and Rickettsia spp. in different ticks collected from livestock hosts in nine districts of Khyber Pakhtunkhwa (KP), Pakistan. In total, 862 ticks were collected from cattle, goats and sheep. Highest tick's infestation was observed on cattle 56.14% (32/57), followed by goats 45.45% (40/88), and sheep 42.05% (45/107). Rhipicephalus microplus (305/862, 35.38%) was predominant species, followed by Haemaphysalis sulcata (243/862, 28.19%), Hyalomma anatolicum (133/862, 15.42%), Haemaphysalis bispinosa (120/862, 13.92%), and Hyalomma kumari (61/862, 7.07%). A subset of 135 ticks were screened for Anaplasma spp. and Rickettsia spp. based on the amplification of partial 16 S rDNA and outer-membrane protein A (ompA) fragments, respectively. In total, 16 ticks (11.85%) were positive for Anaplasma spp. and Rickettsia spp. Obtained 16 S rDNA sequences for Anaplasma spp. detected in Ha. bispinosa and Ha. sulcata showed 99.98% identity with Anaplasma bovis, while other detected in Rh. microplus showed 99.84% identity with Candidatus Anaplasma boleense. Similarly, detected ompA sequence in Ha. sulcata showed 100% identity with Rickettsia sp. and 97.93% with Rickettsia slovaca, and another sequence detected in Rh. microplus showed 100% identity with Candidatus Rickettsia shennongii. In phylogenetic trees, these sequences clustered with corresponding species from Pakistan, China, Turkey, South Korea, South Africa, and Herzegovina. This is the first study reporting detection of A. bovis in Ha. bispinosa and Ha. sulcata, Ca. A. boleense in Rh. microplus collected from goats, and R. slovaca-like in Ha. sulcata. Our results enforce the need for regular surveillance of Rickettsiales in hard ticks infesting livestock in the region.
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Anaplasma , Cabras , Rickettsia , Infestaciones por Garrapatas , Animales , Rickettsia/aislamiento & purificación , Rickettsia/genética , Rickettsia/clasificación , Anaplasma/aislamiento & purificación , Anaplasma/genética , Anaplasma/clasificación , Ovinos , Bovinos , Infestaciones por Garrapatas/veterinaria , Infestaciones por Garrapatas/epidemiología , Enfermedades de las Cabras/microbiología , Enfermedades de las Cabras/parasitología , Pakistán/epidemiología , Enfermedades de las Ovejas/microbiología , Enfermedades de las Ovejas/parasitología , Filogenia , Ixodidae/microbiología , Anaplasmosis/microbiología , Anaplasmosis/epidemiología , Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/parasitología , ARN Ribosómico 16S/genética , FemeninoRESUMEN
OBJECTIVE: To assess long-term clinical outcomes and factors associated with target vessel revascularisation in patients with deferred revascularisation based on negative fractional flow reserve and negative instantaneous wave-free ratio. METHODS: The longitudinal, retrospective study was conducted from July 1, 2020, to January 1, 2022, at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2012 to January 2020 of patients with deferred revascularisation having intermediate to severe coronary lesions on coronary angiogram and had negative fractional flow reserve >0.80 or instantaneous wave-free ratio >0.89 and had not undergone immediate or planned revascularisation on the basis of negative physiological assessment. Data was collected from the institutional records, while final follow-up was taken by reviewing the medical records or telephonic interviews regarding any major adverse cardiac event after the index procedure. Data was analysed using Stata 14.2. RESULTS: Of the 345 patients, 245(71%) were males. The overall mean age was 62±11 years. There were 194(56%) patients who presented with stable angina and 151(44%) presented with acute coronary syndrome. Mean fractional flow reserve was 0.87±0.04 and mean instantaneous wave-free ratio was 0.93±0.03. Multivessel disease was present in 223(65%) patients. Median follow-up period was 29 months (IQR: 24-36 months). Major adverse cardiovascular events occurred in 22(6%) patients, and target vessel revascularisation was required in 11(3%). Diabetes and percentage of stenosis were found to be independent predictors of major adverse cardiovascular events (p<0.05). CONCLUSIONS: Deferral of revascularisation and opting for medical treatment for coronary artery stenosis with higher fractional flow reserve or instantaneous wave-free ratio could be considered a safe and reasonable strategy.
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Angiografía Coronaria , Reserva del Flujo Fraccional Miocárdico , Revascularización Miocárdica , Humanos , Reserva del Flujo Fraccional Miocárdico/fisiología , Masculino , Femenino , Persona de Mediana Edad , Pakistán/epidemiología , Estudios Retrospectivos , Anciano , Revascularización Miocárdica/métodos , Revascularización Miocárdica/estadística & datos numéricos , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/fisiopatología , Estudios Longitudinales , Estenosis Coronaria/fisiopatología , Estenosis Coronaria/cirugía , Síndrome Coronario Agudo/cirugía , Síndrome Coronario Agudo/fisiopatología , Angina Estable/cirugía , Angina Estable/fisiopatología , Resultado del Tratamiento , Intervención Coronaria Percutánea/métodosRESUMEN
Objective: To determine the prevalence of non-alcoholic fatty liver disease, and the effect of oral hypoglycaemic drugs and lifestyle modifications in reducing fatty liver changes and liver enzymes in these patients. METHODS: The comparative, observational study was conducted at the Department of Pharmacology, Sohail University, Karachi, from October 2022 to October 2023, and comprised patients of either gender having elevated liver enzymes and ultrasound finding of fatty liver changes along with raised glycated haemoglobin, transaminases, total cholesterol and triglycerides. The participants were prescribed oral hypoglycaemic agents by endocrinologists. Those given empaglifazolin + metformin were in group A, empaglifazolin + linglaptin in group B, sitaglaptin + metformin in group C, metformin alone in group D and sitaglaptin alone in group E. Lifestyle modifications were advised in all the treatment groups, while control group F was only advised lifestyle modifications. The intervention lasted 3 months. Investigations included B-mode ultrasound liver, liver enzymes and glycated haemoglobin, which were done at baseline and after the intervention. Data was analysed using SPSS 25. RESULTS: Of 200 patients, 40 were males and 160 were females in ratio of 1:4. The overall mean age was 48±16 years. There were 154(77%) patients who had non-alcoholic fatty liver disease with type 2 diabetes mellitus, while 46(23%) had only fatty liver changes. There were 50(25%) patients in group A, 30(15%) in group B, 30(15%) in group C, 40(20%) in group D, 10(5%) in group E and 40(20%) in group F. Post-intervention improvement was noted in 48(24%) patients, with 20(41.7%) of them being in group A. Conclusion: The prevalence of non-alcoholic fatty liver disease with type 2 diabetes was high. Combination of empagliflozin + metformin along with lifestyle modifications was highly effective in reducing fatty changes and the level of liver enzymes.
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Diabetes Mellitus Tipo 2 , Hipoglucemiantes , Enfermedad del Hígado Graso no Alcohólico , Humanos , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Masculino , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Persona de Mediana Edad , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/administración & dosificación , Adulto , Metformina/uso terapéutico , Metformina/administración & dosificación , Hemoglobina Glucada/metabolismo , Ultrasonografía , Hígado/diagnóstico por imagen , Hígado/efectos de los fármacos , Administración Oral , Pakistán/epidemiologíaAsunto(s)
Muerte Súbita Cardíaca , Países en Desarrollo , Domperidona , Humanos , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Domperidona/uso terapéutico , Domperidona/efectos adversos , Anciano , Arritmias Cardíacas/epidemiología , Taquicardia Ventricular , Antieméticos/uso terapéutico , Masculino , Pakistán/epidemiología , FemeninoAsunto(s)
Tuberculosis , Humanos , Adolescente , Niño , Tuberculosis/epidemiología , Pakistán/epidemiología , Morbilidad/tendenciasRESUMEN
Introduction: Oral squamous cell carcinoma (OSCC) is the most prevalent type of head and neck cancer and is associated with high mortality, particularly in Southeast Asian countries. Areca nut usage, smoking, and alcohol consumption are the most common risk factors for OSCC. Areca nut chewing is highly prevalent in Pakistan and has been attributed to an increase in OSCC cases. This study aimed to determine the association between areca nut usage and various clinicopathological features of OSCC and further evaluate the association of clinicopathological parameters of OSCC with tumor recurrence. Materials and Methods: The study was conducted using the data of 228 patients with OSCC resected at Liaquat National Hospital, Karachi, Pakistan, over 5 years between 2018 and 2022. Clinicopathological data were collected from hospital archives, and associations between various risk factors and clinicopathological parameters were determined. Results: Males were more commonly affected (77.2%), and the most common age group was <50 years (54.4%). Areca nut usage was reported in 59.6% of cases, and the buccal mucosa was the most common site (62.7%). Areca nut usage was significantly associated with male gender, greater tumor size, greater depth of invasion (DOI), higher tumor stage, nodal stage, presence of perineural invasion (PNI), and recurrence. In addition, multivariate analysis revealed that OSCC recurrence was significantly associated with older age, larger tumor size and DOI, nodal metastasis, and areca nut usage. Conclusion: Areca nut-related OSCCs were associated with poor prognosis and recurrence in our study population. Furthermore, OSCC recurrence was associated with various clinicopathological parameters, such as larger tumor size, a higher DOI, and nodal metastasis.
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Areca , Neoplasias de la Boca , Recurrencia Local de Neoplasia , Humanos , Masculino , Areca/efectos adversos , Femenino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Neoplasias de la Boca/epidemiología , Factores de Riesgo , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Adulto , Pakistán/epidemiología , Anciano , Estudios Retrospectivos , Pronóstico , Estudios de Seguimiento , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/epidemiología , Estadificación de Neoplasias , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/epidemiología , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidadRESUMEN
BACKGROUND: The COVID-19 pandemic has had a significant impact on different countries because of which various health and safety measures were implemented, with digital media playing a pivotal role. However, digital media also pose significant concerns such as misinformation and lack of direction. OBJECTIVE: We aimed to explore the effects of COVID-19-related infodemics through digital, social, and electronic media on the vaccine-related attitudes of caregivers and health care providers in Pakistan. METHODS: This study employs a qualitative exploratory study design with purposive sampling strategies, and it was conducted at 3 primary health care facilities in the province of Sindh, Pakistan. Seven focus group discussions with health care providers and 60 in-depth interviews with caregivers were conducted using semistructured interviews through virtual platforms (ConnectOnCall and Zoom). Transcripts were analyzed through thematic analysis. RESULTS: Our study reveals the pivotal role of electronic media, mobile health (mHealth), and social media during the COVID-19 pandemic. Four major themes were identified: (1) sources of information on COVID-19 and its vaccination, (2) electronic media value and misleading communication, (3) mHealth leveraging and limitations during COVID-19, and (4) social media influence and barriers during COVID-19. Health care providers and caregivers reported that the common sources of information were electronic media and mHealth, followed by social media. Some participants also used global media for more reliable information related to COVID-19. mHealth solutions such as public awareness messages, videos, call ringtones, and helplines promoted COVID-19 prevention techniques and vaccine registration. However, the overwhelming influx of news and sociobehavioral narratives, including misinformation/disinformation through social media such as WhatsApp, Facebook, and Twitter, were found to be the primary enablers of vaccine-related infodemics. Electronic media and mHealth were utilized more widely to promote information and communication on the COVID-19 pandemic and vaccination. However, social media and electronic media-driven infodemics were identified as the major factors for misinformation related to COVID-19 and vaccine hesitancy. Further, we found a digital divide between the urban and rural populations, with the use of electronic media in rural settings and social media in urban settings. CONCLUSIONS: In a resource-constrained setting like Pakistan, the usage of mHealth, social media, and electronic media for information spread (both factual and mis/disinformation) related to COVID-19 and its vaccination had a significant impact on attitudes toward COVID-19 vaccination. Based on the qualitative findings, we generated a model of digital communications and information dissemination to increase knowledge about COVID-19 and its prevention measures, including vaccination, which can be replicated in similar settings for other disease burdens and related infodemics. Further, to mitigate the infodemics, both digital and nondigital interventions are needed at a larger scale.
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COVID-19 , Cuidadores , Personal de Salud , Investigación Cualitativa , Medios de Comunicación Sociales , Telemedicina , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , Pakistán/epidemiología , Cuidadores/psicología , Masculino , Femenino , Adulto , Personal de Salud/psicología , Actitud del Personal de Salud , Persona de Mediana Edad , Vacunas contra la COVID-19/administración & dosificación , Grupos Focales , Vacunación/psicología , Pandemias/prevención & control , SARS-CoV-2RESUMEN
This study investigated the virulence potential and antibiotic susceptibility analysis of non-O157 Shiga toxin-producing Escherichia coli (STEC) serogroups, which are significant cause of food borne diseases. A study collected 800 samples of dairy bovine raw milk through various sources, 500 from milk shops, 200 from dairy farms, 26 from milk collection centers, and 74 from street vendors. Using a standard method, E. coli was detected in 321 out of the 800 samples collected. Out of the 321 E. coli-positive samples isolated, 148 were identified as STEC using selective media, specifically Cefixime Tellurite Sorbitol MacConkey's Agar (CT-SMA). Out of the 148 positive samples, 40 were confirmed as STEC non-O157 strains using multiplex PCR, indicating a prevalence of 5% (40 out of 800 samples). STEC isolates were subjected to antimicrobial susceptibility testing, and all isolates were resistant to at least one or more antimicrobials tested through the disk diffusion method, revealed high resistance to Amoxicillin 100%, Ceftriaxone 50%, and Penicillin 44.5%, and notably 44% of the strains exhibited Streptomycin resistance, while Enrofloxacin 55%, Florfenicol 50% and Norfloxacin 44%, demonstrated the highest susceptibility. Out of 40 STEC non-O157, twelve were subjected to Multi Locus Sequence Typing (MLST) sequencing through Illumina Inc. MiSeq platform's next-generation sequencing technology, United States. The genome investigation evidenced the persistence of twelve serotypes H4:O82, H30:O9a, H4:O82, H16:O187, H9:O9, H16:O113, H30:O9, H32:O, H32:O, H32, H32, and H38:O187, linked to the potential infections in humans. Conclusion: STEC isolates showed resistance to multiple antimicrobials, raising concerns for both animal and public health due to widespread use of these drugs in treatment and prevention. The study contributes new insights into monitoring STEC in raw milk, emphasizing the critical role of whole genome sequencing (WGS) for genotyping and sequencing diverse isolates. Still a deficiency in understanding STEC pathogenesis mechanisms, ongoing surveillance is crucial for safeguarding human health and enhancing understanding of STEC genetic characteristics.
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Antibacterianos , Pruebas de Sensibilidad Microbiana , Leche , Escherichia coli Shiga-Toxigénica , Animales , Bovinos , Escherichia coli Shiga-Toxigénica/genética , Escherichia coli Shiga-Toxigénica/efectos de los fármacos , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Escherichia coli Shiga-Toxigénica/patogenicidad , Leche/microbiología , Antibacterianos/farmacología , Pakistán/epidemiología , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/epidemiología , Farmacorresistencia Bacteriana/genética , Secuenciación Completa del Genoma , SerogrupoRESUMEN
Hyperlipidemia significantly contributes to the risk of developing cardiovascular diseases. However, about half of the patients do not adhere to their antihyperlipidemic medications, leading to healthcare costs and premature mortality. This study's objective was to determine the prevalence and associated factors of non-adherence to antihyperlipidemic medications. The study covered hypertensive patients (21,451) aged 21-75 years, presenting to the primary and secondary healthcare facilities across Pakistan (covering 21 divisions) from January 2022 to April 2023. The outcome intended was non-adherence to antihyperlipidemic medication, which was assessed by SEAMS and pill-counting methods (non-adherence < 80%). The study found overall non-adherence to antihyperlipidemic medication of 60.6% across Pakistan, with the highest non-adherence rates found in Azad Jammu and Kashmir (71.9%) and the lowest in Islamabad (47.7%). Multivariable logistic regression analysis revealed that female, no health card (Sehat Sahulat Program government insurance), < 5 years of illness, < 5 daily medications, and dose frequency of twice daily revealed a positively significant association with non-adherence. While monthly income 51,000-100,000, graduation level of education, Muhajir, and hyperlipidemia with one comorbid condition had a significant negative association with the non-adherence. Antihyperlipidemic non-adherence is a multifaceted, multifactorial, profound problem requiring a multipronged approach.