Evaluation of stress and its clinical correlation among the students of Allied Health Sciences

Background: Stress is a key indicator affecting the psychological and physical health of students throughout the world. The current study was planned to find out depression, stress, and anxiety and their impact on obesity and different clinical markers among the students of Allied Health Sciences.Methods: To assess stress, anxiety, and depression levels; the Depression, Anxiety, and Stress Scale (DASS- 21) was utilized. A total of 1446 individuals participated in the current research project. After assessing the BMI of students, a blood sample of two hundred and two (202) obese students were collected. Spectrophotometry, latex agglutination, and flow cytometry were employed to determine the different clinical markers.Results: Stress was found in 63.10% population, while depression was 59.70% and the prevalence of anxiety was 61.90%. After analysis of the blood samples of students, a significant increase was seen in cholesterol and HDL, while VLDL was moderately decreased. LDL, triglycerides, and CBC showed no significant change. Random blood glucose was normal, and CRP was also found negative in all the participants. There was no significant correlation between serum lipid profile and CBC parameters during stress, anxiety, and depression in students.Conclusion: A significant stress level was found among the students of Allied Health Sciences. It is a dire need of time to be focused on the mental health of students. Psychological counseling should be provided in the institutes for the mental well-being of the students.Keywords: Stress, Depression, Anxiety, Dass-21, Health sciences students     

Development and Exploitation of KASP Assays for Genes Underpinning Drought Tolerance Among Wheat Cultivars From Pakistan

High-throughput genotyping for functional markers offers an excellent opportunity to effectively practice marker-assisted selection (MAS) while breeding cultivars. We developed kompetitive allele-specific PCR (KASP) assays for genes conferring drought tolerance in common wheat (Triticum aestivum L.). In total, 11 KASP assays developed in this study and five already reported assays were used for their application in wheat breeding. We investigated alleles at 16 loci associated with drought tolerance among 153 Pakistani hexaploid wheat cultivars released during 1953–2016; 28 diploid wheat accessions (16 for AA and 12 for BB) and 19 tetraploid wheat (AABB) were used to study the evolutionary history of the studied genes. Superior allelic variations of the studied genes were significantly associated with higher grain yield. Favored haplotypes of TaSnRK2.3-1A, TaSnRK2.3-1B, TaSnRK2.9-5A, TaSAP-7B, and TaLTPs-1A predominated in Pakistani wheat germplasm indicating unconscious pyramiding and selection pressure on favorable haplotypes during selection breeding. TaSnRK2.8-5A, TaDreb-B1, 1-feh w3, TaPPH-7A, TaMOC-7A, and TaPARG-2A had moderate to low frequencies of favorable haplotype among Pakistani wheat germplasm pointing toward introgression of favorable haplotypes by deploying functional markers in marker-assisted breeding. The KASP assays were compared with gel-based markers for reliability and phenotypically validated among 62 Pakistani wheat cultivars. Association analyses showed that the favorable allelic variations were significantly associated with grain yield-contributing traits. The developed molecular marker toolkit of the genes can be instrumental for the wheat breeding in Pakistan

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

To Assess the Frequency and Risk Factors of Type 2 Diabetes Mellitus in Adult Population of District Peshawar Pakistan

Background: The prevalence of type 2 diabetes in Pakistan is 17.1% reported in National survey conducted in 2017-2018 exposing the people to high risk of complications. Objective: To find frequency of type 2 diabetes mellitus and its risk factors, in adults >30 years of district Peshawar and to identify risk factors. Study type, settings & duration: A cross-sectional descriptive study was conducted in 04 areas of district Peshawar (Palosi Village, Hayatabad, Tehkal and Shaheen Town) from January 2019 to December 2019. Methodology: A cross-sectional descriptive study design was used to survey adult population (aged 30+ years) of district Peshawar. Data was collected from Tehkal, Shaheen town, Palosi and Hayatabad. Random blood sugar of 123 participants was checked through digital glucometer. Weight and height of participants were checked for BMI calculation. Questions were asked from participants to find risk factors of type 2 diabetes mellitus. Results: The frequency of type 2 diabetes mellitus was found to be 13.0%. Among 123 participants, 13 were pre diabetic, 16 diabetic and 94 people were non-diabetic. The result showed that frequency of type 2 diabetes increased with age, 62.5% of diabetic people were above 50 years. Results also showed positive relation of BMI with the diabetes, 87.5% of diabetic people had BMI more than 25. 62.5% diabetic people had positive family history. Hypertension had positive influence on type 2 diabetes mellitus, 56.25% people among diabetics were hypertensive. Among diabetics, about 60% were male and 40% were females. Physical inactivity had positive relation with type 2 diabetes, 62% of diabetic had no physical activity. Conclusion: We found some other factors which also affected type 2 diabetes mellitus, like sedentary life style, taking mixed meal and polycystic ovary syndrome. The study results also showed no difference in DM prevalence if someone is on medications for other diseases

Effects of Conventional UPS vs Smart Energy Metering Solution on Harmonics and Grid Stability for Low Voltage Consumers in Developing Countries: A Case Study of Pakistan

To deal with frequent power outages in developing countries, people turn to solutions like uninterruptible power supply (UPS), which stores electric energy during normal operating hours and use it to meet energy needs during rolling blackout intervals. Locally produced UPSs of poorer power quality are widely accessible in the marketplaces, and they have a negative impact on power quality. The charging and discharging of the batteries in these UPSs generate significant amount of power losses in weak grid environments. The Smart-UPS is our proposed smart energy metering (SEM) solution for low voltage consumers that is provided by the distribution company. It does not require batteries, therefore there is no power loss or harmonic distortion due to corresponding charging and discharging. Through load flow and harmonic analysis of both traditional UPS and Smart-UPS systems on ETAP, this paper examines their impact on the harmonics and stability of the distribution grid. The simulation results demonstrate that Smart-UPS can assist fixing power quality issues in a developing country like Pakistan by providing cleaner energy than the battery-operated traditional UPSs

Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study

Background: Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Methods: Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. Results: A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53–163.57, p = 0.021). Conclusions: With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially