The role of diet therapy in chronic kidney disease

Background Chronic kidney disease (CKD) is a condition characterized by gradual loss of kidney function over time. Millions of adults have CKD and those who have diabetes, hypertension, and family history of kidney failure are at highest risk of its development. Patients may develop comorbidities, such as cardiovascular disease, anemia, mineral and bone disorders, and peripheral nervous system diseases. Those with kidney failure require dialysis or kidney transplantation, as well as medications, diet therapy, restriction of fluid intake, and lifestyle modifications. The cost for such treatment represents an enormous burden on healthcare systems worldwide, costing about 8% of the Medicare budget in the U.S. Literature review findings Chronic kidney disease is now described based on internationally accepted definitions and diagnosed, when structural or functional abnormalities of the kidneys persist for more than 3 months. End-stage kidney disease is the last stage of chronic kidney disease and is associated with a decreased quality of life and life expectancy. This comprehensive literature review focuses on the effectiveness of dietary therapy in delaying the progression of CKD to end stage kidney disease (ESKD). Current evidence provides guidelines to manage ESRD with the general population. However, despite this, many clinicians do not know how to use diet as part of clinical management. Proposed methods Given the broad spectrum of different dietary therapies to decelerate progression of CKD, many providers do not utilize this information in clinical practice. A workshop hosted by registered dieticians, summarizing the most up-to-date literature on the topic of dietary interventions to slow down CKD progression would be beneficial. The workshop will measure mid-level and high-level practitioner’s knowledge on dietary therapy for CKD and assess this post-workshop. The goal is to expand the knowledge of providers and equip them with the resources necessary to educate patients on healthy dietary modifications, in order to minimize progressive CKD. Conclusions Despite the availability of dialysis and recent advancements in post-transplant care, there is a benefit to lifestyle modification. There is promising evidence that a diet low in protein, potassium, or salt and following certain diets, such as the Mediterranean diet, is beneficial in the deceleration of CKD to end stage renal disease (ESRD). A diet containing processed foods, high protein, high salt, and high potassium content has been associated with an increased risk of transition from late-stage CKD to ESRD. It is possible that these dietary recommendations may apply to prevention of CKD or ESRD. The workshop will present the most up-to-date knowledge in the area of dietary therapies for CKD. A curriculum for mid- and advanced-level health care providers will provide them with the tools necessary to provide their patients with nutrition and lifestyle management

Heavy metal accumulation in Trichogaster fasciata (Bloch & Schneider) from the river Ganges and its tributaries: A health concern for fish-consuming populations

176-183Accumulation of metal in fish flesh is increasing because of heavy metal pollution in rivers of India, which poses significant threat to the consumers’ health. Here, we studied the concentrations of heavy metals [cadmium (Cd), chromium (Cr), copper (Cu), lead (Pb) and zinc (Zn)] in the muscle tissues of Banded or Striped gourami, Trichogaster fasciata Bloch & Schneider collected from the river Ganges and its tributaries in order to assess the risk the consumers are put to. The order of metal accumulation (Zn>Pb>Cu>Cr>Cd) was found to be the same in both the fish muscle and the water samples. Significant values of correlation of coefficient (R = 0.9184-0.9612) of length-weight relationship and mean condition factor ranging between 1.876-2.420 g/cm3 of different populations of the fish were recorded. All metal concentration was negatively correlated with the fish size and condition factor except Zn in Ghaghara and Yamuna (P <0.05) and Pb in the Ganges (P <0.05) and Yamuna (P <0.001). Estimated daily intakes by the fish-eating inhabitants were lower than the maximum tolerable daily intake value except for that of Zn. The target hazard quotient and health index showed that intake of these heavy metals was quite safe by the fish consuming local populations including both the male and females. This study could be used as an essential piece of information for the management purposes of river Ganga to prevent heavy metal pollution and risk associated with it

Optimizing the utilization of biochar from waste: an energy–water–food nexus assessment approach considering water treatment and soil application scenarios

Introduction: As a result of the rapid increase in population and depletion of natural resources, particularly energy and water, approximately 200 million people are expected to face hunger by 2030. Going forward, the sustainability of energy, water, and food (EWF) resources can be enhanced by considering a nexus approach, which supports effective resource management by identifying synergies and trade-offs. Furthermore, the regeneration of biomass into value-added products, such as biochar (BC), can reduce cross-sectoral environmental impacts and support the EWF nexus.Methodology: This research investigates the optimum options for utilizing BC within the context of the EWF nexus for both wastewater treatment and soil applications whilst considering the optimal blending ratio of various biomass (camel manure, date pits, sewage sludge, and coffee waste) for both single-end use and multi-end use stages to fulfill various objectives within defined scenarios based on maximum savings in energy, water, cost, and emissions.Results and discussion: The single-end use stage considered using BC for wastewater treatment (WWT) and as a soil amendment (SA) individually, and 18 optimal solutions were collected for this stage. The optimization of the multi-end use stage resulted in 70 optimal solutions, where BC was applied for both WWT and SA. The solutions that leaned toward SA application suggested that BC should consist of 97%–99% of date pits with relatively smaller proportions of the other biomass. On the other hand, the other solutions that leaned toward the WWT pathway suggested that the optimum biomass mix should consist of relatively equal proportions of camel manure, sewage sludge, and coffee waste of 29%—33% and smaller amounts of date pits of approximately 2%–5%

Response of extensively drug resistant salmonella typhi to treatment with meropenem and azithromycin, in Pakistan

Introduction: Salmonella Typhi is one of the leading health problems in Pakistan. With the emergence of extensively drug resistant (XDR) Salmonella Typhi, treatment options are limited. Here we report the clinical manifestations and the response to treatment of patients with XDR Typhoid fever. The patients were treated with either Meropenem or Azithromycin or a combination of both.Methods: We reviewed the records of culture confirmed XDR typhoid who visited Aga Khan University Hospital (AKUH), Karachi and Aga Khan Secondary Care Hospital, Hyderabad from April 2017 to June 2018. Symptoms developed during disease, unplanned treatment extension and complications developed while on antimicrobials was recorded. Means with standard deviation were calculated for duration of treatment, time to defervescence, and cost of treatment.Results: Records of 81 culture confirmed XDR typhoid patients admitted at the AKU hospitals were reviewed. Most, (n = 45; 56%) were male. Mean age of the cases was 8.03 years with range (1-40). About three quarter (n = 66) of the patients were treated as inpatient. Fever and vomiting were the most common symptoms at the time of presentation. Oral azithromycin alone (n = 22; 27%), intravenous meropenem alone (n = 20; 25%), or a combination of azithromycin and meropenem (n = 39; 48%) were the options used for treatment. Average (95% confidence interval) time to defervescence was 7.1(5.5-8.6), 6.7(4.7-8.7), and 6.7(5.5-7.9) days for each treatment option respectively whereas there were 1,0 and 3 treatment failures in each treatment option respectively. Average cost of treatment per day for azithromycin was US$5.87 whereas it was US$88.46 for meropenem.Conclusion: Patients treated with either Azithromycin, Meropenem alone or in combination showed similar time to defervescence. Because of the lower cost of azithromycin, it is preferable in lower socio-economic areas. Background estimates for power calculation can be made for more robust clinical trials using this observational data

The role playing by social media in COVID-19 to exacerbate anxiety and depression among Pakistani community

Introduction: The purpose of the worldwide lockdown was to impede the spread of this virus via social distancing. WHO detected symptoms like anxiety, stress, fear which have affected people’s psychology across the globe due to loneliness, substance abuse, depression and constant fear?  With the surge of information regarding COVID-19 on social media (myths and beliefs), it certainly played a major role for communities’ psychology all around the globe. Methods: A cross sectional study design was chosen with convenient sampling size of 800 via online. Questionnaire shared through online social media platforms. Statistical analysis was done through SPSS version 21 and responses were taken as frequencies, percentages and chi-square test. Results:  there was a significant association between highly educated peoples and social media usage with p-value less than 0.000 suggestive of myths generating decline of mental health.  Conclusion: COVID-19 information available over social media was used by everyone and considered as authentic. Therefore, control measures and legislation should be applied on them to restrict the ambiguity.  Key-words:  Social media; COVID-19; Myths; life worth; save humanity; Attitude;

Serial population-based serosurveys for COVID-19 in two neighbourhoods of Karachi, Pakistan

Objective: To determine population-based estimates of COVID-19 in a densely populated urban community of Karachi, Pakistan.Methods: Three cross-sectional surveys were conducted in April, June and August in low- and high-transmission neighborhoods. Participants were randomly selected to provide blood for Elecsys® immunoassay for detection of anti-SARS-CoV-2 antibodies. Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district RESULTS: We enrolled 3005 participants from 623 households. In Phase 2, adjusted seroprevalence was estimated as 8.7% (95% CI 5.1-13.1) and 15.1% (95% CI 9.4 -21.7) in low and high transmission areas respectively, compared to 0.2% (95% CI 0-0.7) and 0.4% (95% CI 0 - 1.3) in Phase 1. In Phase 3, it was 12.8% (95% CI 8.3 - 17.7) and 21.5% (95% CI 15.6-28) in low and high transmission areas, respectively. CRI was 0.31 (95% CI 0.16-0.47) and 0.41(95% CI 0.28-0.52) in low and high transmission neighborhoods respectively in Phase 2. Similar trends were observed in Phase 3. Only 5.4% of participants who tested positive for COVID-19 were symptomatic. IFR was 1.66%, 0.37% and 0.26% in Phases 1, 2 and 3 respectively.Conclusion: Continuing rounds of seroprevalence studies will help us better understand secular trends and extent of infection during the course of the pandemic

Effectiveness of typhoid conjugate vaccine against culture-confirmed salmonella enterica serotype typhi in an extensively drug-resistant outbreak setting of Hyderabad, Pakistan: A cohort study

Background: Salmonella enterica serotype Typhi (S Typhi) is a major public health problem in low-income and middle-income countries. We aimed to investigate the effectiveness and impact of the typhoid conjugate vaccine Typbar-TCV against S Typhi among children in an outbreak setting of extensively drug-resistant (XDR) S Typhi in Pakistan.Methods: This cohort study was done from Feb 21, 2018, to Dec 31, 2019. A census survey of all households located in the Qasimabad and Latifabad subdistricts of Hyderabad, Pakistan, was done at baseline, and 174 005 households were registered in the census. The Typbar-TCV immunisation campaign was initiated at temporary vaccination centres and 207 000 children aged 6 months to 10 years were vaccinated from Feb 21, 2018, to Dec 31, 2018. Social mobilisers informed parents about the vaccination process. Vaccination records were maintained electronically and linked with the household census surveys. Active surveillance for suspected and blood-culture-confirmed S Typhi was established in hospitals, clinics, and laboratories to assess the following outcomes: cases of suspected typhoid fever, culture-confirmed S Typhi, and antimicrobial resistance. An age-stratified cohort of 1100 vaccinated children was randomly selected from the vaccination registry, tested for Vi-IgG antibodies (data not reported), and followed up fortnightly (via telephone calls or household visits) until Dec 31, 2019, for ascertainment of outcomes during the study period. 20 847 vaccinated and unvaccinated children were randomly selected from the census registry as a quality control cohort and followed up from Oct 1 to Dec 31, 2019, for ascertainment of outcomes. Vaccine effectiveness against suspected, culture-confirmed, and XDR S Typhi was calculated.Findings: 23 407 children from the census registry and surveillance system were included in the vaccine effectiveness analysis. 13 436 (57·4%) children were vaccinated, 12 214 (52·2%) were male, and 10 168 (43·4%) were aged 6-59 months. 5378 (23·0%) of 23 407 children had suspected S Typhi, among whom 775 (14·4%) had culture-confirmed S Typhi and 361 (68·6%) of 526 had XDR S Typhi. Vaccine effectiveness was 55% (95% CI 52-57) against suspected S Typhi (regardless of culture confirmation), 95% (93-96) against culture-confirmed S Typhi, and 97% (95-98) against XDR S Typhi.Interpretation: Typbar-TCV is effective in protecting children against S Typhi infection in an outbreak setting, and was able, with moderate deployment, to curtail a major XDR S Typhi outbreak in a densely populated setting. The vaccine shows efficacy against S Typhi irrespective of antimicrobial resistance.Funding: Bill & Melinda Gates Foundation

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Basic Life Support Training as Mandatory Training in Educational Institutions to Deal with Emergencies

Background: Injury is a significant issue of public health, a major global burden and first aid training programs incorporated as part of school curriculum will have a considerable impact on public health, and this will in turn reduce out of hospital cardiac arrests. The study aimed to determine the immediate First aid knowledge and long term retention of its knowledge (after three months) of the students (13-18 years), participating in a volunteer program in Karachi. Methods: This study was conducted in a tertiary care hospital, delivering First aid training to 143 participants by Basic life support (BLS) trained staff in a tertiary care hospital. The design consisted of a pre-test, post-test and follows up assessments, carried out via questionnaire and hands-on assessment. SPSS was used for statistical analysis. ANOVA and Friedman test was applied to evaluate the dependent variable’s improvement in knowledge between pre, post and follow up tests. Results: From 143 participants, 41.5 %, 63.8 % and 61 % satisfactory results were seen in the pre-test, post-test and follow up assessments, respectively. In Pre-test, males scored 18.75 % and the females scored 8.42%, whereas, in the post-test, the scores were 75.7% and 64.58% respectively. Similarly, in follow up evaluations results obtained were 62.1% and 45.8% respectively. Hands-on scores were 88.4% in males and 95.8 % in females. Conclusion: The level of first aid knowledge was unquestionably less satisfactory in the pre-test evaluations compared to post-test and follows up assessments. Due to its effectiveness, it should be incorporated as part of the school curriculum. Keywords: Adolescents; Knowledge; Cardiopulmonary Resuscitation