Frequency of Human Immune Deficiency Virus (HIV) Infections at Tertiary Care Hospital of Karachi from 2017-2019

Background: Human immunodeficiency virus (HIV) is the world’s most serious health problem. Pakistan is included among high prevalent countries and two outbreaks of HIV have been reported one in 2018, in Sargodha (Kot Momin) and the other largest so far in 2019 in Larkana, first time infecting children as well. Therefore, a study was designed to find out the frequency as well as risk factors involved in the transmission of HIV. Methods: This was a retrospective cross-sectional study (n=28,679), conducted in the Microbiology laboratory of Dow Diagnostic Reference and Research Laboratory (DDRRL), Karachi, Pakistan from 1st January 2017 to 31st December 2019. Serum samples were screened for the presence of HIV antigen and antibody by using HIV combo ARCHITECT i2000 SR, chemiluminescent immunoassay (CMIA). The Chi-square was used to analyze the data and a p-value of <0.05 was considered statistically significant. Results: The total HIV-positive samples were 198 (0.69%). The mean age was 30.39 ± 10.1 with a predominance of males 158 (79.8%) followed by females 39(19.7%) and trans-genders 1(0.5%). The most prevalent ethnic background was Sindhi 40(20.2%) followed by Urdu speaking 32(16.2%). The major risk factors were sexual contact (25%) and surgical procedure (13%). The research found the highest incidence reported in Malir District (17.12%) followed by East (13.63%) and West (11.6%) of Karachi. The most significant association (p<0.001) of HIV was found with age. Conclusion: The male population from the Malir district of Sindhi ethnicity had a high frequency of HIV. Moreover, sexual contact and surgical procedures were found major risk factors for HIV. Keywords: Human Immunodeficiency Virus (HIV); Risk Factors; Sexually Transmitted Diseases; Epidemic

Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan

Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal

Quality Testing and Antimicrobial Activity of Norfloxacin in Pakistan

Background: There are 400 licensed pharmaceutical companies in Pakistan; one third of Pakistan total consumption of pharmaceuticals is imported. Market potential is good for antibiotics, vaccines, hormones etc. Introduction: High performance liquid chromatography is an important tool for routine determination of antimicrobial drugs with specific emphasis on fluoroquinolones. The quality testing of norfloxacin was also done by Liquid chromatography coupled with mass spectrometry. Antibacterial activity of norfloxacin is good for aerobic gram negative bacteria, including Enterobacteriaceae and Pseudomonas aeruginosa. It has moderate antibacterial activity against gram positive microorganisms, such as staphylococci; anaerobic bacteria are generally resistant.Method: Our investigation focuses on the quality testing of brands of Norfloxacin available in market with variety of trade names. Reverse phase chromatographic technique RP-HPLC was used for the quality testing of norfloxacin at temperature of 35°C and a flow rate of 0.8ml/ml with Isocratic plution. Disk diffusion techniquewas used to check the antibacterial activity of norfloxacin against Proteus mirabilis, Klebsiella pnemoniae, Escherichia coli and Pseudomonas aeruginosa. Different brands of Norfloxacin (noroxin, uracin, qunor, urid , uroquin, webnor, bactinor, uritac , floxacin, norocin and ecoflaxin) from pharmaceutical companies A, B C, D,  F , G , H, I, J &amp; and K were collected from markets of Rawalpindi and Islamabad (Pakistan). The claimed concentration of tablet was 400mg. Result: The quality testing of norfloxacin with sample and standard showed that brands from companies C and F Qunor, Webnor did not qualify the quality testing, they were of medium standard for the treatment of infections while H Company with a brand Uritac stands highest for quality test. Disk diffusion technique showed that all brands of norfloxacin were sensitive against the mentioned bacteria.Conclusion:  This research concluded that special effective measures should be taken by all the pharmaceutical companies in Pakistan to check the quality standards of pharmaceuticals especially antibiotics before manufacturing. If they qualify the quality standards they will be effective to treat infections, if they are of low standard it would be difficult for the clinician to advise the correct amount of dosage for patient.

Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years of age: a cluster randomized trial in Pakistan

Background Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal. Methods 40 village clusters in Pakistan were randomly allocated using a computerised randomisation sequence to receive a group-based, psychosocial intervention and enhanced usual care for 36 months, or enhanced usual care alone. Pregnant women (≥18 years) were screened for moderate or severe symptoms of depression (patient health questionnaire-9 [PHQ-9] score ≥10) and were recruited into the trial (570 participants), and a cohort without depression (PHQ-9 score <10) was also enrolled (584 participants). Including the non-depressed dyads enabled us to determine how much of the excess risk due to maternal depression exposure the intervention could mitigate. Research teams responsible for identifying, obtaining consent, and recruiting trial participants were blind to the allocation status throughout the duration of the study, and principal investigators, site coordinators, statisticians, and members of the trial steering committee were also blinded to the allocation status until the analysis of 6-month data for the intervention. Primary outcomes were maternal depression symptoms and remission (PHQ-9 score <10) and child socioemotional skills (strengths and difficulties questionnaire [SDQ-TD]) at 36-months postnatal. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02658994. Findings From Oct 15, 2014 to Feb 25, 2016 46 village clusters were assessed for eligibility, of which 40 (including 1910 mothers were enrolled. After exclusions, 288 women were randomly assigned to the enhanced usual care group and 284 to the intervention group, and 1159 women were included in a group without prenatal depression. At 36-months postnatal, complete data were available from 889 mother-child dyads: 206 (72·5%) in the intervention group, 216 (75·3%) in the enhanced usual care group, and 467 (80·0%) women who did not have prenatal-depression. We did not observe significant outcome differences between the intervention group and the enhanced usual care group for the primary outcomes. The standardised mean difference of PHQ-9 total score was −0·13 (95% CI −0·33 to 0·07), relative risk of patient health questionnaire-9 remission was 1·00 (95% CI 0·88 to 1·14), and the SDQ-TD treatment estimate was −0·10 (95% CI −1·39 to 1·19). Interpretation Reduced symptom severity and high remission rates were seen across both the intervention and enhanced usual care groups, possibly masking any effects of the intervention. A multi-year, psychosocial intervention can be task-shifted via peers but might be susceptible to reductions in fidelity and dosage over time (which were not among the outcomes of this trial). Early intervention efforts might need to rely on multiple models (eg, collaborative care), be of greater intensity, and potentially targeted at mothers who are at high risk for depression to reduce the intergenerational transmission of psychopathology from mothers to children. Funding National Institutes of Health

Delivering the Thinking Healthy Programme for Perinatal Depression Through Volunteer Peers: A Cluster Randomised Controlled Trial in Pakistan

Background The Thinking Healthy Programme (THP), which is endorsed by WHO, is an evidence-based intervention for perinatal depression. We adapted THP for delivery by volunteer peers (laywomen from the community) to address the human resource needs in bridging the treatment gap, and we aimed to assess its effectiveness and cost-effectiveness in Rawalpindi, Pakistan. Methods In this cluster randomised controlled trial, we randomly assigned 40 village clusters (1:1) to provide either THP peer-delivered (THPP) and enhanced usual care (EUC; intervention group) or EUC only (control group) to the participants within clusters. These villages were randomly selected from eligible villages by an independent researcher. The participants were pregnant women aged 18 years or older who had scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9), who we recruited from households within communities in Rawalpindi, Pakistan. The research teams who were responsible for recruiting trial participants were masked to treatment allocations. Participants attended follow-up visits at 3 and 6 months after childbirth. The primary outcomes were the severity of depressive symptoms (assessed by PHQ-9 score) and the prevalence of remission (defined as a PHQ-9 score of less than 5) in participants with available data 6 months after childbirth, which was assessed by researchers who were masked to treatment allocations. We analysed outcomes by intention to treat, adjusting for covariates that were defined a priori or that showed imbalance at baseline. The trial was registered with ClinicalTrials.gov, number NCT02111915. Findings Between April 15 and July 30, 2014, we randomly selected 40 of 46 eligible village clusters for assessment, as per sample size calculations. Between Oct 15, 2014, and Feb 25, 2016, we identified and screened 971 women from 20 village clusters that had been randomly assigned to the THPP and EUC group and 939 women from 20 village clusters that had been randomly assigned to the EUC only group. In the intervention group, 79 women were ineligible for inclusion, 11 women refused screening, 597 women screened negative on the PHQ-9, and one woman did not consent to participate. In the control group, 75 women were ineligible for inclusion, 14 women refused screening, 562 women screened negative on the PHQ-9, and one woman did not consent to participate. We enrolled 283 (29%) women in the intervention group and 287 (31%) women in the control group. At 6 months after childbirth, 227 (80%) women in the THPP and EUC group and 226 (79%) women in the EUC only group were assessed for the primary outcome. The severity of depression (assessed by PHQ-9 scores; standardised mean difference −0·13, 95% CI −0·31 to 0·06; p=0·07) and prevalence of remission (49% in the intervention group vs 45% in the control group; prevalence ratio 1·12, 95% CI 0·95 to 1·29; p=0·14) did not significantly differ between the groups 6 months after childbirth. There was no evidence of significant differences in serious adverse events between the groups. Interpretation THPP had no effect on symptom severity or remission from perinatal depression at 6 months after childbirth, but we found that it was beneficial on some other metrics of severity and disability and that it was cost-effective. THPP could be a step towards use of an unused human resource to address the treatment gap in perinatal depression

Predictors of Prenatal Depression: A Cross-Sectional Study in Rural Pakistan

Objective: To determine the prevalence and association of prenatal depression with socioeconomic, demographic and personal factors among pregnant women living in Kallar Syedan, Rawalpindi, Pakistan. Methods: Five hundred women in the second and third trimester of pregnancy, living in Kallar Syedan, a rural area of district Rawalpindi Pakistan, were included in the study. Depression was assessed using “Patient health questionnaire” (PHQ9) in Urdu, with a cut-off score of 10. Multi-dimensional scale of perceived social support (MSPSS) was used to assess perceived social support. Life Events and Difficulties Schedule (LEDS) were used to measure stressful life events in past 1 year. Tool to assess intimate partner violence (IPV) was based on WHO Multi Country Study on “Women's Health and Domestic Violence against Women.” Results: Prevalence of prenatal depression was found to be 27%. Number of pregnancies was significantly associated with prenatal depression (p < 0.01). Women living in a joint family and those who perceived themselves as moderately satisfied or not satisfied with their life in the next 4 years were found to be depressed (p < 0.01, OR 6.9, CI 1.77–26.73). Depressive symptomatology in women who experienced more than five stressful life events in last 1 year was three times higher (p < 0.001, OR 3.2, CI 1.68–5.98) than in women with 1–2 stressful events. Women who were supported by their significant others or their family members had 0.9 times (p < 0.01, OR 0.9, CI 0.85–0.96) less chance of getting depressed. Pregnant women who were psychologically abused by their partners were 1.5 times more depressed (p < 0.05 CI 1.12–2.51). Odds of having depression was also high in women who had less mean score of MSSI (p < 0.05, OR 1.1, CI 1.01–1.09). Women who had suitable accommodation had 0.5 times less chance of having depression than others (p < 0.05, OR 0.5, CI 0.27–0.92). Conclusion: Over a quarter of the women in the study population reported prenatal depression, which were predicted predominantly by psychosocial variables

Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan

BACKGROUND: The Thinking Healthy Programme (THP) is recommended to treat perinatal depression in resource-limited settings, but scale-up is hampered by a paucity of community health workers. THP was adapted for peer-delivery (THPP) and evaluated in two randomized controlled trials in India and Pakistan. Our aim was to estimate the effectiveness of THPP on maternal outcomes across these two settings, and evaluate effect-modification by country and other pre-defined covariates. METHODS: Participants were pregnant women aged≥18 years with depression (Patient Health Questionnaire (PHQ-9) score≥10), randomized to THPP plus enhanced usual care (EUC) or EUC-only. Primary outcomes were symptom severity and remission (PHQ-9 score<5) 6 months post-childbirth. Secondary outcomes included further measures of depression, disability and social support at 3 and 6 months post-childbirth. RESULTS: Among 850 women (280 India; 570 Pakistan), 704 (83%) attended 6-month follow-up. Participants in the intervention arm had lower symptom severity (PHQ-9 score adjusted mean difference -0.78 (95% confidence interval -1.47,-0.09)) and higher odds of remission (adjusted odds ratio 1.35 (1.02,1.78)) versus EUC-only. There was a greater intervention effect on remission among women with short chronicity of depression, and those primiparous. There were beneficial intervention effects across multiple secondary outcomes. LIMITATIONS: The trials were not powered to assess effect-modifications. 10-20% of participants were missing outcome data. CONCLUSIONS: This pooled analysis demonstrates the effectiveness, acceptability and feasibility of THPP, which can be scaled-up within a stepped-care approach by engaging with the existing health care systems and the communities to address the treatment gap for perinatal depression in resource-limited settings

Exploring the determinants of delayed diagnosis of breast cancer in the female population of Punjab (Pakistan)

Objective: To explore the factors contributing to late diagnosis of breast cancer in female population of Punjab, Pakistan. Methodology: Descriptive qualitative study with phenomenological approach was used. The study was carried out in University of Health Sciences, Lahore in collaboration with breast cancer clinics/departments of the Jinnah Hospital, Lahore, Sir Ganga Ram Hospital Lahore and Mayo Hospital Lahore. 15 Females diagnosed more than 4 months after appearance of symptoms of breast cancer were recruited using purposive sampling until saturation of data. Data collected through in depth semi structured face to face interviews was tape-recorded, transcribed and then analysed using thematic analysis framework method. Results: Personal/psychological factors, Sociocultural and Health care system related factors were identified as main themes emerged from data. Lack of knowledge, religious believes, use of Alternative medicine, socioeconomic status cultural myths and poorly facilitated health care facility were the most influential determinants of delay among breast cancer patients. Conclusion: Diagnosis delay is very significant health problem in women with breast cancer linked with multiple determinants. However, educating women for recognition of symptoms and reinforcement to pursue for earlier medical consultation will be helpful in reducing breast cancer diagnosis delay in the country. Key terms: Breast Cancer, Metastasis, Delayed Diagnosis, Prognosis, Advance Stage. Continuous..

Metabolic and Behavioral Effects of Nicotine in Swim Stressed Mice

Nicotine, in the form of tobacco smoking, is the most commonly abused drug throughout the world. It contributes to the harmful tobacco smoking habit leading to high morbidity and mortality throughout the world. The drug has addictive properties and causes drug dependence. Apart from these effects, nicotine alters a number of metabolic pathways such as lipid profile and glucose homeostasis leading to increased risk of cardiovascular diseases. Present study investigated the metabolic and behavioral effects of nicotine in stressed mice. For this purpose adult male mice were subjected to chronic nicotine treatment(3.08 mg/100 ml in drinking water) for 3 weeks followed by forced swim test (FST) and serum glucose, lipid profile and tryptophan were investigated. When swim stressed mice were compared with chow control, it was found that serum glucose (P&lt;0.001), total cholesterol (P&lt;0.001), triglycerides (P&lt;0.01), and LDL cholesterol (P&lt;0.01) were increased. Similarly glucose concentration (P&lt;0.05), total cholesterol (P&lt;0.05), triglycerides (P&lt;0.01) and LDL cholesterol (P&lt;0.05) were increased in drug treated swim stressed mice. However HDL remained unaltered in both groups. Serum tryptophan was decreased (P&lt;0.01) in swim stressed and nicotine treated swim stressed mice. During FST, swimming behavior was significantly increased at the cost of climbing with no change in immobility in nicotine treated mice as compared to controls. It is concluded that nicotine worsens lipid profile and glucose homeostasis in stressful situations thereby increasing the risk of cardiovascular diseases in chronic smokers and the drug induced behavioral alterations may be related to the serotonergic pathway

مومن خاں مومنؔ کے منظوم شخصی قصوں کی تنقید: ایک تجزیہ

In 18th century, Momin Khan Momin wrote autobiographical narrative poetry in consideration of the changing circumstances and trends. This depicts the fact that the poets were agglomerating imagination and reality while returning from externality to internality. The analysis of these Masnavi-like poetic tales clearly shows that the characters are now real human beings instead of genies, fairies and princesses and the elements of sentimentality and cheerfulness are more valuable than those of fight and feast. Moreover, these poetic tales of Momin are the descent of shady Urdu Masnavis and the precursor of constituting the new form of poetry.