The Role of Neighborhood Environment in Promoting Risk Factors of Cardiovascular Disease among Young Adults: Data from Middle to High Income Population in an Asian Megacity

Background: Modifiable risk factors of cardiovascular diseases (CVD) have their triggers in the neighborhood environments of communities. Studying the environmental triggers for CVD risk factors is important to understand the situation in a broader perspective. Young adults are influenced the most by the environment profile around them hence it is important to study this subset of the population.Methods: This was a descriptive study conducted using the EPOCH research tool designed by the authors of the PURE study. The study population consisted of young adults aged 18-25 in two areas of Karachi. The study setting was busy shopping malls frequented by young adults in the particular community being studied.Results: Our total sample size was 120 individuals, who consented to be interviewed by our interviewers. Less than 50% of the population recognized some form of restriction regarding smoking in their communities. The largest contributor to tobacco advertising was actors smoking in movies and TV shows with 89% responses from both communities. Only 11.9% of the individuals disapproved of smoking cigarettes among men with wide acceptance of \u27sheesha\u27 across all age groups. Advertising for smoking and junk food was more frequent as compared to smoking cessation, healthy diet and exercise in both the areas. Unhealthy food items were more easily available in contrast to healthier options. The cost of healthy snack food options including vegetables and fruits was higher than sugary drinks and foods.CONCLUSION: This assessment showed that both communities were exposed to environments that promote risk factors for cardiovascular diseases

Prevalence of nomophobia and its associated factors among medical students of a private medical college in Lahore

Background and Objective: Mobile phones have become an indispensable part of our daily life. Nomophobia (NMP) is an abbreviation for &ldquo;no-mobile-phone phobia,&rdquo; which defines apprehension faced by mobile phone users in its absence which leads them to become technically unable to communicate. Objective of the study is to determine the prevalence of NMP and its association with the demographic factors among medical students of a private medical college in Lahore. Methods: A cross-sectional study was conducted among the medical students from first to final year classes from May to November 2021. A validated NMP questionnaire was used along with questions related to the sociodemographic profile and frequency of mobile phone usage by the respondents. The self-reported questionnaire was filled out by all the students who were present on the day of data collection. Data were analyzed by SPSS 20. Results: Out of 646 medical students, 618 filled the questionnaire. Out of 618 respondents, 51.5% had moderate and 38.2% had severe NMP. Among sociodemographic variables, females (40.8%) had a statistically significant association with NMP (p = 0.027). Usage of mobile phones per day and disturbance in the students&rsquo; daily routine had a statistically significant association with the NMP (p = 0.029 and p = &lt;0.001, respectively). Conclusion: NMP is very common among medical students and females are more likely to experience this phenomenon. Frequent usage of mobile phones is directly related to NMP affecting the daily routine of the medical students.</p

Effect of Quinolones Versus Cefixime on International Normalized Ratio Levels After Valve Replacement Surgery with Warfarin Therapy

Background and Objectives: A dispute over interaction of warfarin with two quinolones&mdash;i.e., moxifloxacin and levofloxacin&mdash;leading to significant increase in international normalized ratio (INR) levels and coagulopathies is currently in debate. The study objective was to compare the INR values due to addition of quinolones and cefixime in warfarin treated patients after replacement of disease valves with metallic valves. Material and Methods: A prospective evaluation of patients who undergone valve replacement surgeries in the cardiology hospital setup in Pakistan during the period 2018&ndash;2019 was done, including all those subjects treated concurrently with levofloxacin, moxifloxacin, cefixime, and warfarin for the study. Data organized included demographic information, concurrent medications, and appropriate analytical parameters, especially INR values taken before and within seven days after prescribing three antibiotics in discharged patients who had undergone valve replacement surgeries. Patients for whom laboratory INR values were not given at the time of discharge and with deranged liver function, renal function, low albumin levels, and febrile patients were removed from study. Furthermore, patients were advised on possible food interactions and evaluated to examine if these factors have any possible influence on the interaction being studied. Results: Differences in INR were analyzed statistically by means of SPSS analysis before and after the possible interaction. Following the administration of levofloxacin and moxifloxacin to warfarin therapy, statistical analysis showed remarkable increase in INR (p &lt; 0.001) and no significant change in INR was observed after cefixime treatment (p &gt; 0.05). Conclusion: Results showed that, after adding levofloxacin and moxifloxacin in patients on warfarin, therapy contributed to remarkable increase in INR. However, addition of cefixime prevented frequent coagulopathies; therefore, close monitoring of INR and switching to a safe antibiotic such as cefixime is recommended

Drug prevalence and comparison interaction between numbers of patients admitted at two teaching hospitals; Quetta, Pakistan

Aim and objective: Drug-drug interaction (DDI) is of major concern in patients with complex therapeutic regimens. The study aims to assess the prevalence of DDIs in the prescriptions of patients during the hospitalization to evaluate the DDIs of drugs regarding its severity, pharmacodynamic and pharmacokinetic.Methodology: The prescribed drugs in the admission chart of 183 patients were screened for Drug-drug interaction using Mediscape interaction screening program. Drug-drug interactions have been classified on the basis of severity (contraindicated, significant, minor, major, moderate and serious). Frequency and the percentage of pairs of drugs with DDIs, number of prescribed drugs, demographics and DDIs on the basis of and Pharmacodynamics, Pharmacokinetics have been analysed.Results: The overall result shows the frequency and percentage of drug-drug interaction present in hospitalized patients, out of 183 was 125(68.3%). Majority of interactions was found on the basis pharmacokinetic DDI 108(59.0%). On the basis of severity, minor Drug-drug interaction was found dominant 91(49.7%) followed by contraindicated 19(10.4%).Conclusion: Drug-drug interaction is common among hospitalized patient’s medications. My study evaluated a positive relation between prevalence of DDIs and number of drugs prescribed. Survey concluded that percentage of minor and contraindicated DDIs at admission were produced by changes of medication during hospitalization.</p

A case of a patient infected with a hepatitis C virus genotype 3a multidrug resistant variant in Pakistan

Abstract Background Approximately 10 million people in Pakistan are infected with the hepatitis C virus (HCV). Most patients develop chronic hepatitis, with rare cases of spontaneous clearance. However, little is known about multidrug resistant viral variants in Pakistan. Findings This case study describes a 47-year-old male diagnosed with chronic HCV genotype 3a infection in 2003. After an initial diagnosis of viral infection, the patient remained treatment naïve for 5 years. He received two therapy cycles of interferon (IFN) plus ribavirin (RBV) in 2007 and 2010, however, he was non-responsive to the therapy. The patient then received an additional two treatment cycles of pegylated IFN α-2b plus RBV (in 2011 and 2013); he was still non-responsive. In 2016, the patient underwent sofosbuvir plus RBV combination therapy, however, the sustained virological response was still not achieved. The host genetic factor was found to be heterozygous guanine and thymine (GT) and cytosine and thymine (CT) genotypes of rs8099917 and rs12979860 polymorphism of IL28B, respectively. Phylogenetic analysis suggests that the resistant variant belong to an out-group and may require triple therapy. Conclusions This is the first case that reports on a HCV-infected individual who was a non-responder to multiple IFN therapies in Pakistan. Further studies are needed to understand multidrug-resistant HCV variants in the Pakistani population

Mutations in ISDR may be linked to high viremia and virus resistance to IFN-alpha-2b but responsive to PEG-IFN-alpha-2a

Mutation in interferon sensitivity determining region may play role in virus resistance. Genotype 3a patient was subjected to 48 weeks combination therapy of IFN-alpha-2b plus ribavirin but he showed high levels of viremia before, during and after treatment although his ALT level became normal. His IL-8 and TNF-alpha levels werefound quite high before and after IFN-alpha-2 combination therapy. While comparing its ISDR-NS5A with end of treatment responder patient, eight mutations were observed in a 52 amino acid protein residue. Patient was advised for PEG-IFN-alpha-2a combination therapy for 24 weeks, to which he responded well after 4 week and showed sustained virologic response after 06 months of completion of therapy. His IL-8 and TNF-alpha levels also came to lower levels after treatment with PEG-IFN-alpha 2a combination therapy. In phylogenetic tree its genome (NZ1) along with another nonresponder case (NZ2) was placed close to Brazilian isolates. NZI and NZ2 showed 87 % sequence homology with each other while NZ1 had 89% sequence homology with EF208017 and 87% with EF20995. NZ2 showed 91% homology with EF208017 and 98% with EF207995 which is quite interesting. Mutations in ISDR sequence may be the reason for non response to IFN combination therapy of this HCV genotype 3 patient. ISDR of genotype 3 along with IL-8 and TNF-alpha may be screened on larger scale in Pakistani population which may help in deciding a cost effective treatment plan

Advancing medical laboratory practice in Pakistan: Insights from a focus group study on technologists\u27 training needs

Background: The realm of medical laboratory technology (MLT) training and education is unstructured in Pakistan. The primary challenge currently confronting the workforce in MLT is the absence of standardized curricula and assessments in education and training. This was an exploratory study aiming to inquire experiences of trainees, alumni and teaching coordinators regarding the technologist training program in a single institute at Pakistan.Methods: To gain an in depth understanding of MLT program, three focus group discussions (FGDs) were held at Department of Pathology and Laboratory Medicine, Aga Khan University, Pakistan during Feb-April 2024. A team of pathologists and educationists developed interview guides for FGDs in English. Interviews were bilingual, transcribed verbatim and coded using thematic analysis. Participants included current trainees, alumni, teaching and learning coordinators and moderators for the interview.Results: A total of 29 participants were engaged; these included current MLT trainees (n = 10), alumni (n = 10), and teaching/learning coordinators and sectional supervisors (n = 9). Five main themes emerged from the analysis of FGDs: (Scott MG, Rifai N, Smith B, Oellerich M, Panteghini M, Apple F et al. The changing face of laboratory medicine: a more service and less academically oriented profession? 2015;61(2):322-9.) Recognition of key features of the MTT program, (Ferraro S, Braga F, Panteghini MJCC, Medicine L. Lab Med new Healthc Environ. 2016;54(4):523-33.) Evaluating curriculum design, (Waheed U, Ahmad M, Wazeer A, Saeed M, Saba N, Rasheed FJMJMS. Medical laboratory science education; shaping competent and skilled healthcare professionals. 2023;1(1):58-63.) Teaching and learning strategies, (Ned-Sykes R, Johnson C, Ridderhof JC, Perlman E, Pollock A, DeBoy JM. Competency guidelines for public health laboratory professionals. 2015.) Addressing the need to improve assessment methods, and (Linder RJJM, Education B. Educating medical laboratory technologists: revisiting our assumptions in the current economic and health-care environment. 2012;13(2):150-4.) Navigating the transition from a trainee to a competent technologist.Conclusion: Our investigation demonstrated its potential as a valuable needs assessment study, highlighting key strengths, drawbacks, and challenges of the existing MTT program. Importantly, these findings at our institute can inform further research efforts to design competency-based MLT education and training programs in Pakistan

Additional file 1: of A case of a patient infected with a hepatitis C virus genotype 3a multidrug resistant variant in Pakistan

Multilingual abstract in the five official working languages of the United Nations. (PDF 460 kb