Public Trust and Healthcare Institutions: A Quantitative Analysis in Pakistani Healthcare Contexts

This paper presents a case for generalizing Seok-Eun Kim’s model of public trust to healthcare institutions. The model consists of five variables that together conceptualize trustworthiness: credible commitment, benevolence, honesty, competency, and fairness. Respondents were asked to answer questions that captured these variables with regards to two hospitals in Karachi, Pakistan: Jinnah Postgraduate Medical College and Aga Khan University Hospital. The sample consisted of 41 people and was collected through snowball sampling, which compromises its randomness. Seven hypotheses were tested. The first five consisted of seeing if Kim’s variables are related to institutional trustworthiness. Of these five, the first and third null hypotheses were rejected, with the variables (credible commitment and competency) having a positive correlation with institutional trustworthiness. Benevolence, honesty, and fairness were not significantly related to institutional trustworthiness. The sixth hypothesis claimed that an average of Kim’s variables would be positively related to measures of institutional quality (which are typically taken to be predictors of institutional trust in the literature). This null hypothesis was rejected, and there was a positive relation between the two variables (however, this was primarily due to treatment quality, as this was the only statistically significant measure of institutional quality). Lastly, there was a statistically significant, positive correlation between the average of Kim’s variables (an operationalization of institutional trust) and interpersonal trust, which provides support for the theoretical mechanism being put forward, which claims, inter alia, that interpersonal and institutional trust reinforce each other in a feedback loop.Master's Thesis in Public AdministrationAORG351MASV-PUBA

A Comprehensive Electroencephalogram Audit in A Tertiary Care Center in Pakistan: Demographic Distribution, Referral Indications and Findings

Background and Objective: Electroencephalography (EEG) is a widely employed non-invasive technique for recording brain electrical activity, pivotal for diagnosing various neurological conditions. The study aims to provide insight into demographic distribution, referral indications, and EEG findings in a tertiary care hospital in Pakistan. Methods: A retrospective cross-sectional analysis was conducted involving 2,924 patients who underwent routine EEG evaluations over a three-year period. Data was collected from the EEG records after approval from the ethical review committee. Demographic variables, referral reasons, and EEG findings were recorded and analyzed using descriptive statistics. Results: The study revealed a gender distribution of 41.35 % females and 58.65 % males, aligning with broader epidemiological trends. Participants were categorized into different age groups and most of the patients in our study belonged to the five to 18 years of age group. Most common indication was a suspected seizure disorder (78.32 %), followed by subclinical seizures (7.38 %) and medication adjustment (6.81 %). Notably, encephalopathy was the most common abnormal EEG finding (31 %), with temporal epilepsies being predominant within the focal seizure category. Conclusion: The descriptive nature of the study contributes novel insights. The study’s contribution provides valuable guidance for healthcare professionals, enhancing their comprehension of neurological conditions and refining diagnostic and treatment strategies

Frequency of Hyperlipedemia in Patients Coming with Ischemic Stroke in Tertiary Care Hospital Karachi

Background and objective: Stroke is the second leading cause of death and the third leading cause of disability. This study was designed to determine the frequency of hyperlipidemia in patients with ischemic stroke visiting at a tertiary care hospital in Karachi. Methods:This was a descriptive cross-sectional study and was done in Department of Medicine, LCMD/ Dar-ul-Sehat Hospital Karachi, Pakistan. A total of 184 patients were studied during the study period of six months and all the consecutive patients were recruited who presented with acute stroke in the department of medicine from the duration April 1st 2022 to September 30th, 2022.Those fulfilling the inclusion criteria for this study were included for data analysis, while the patients who did not meet the said criteria were excluded. Their serum lipid levels were collected within 24 hours of admission. Hyperlipidemia was measured through fasting lipid profile and was labeled as present if any one or more of the following profile like total cholesterol \u3e200 mg/dl, LDL cholesterol \u3e 100 mg/dl, TGL \u3e 150 mg/dl, HDL cholesterol \u3c 40 mg/dl, as appropriate. Results:The mean age of the patients was 65.17±12.73. Average systolic and diastolic blood pressure was 152.34±21.31 & 83.35±13.71 mm Hg respectively. Mean duration of smoking and diabetes mellitus in first ever ischemic stroke patients was 9.33±4.03 & 13.65±5.8 years respectively, whereas average fasting blood sugar was found 151.98±69.73mg/dl; 118 (64%) were males and 66 (36%) were females. A total of 124 (67.4%) of patients had a history of hypertension, while 94 (51.1%) were diabetic. Fifty-three (28.8%) of patients had a history of coronary artery disease while 22 (11.95%) patients had history of smoking. Increased triglycerides level was seen in 47 (25. 5%). The frequency of hyperlipidemia was 145 (79%) patients respectively. Conclusion: Frequency of hyperlipidemia was 145 (79%) in patients with ischemic stroke which is moderately high in our setup. A high prevalence of hyperlipidemia is alarming in our setup and requires attention of the physicians on modifiable risk factors

Social Anxiety and Quality of Life: Mediating Role of Stigma Perception in Individuals Who Stutter

Children, adolescents, and adults who stutter widely experience anxiety and avoid social situations; hence stuttering negatively affects their quality of life (Yaruss & Quesal, 2004). The study aims to investigate the relation between social anxiety, stigma perception, and quality of life among individuals who stutter and to examine if stigma perception mediates between social anxiety and quality of life. Participants of aged 11- 25 years (Mage =18.83, SD = 4.74, N = 117) were recruited using purposive and snowball sampling technique. Participants were screened based on dysfluency using DSM-5 (2013) stuttering criteria. Results revealed significant association between social anxiety, stigma perception, and quality of life. Mediation analysis also showed that stigma perception partially mediated the relation between social anxiety and quality of life in individuals who stutter. Furthermore, significant age differences were found in social anxiety and quality of life in individuals who stutter. The study concluded that stigma perception partially mediates the relationship between social anxiety and quality of life; therefore, social anxiety and perceived stigma need to be reduced to enhance stuttering individuals’ quality of life. Results highlight the importance of multidisciplinary approach in the management of stuttering

The potential of IFN-λ, IL-32γ, IL-6, and IL-22 as safeguards against human viruses: a systematic review and a meta-analysis

Many studies have investigated the antiviral activity of cytokines, including interleukin-6 (IL-6), interleukin-22 (IL-22), interleukin-32 gamma (IL-32γ), and interferon-lambda (IFN-λ) in diverse populations. This study aims to evaluate the role of these cytokines in inhibition of various human and animal viruses when administered exogenously. A comprehensive meta-analysis and systematic review were conducted on all the relevant studies from three databases. Standard mean differences (SMDs) of overall viral inhibition were used to generate the difference in the antiviral efficacy of these cytokines between control and experimental groups. A total of 4,618 abstracts for IL-6, 3,517 abstracts for IL-22, 2,160 abstracts for IL-32γ, and 1,026 abstracts for IFN-λ were identified, and 7, 4, 8, and 35 studies were included, respectively, for each cytokine. IFN-λ (SMD = 0.9540; 95% CI: 0.69–0.22) and IL-32γ (SMD = 0.459; 95% CI: 0.02–0.90) showed the highest influence followed by IL-6 (SMD = 0.456; CI: −0.04–0.95) and IL-22 (SMD = 0.244; 95% CI: −0.33–0.81). None of the cytokines represented heterogeneity (tau² > 0), but only IFN-λ indicated the funnel plot asymmetry (p = 0.0097). Results also indicated that IFN-λ and IL-32γ are more potent antivirals than IL-6 and IL-22. The collective findings of this study emphasize that exogenously administered pro-inflammatory cytokines, specifically IFN-λ and IL-32, exhibit a significant antiviral activity, thereby underscoring them as potent antiviral agents. Nonetheless, additional research is required to ascertain their clinical utility and potential for integration into combinatorial therapeutic regimens against viral infections

Microbial Contamination in Drinking Water of Saggiyan-Lahore, Pakistan

The present study was carried to evaluate the physico-chemical parameters and microbial contamination of drinking water in the area of Saggiyan, Lahore. The tested water samples (S1-S30) were found to contain 199.6-402 mg/L TDS, 196-260 ppm EC, 196-260 ppm Hardness, 0.8-17 NTU turbidity, 169-290 mg/L alkalinity, 0-0.1 ppb arsenic and 0-0.1 ppm fluoride contents. 95% of the water samples were found contaminated with fecal coliforms while 27% of the samples had shown the presence of E. coli. Though the physico-chemical parameters of most water samples were found in the safe limits of WHO, however, the presence of microbial contamination rendered it non-suitable for drinking purposes

Effects of different acetylsalicylic acid doses on body organs, histopathology, and serum biochemical parameters in broiler birds

A indústria avícola é afetada por diversas doenças ou estresses. Particularmente devido às aves serem antipiréticas. O ácido acetilsalicílico (AAS) é largamente utilizado com diferentes objetivos que incluem o controle do estresse calórico, bem como a atividade respiratória e digestiva. O propósito deste estudo foi a avaliação dos efeitos benéficos e tóxicos do emprego de diferentes dosagens do AAS em frangos de corte. As variáveis analisadas foram: exame físico, parâmetros bioquímicos, bem como as alterações histopatológicas em seções de tecidos colhidas das aves em um ensaio experimental. O estudo foi conduzido em 60 frangos de corte com um dia de idade adquiridos em um mercado local de Faisalabad que foram recriados nos primeiros 14 dias em idênticas condições. Então no 15º dia as aves foram distribuídas randomicamente em quatro grupos identificados pelos números 1 a 4, com 15 aves em cada grupo. O grupo 4 foi mantido como grupo controle e os grupos 1, 2 e 3 foram tratados com AAS, respectivamente, nas doses de 300, 600 e 1200 mg/L de água de bebida, durante 21 dias. Foram realizadas três amostragens nos dias 21, 28 e 35 pós-tratamento. O peso vivo corpóreo e da carcaça foi registrado em cada amostragem. Em todos os órgãos viscerais foi analisada a presença de alterações patológicas. As amostras de soro sanguíneo foram colhidas para a avaliação bioquímica. O exame histopatológico de todos os órgãos viscerais foi realizado para a observação de alterações microscópicas. A partir da segunda amostragem foi observado um aumento significante (p<0,05) no peso corpóreo na dosagem de 300mg/L. Um significante aumento no peso relativo dos órgãos foi registrado na dosagem de 1200 mg/L. Os grupos tratados com dosagens de 600 e 1200 mg/L de AAS, apresentaram aumento significante dos níveis de AST, ALT e de creatinina quando comparados ao grupo controle. O grupo tratado com 1200 mg/L de AAS apresentou um aumento significante (P,0,05) de uréia, proteína sérica total e de albumina em todas as amostragens. No grupo de alta dosagem foram observados alterações histopatológicas constituídas por aumento dos hepatócitos, aumento dos espaços sinusoidais no fígado, congestão e anormalidades nos espaços glomerulares nos rins, congestão e ruptura alveolar nos pulmões, degeneração das vilosidades e celular nos intestinos A conclusão obtida foi que em frangos de corte uma baixa dosagem do AAS pode ser utilizada por um período de longa duração, apresentando um efeito promotor do crescimento, contudo as doses elevadas determinam toxicidade hepática e renal.The poultry industry suffers from various diseases or stresses. In poultry, apart from being antipyretic, acetylsalicylic acid (ASA) is widely used to cope with different issues including heat stress, and respiratory and digestive orders. This study evaluated the beneficial and toxic effects of ASA at different dose levels in broiler birds. To evaluate these toxic and beneficial effects it is necessary to examine the physical and serum biochemical parameters as well as the histopathological changes with tissue sections taken from broiler birds under experimental trial. This study was conducted on 60 one-day-old broiler chicks purchased from a local market in Faisalabad. Chicks were reared for the first 14 days under similar conditions. On the 15th day, birds were randomly divided into 4 groups (1-4) with 15 birds in each group. Group 4 was kept as control, while groups 1, 2, and 3 were treated with ASA at the dose of 300, 600, and 1200 mg/L of drinking water for 21 days. There were 3 samplings performed at 21, 28, and 35 days post-treatment. The live body weight and carcass weight were noted on each sampling. All the visceral organs were recorded for gross pathological changes. The serum samples were collected for biochemical evaluation. Histopathology of all the visceral organs was performed to observe the microscopic changes. A significant (P<0.05) increase in live body weight at a 300mg/L dose was noted after the first 2 samplings. A significant (P<0.05) increase in the relative organ weight was recorded at 1200 mg/L. The groups treated with ASA 600 and 1200 mg/L showed increased (P<0.05) AST, ALT, and creatinine levels from that of the control group. The group treated with 1200 mg/L of ASA showed increased (P<0.05) urea, serum total protein, and albumin level in all the samplings. Histopathological changes revealed swollen hepatocytes, increased sinusoidal spaces in the liver, congestion and abnormal glomerular spaces in the kidney, congestion and alveolar disruption in the lungs, and generation of villi and cellular degeneration in the intestine in a high-dose group. The study concluded that ASA at a low dose can be used for a long time in broilers and has a growth promontory role, while high-level doses cause hepatorenal toxicity

Experimental and in silico evaluation of Carthamus tinctorius L. oil emulgel: a promising treatment for bacterial skin infections

PurposeThe current study aimed to develop a topical herbal emulgel containing Carthamus tinctorius L. (CT) oil extract, which has been scientifically proven for its antibacterial and antioxidant activities for the ailment of bacterial skin infections.MethodThe CT emulgel was formulated by response surface methodology (RSM) and was evaluated by various parameters like extrudability, spreadability, pH, viscosity, and antibacterial and antioxidant activities. Molecular docking was also performed using AutoDock.ResultsAmong all formulated CT emulgels, F9 and F8 were optimized. Optimized formulations had shown good spreadability and extrudability characteristics. Sample F8 had % inhibition of 42.131 ± 0.335, 56.720 ± 0.222, and 72.440 ± 0.335 at different concentrations. Sample F9 had % inhibition of 26.312 ± 0.280, 32.461 ± 0.328, and 42.762 ± 0.398 at concentrations of 250 µg/ml, 500 µg/ml, and 1,000 µg/ml, respectively, which shows that both samples F8 and F9 have significant antioxidant potential. Optimized CT emulgels F8 and F9 had significant antibacterial activity against Staphylococcus aureus and Escherichia coli at p-value = 0.00, the Emulgel-F8 shows zone of inhibition of 24 mm for E-coli and 19 mm for S-aureus. Emulgel-F9 shows zone of inhibition of 22 mm for E-coli and 15 mm for S-aureus while pure CT- Oil extract shows zone of inhibition of 25 mm for E-coli and 20 mm for S-aureus and ciprofloxacin used as standard shows 36mm zone of inhibition against both E-coli and S-aureus. The comparative investigation through molecular docking binding affinities and interactions of ligands with various target proteins provides insights into the molecular processes behind ligand binding and may have significance for drug discovery and design for the current study.ConclusionThe current study suggests that C. tinctorius L.-based emulgel has good antioxidant and antibacterial activities against E. coli for the treatment of bacterial skin infections

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Isolation and sequence analysis of cotton infecting begomoviruses

Cotton is an important cash crop of Pakistan which is severely suffered from a leaf curl disease called cotton leaf curl disease. Studies had shown that a number of begomoviruses collectively called cotton leaf curl viruses (CLCVs) are responsible for leaf curl disease. Some of the important viruses in this group are Cotton leaf curl Multan virus, Cotton leaf curl Kokhran virus, Cotton leaf curl Burewala virus, Cotton leaf curl Rajasthan virus, and Cotton leaf curl Allahabad virus. In this study diseased cotton plants were screened for the presence of cotton-infecting begomoviruses. Amplified viruses were cloned and sequenced. Sequence analysis showed that Cotton leaf curl Burewala virus (CLCuBuV) is the causal organism of cotton leaf curl disease and this result is the affirmation of previous findings that, unlike first epidemic of the cotton leaf curl disease when a group of begomoviruses were affecting the cotton crop, there is a single virus CLCuBuV damaging the economically important crop of the country. Pairwise sequence comparison showed that sequences of isolates obtained in this study have maximum 98.9% to 99.55% homogeneity to published sequences of CLCuBuV. Surprisingly one of the isolates lacks an intact Rep, which is invariably present in begomoviruses