Mapping Sustainable Development Goal Indicators for Pakistan: Way Forward

This paper aims at developing tools for data collection for the successful implementation of the Sustainable Development Goals in the light of data poverty in Pakistan. To this end, 232 SDG indicators were individually mapped with individual questions from Pakistan’s national data sources. After a comprehensive mapping exercise, the data was further broken down by the UN Statistics Division 3 Tiers. Recommendations were made on specific indicators that fall under Tier I where data was still found missing under SDG 7 and 9 and a collation of disparate sets of data was proposed. The paper concludes with policy implications for structured data collection for SDGs in Pakistan

Resource allocation in the public health sector: Current status and future prospects

Background: Funding practices in Ontario's acute care sector have undergone a substantive shift away from ‘lump-sum funding’ towards a combination of population-needs and performance-based financing (MOHLTC, 2013). In contrast very little is known about how funds are distributed across the province’s public health sector, specifically the 36 public health units (PHUs) that are mandated to deliver health promotion and disease prevention programs across Ontario. In fact the funding arrangement utilized by the public health sector has remained unchanged for several years, despite the growing burden of responsibilities on PHUs in terms of evolving population health needs and more expansive programmatic and performance expectations. Current literature on the processes, variables and overarching principles that govern the distribution of funds across PHUs remains considerably limited. Objectives: The objectives of this study were to develop a better understanding of how PHUs in Ontario are currently funded, and to examine what principles public health professionals believe should guide the distribution of resources across PHUs. The project sought to identify the fundamental principles that public health professionals believe should inform future thinking around public health funding. Methods: The perspectives of public health professionals who have proximal links to the current public health funding process served as the basis of the data discovery component for this study. A total of 14 in-depth interviews were conducted with a number of public health professionals to gather their insights on the current funding arrangement, and explore what principles they believe should be used to guide allocation decisions in the public health sector. Interviews were followed by a web survey to examine how public health professionals rank principles and perceive trade-offs between competing principles. Results: Public health professionals proposed a total of 12 principles to guide the distribution of resources across PHUs. These principles were grounded in three core social value judgments (need, equity, and transparency and accountability). The study provides important insights into the fundamental principles that public health professionals believe should guide allocation decisions and illustrates the complexity associated with distributing limited resources across health units, as well as possible directions for future research on this topic

OXIDATIVE CHANGES AND COGNITIVE FUNCTION DECLINE IN AGING RATS

Objective: This study aims to show that impairment of cognitive function occurred during aging is related to increased oxidative stress. Methods: A total of 36 Sprague Dawley rats were divided into four groups: Young (3 months), middle (14 months), and old age groups (18 and 23 months). Rats were killed and blood was collected for the measurement of oxidative stress which includes deoxyribonucleic acid (DNA) damage and lipid peroxidation (malondialdehyde [MDA] levels). Cognitive function of rats was measured through open-field experiments, Morris water maze (MWM), and object identification. Results: Increased DNA damage and MDA levels were found in middle age and old rats compared to young rats (3 months old, p<0.05). There was an increase in anxiety with age as indicated by the increased production of fecal boli and decreased activity of grooming and rearing. For the navigation test, older rats took a long time to search for the hidden platform compared to young rats. In the probe test (spatial memory test 24 h after the last training), the middle- and old-age groups spent less time at the quadrant compared to the young age group. Conclusion: There is a decline in cognitive function with increased oxidative stress in aging rats

Psychiatric Comorbidity in People with Epilepsy

Background and Objective: People with epilepsy often experience psychiatric comorbidity. This study aims to investigate the relationship among seizure regulation, psychiatric comorbidity, and antiepileptic drug use in a group of individuals with epilepsy in Pakistan. Methods: This is an observational study conducted at Pakistan Institute of Medical Sciences, over a period of six months (1st June – 31st Dec 2022). One-hundred-twenty people (sample size) with epilepsy above the age of 18 with confirmed diagnosis of epilepsy were included in the study who completed a questionnaire that assessed their seizure control, psychiatric comorbidity, and antiepileptic drug use. Data was analyzed using SPSS version 25 Results: The majority of participants (80.8%) reported effective seizure control , while 19.2% reported ineffective seizure control . Regarding psychiatric comorbidity, 84.2% of the participants reported some form of psychiatric comorbidity, with depression being the most commonly reported (31.7%). In terms of antiepileptic drug use, 69.2% of the participants reported being on monotherapy, 28.3% reported being on polytherapy, and 2.5% reported not being on any medication. Conclusion: People with epilepsy have a significant likelihood of experiencing psychiatric comorbidity which highlights the need for screening and therapy

Exploring The Relationship Between Egris and The Need For Mechanical Ventilation In Guillain Barré Syndrome

Background and objective: Guillain-Barré syndrome (GBS) is an immune system-mediated polyradiculoneuropathy that accounts for approximately 100,000 new patients per year globally. GBS has also been linked to respiratory failure in 20% to 40% of cases. The objective of this study was to find an association between Erasmus GBS respiratory insufficiency score (EGRIS) and the need for mechanical ventilation. Methods: We conducted our cross-sectional study at department of Neurology, Pakistan Institute of Medical Sciences from November 2019 to February 2020. Sixty patients were selected for this study. Data including demographic profile, variant of GBS, and EGRIS was calculated from all the study participants. Data was entered and analyzed using SPSS version 25. Results: All 60 patients enrolled in the study underwent continuous monitoring during admission time. Out of 60 patients, three (5%) endured mechanical ventilation with a mean EGRIS of 4.5. Others who didn\u27t need mechanical ventilation had mean EGRIS of 1.5. The three patients requiring mechanical ventilation were one each from Acute Inflammatory Demyelinating polyradiculoneuropathy, Acute Motor Axonal Neuropathy, and Acute Motor and Sensory Axonal Neuropathy variants of GBS. p-value was non-significant for the presented data. Conclusion: EGRIS could not meet statistical significance in identifying the requirement of mechanical ventilation for GBS in this study. This may be due to low sample size

Morphological spectrum of vesiculobullous skin lesions: An institutional perspective

Introduction: A vesiculobullous lesion of the skin encompasses a group of dermatological disorders with protean clinicopathological features. They usually occur as a part of the spectrum of various infectious, inflammatory, drug-induced, genetic, and autoimmune disorders. Therefore, accurate diagnosis of these lesions is essential for appropriate management and to reduce the associated morbidity and mortality. The conventional skin punch biopsy is the mainstay in the diagnosis of dermatological diseases, especially when combined with confirmatory tests, such as direct immunofluorescence (DIF). Our study evaluated the clinicopathological spectrum of vesiculobullous lesions.Methods: We studied 150 cases of vesiculobullous lesions at the Department of Histopathology, Liaquat National Hospital and Medical College Karachi, Pakistan. Written and informed consent was taken from the patients followed by skin punch procedure in which three biopsies were obtained, which included one biopsy from the lesion and two peri-lesional biopsies. One peri-lesional biopsy was sent in cryomatrix for DIF studies, whereas the other two were sent in formalin to follow the standard tissue-processing protocol.Results: Our results showed that most patients belonged to the geriatric age group of more than 50 years (44.7%), and 54.7% of the patients were females. Total 74.7% of the patients had generalized lesions, followed by lower limbs (9.3%) and trunk (7.3%) involvement. Most patients were diagnosed with bullous pemphigoid (31.3%), followed by pemphigus vulgaris (27.3%), dermatitis herpetiformis (15.3%), Darier’s disease (14.7%), pemphigus foliaceus (4.7%), epidermolysis bullosa (2%), linear immunoglobulin A dermatosis (2%), paraneoplastic pemphigus (0.7%), and drug reactions (0.7%). DIF studies were applied on 60 cases, out of which complement protein C3c was the most commonly deposited protein (53.3%).Conclusion: Our study emphasized the diagnostic role of skin punch biopsy in the proper evaluation of vesiculobullous skin lesions. Histopathology is the cornerstone diagnostic tool in this regard, with DIF being a useful adjunct

Capacity building and mentorship among pan-Canadian early career researchers in community-based primary health care

Aim: To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams. Background: In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdictional research to improve the delivery of high-quality CBPHC to Canadians. This signature initiative also aimed to enhance CBPHC research capacity among an interdisciplinary group of trainees, facilitated by a collaboration between a capacity building committee led by senior researchers and a trainee-led working group. Methods: After the committee and working group were established, capacity building activities were organized based on needs and interests identified by trainees of the CBPHC Teams. This paper presents a summary of the activities accomplished, as well as the outcomes reported through an online semistructured survey completed by the trainees toward the end of the five-year funding period. This survey was designed to capture the capacity building and mentorship activities that trainees either had experienced or would like to experience in the future. Descriptive and thematic analyses were conducted based on survey responses, and these findings were compared with the existing core competencies in the literature. Findings: Since 2013, nine webinars and three online workshops were hosted by trainees and senior researchers, respectively. Many of the CBPHC Teams provided exposure for trainees to innovative methods, CBPHC content, and showcased trainee research. A total of 27 trainees from 10 of the 12-Teams responded to the survey (41.5%). Trainees identified key areas of benefit from their involvement in this initiative: skills training, networking opportunities, and academic productivity. Trainees identified gaps in research and professional skill development, indicating areas for further improvement in capacity building programs, particularly for trainees to play a more active role in their education and preparation

Factors Determining Pakistani Medical Students\u27 Career Preference for General Practice Residency Training.

Background Few studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students’ general practice career aspirations in Karachi, Pakistan. Methods From January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The “intent to inherit existing practice” and “other academic or professional experiences prior to medical school” had a positive association with choosing general practice while “having a physician parent’’ had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked “clinical diagnostic reasoning”, “community-oriented practice”, “involvement in preventive medicine”, and “frequent patient communication” as highly important were more likely to choose general practice, whereas, “access to advanced medical fields”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration. Conclusion The study’s results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine