Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: A cross-sectional study in rural South Asia—Bangladesh, Pakistan and Sri Lanka

Objective: To determinate the prevalence and correlates of cardiometabolic multimorbidity (CMM), and their cross-country variation among individuals with hypertension residing in rural communities in South Asia.Design: A cross-sectional study.Setting: Rural communities in Bangladesh, Pakistan and Sri Lanka.Participants: A total of 2288 individuals with hypertension aged ≥40 years from the ongoing Control of Blood Pressure and Risk Attenuation- Bangladesh, Pakistan and Sri Lanka clinical trial.Main outcome measures: CMM was defined as the presence of ≥2 of the conditions: diabetes, chronic kidney disease, heart disease and stroke. Logistic regression was done to evaluate the correlates of CMM.Results: About 25.4% (95% CI 23.6% to 27.2%) of the hypertensive individuals had CMM. Factors positively associated with CMM included residing in Bangladesh (OR 3.42, 95% CI 2.52 to 4.65) or Sri Lankan (3.73, 95% CI 2.48 to 5.61) versus in Pakistan, advancing age (2.33, 95% CI 1.59 to 3.40 for 70 years and over vs 40-49 years), higher waist circumference (2.15, 95% CI 1.42 to 3.25) for Q2-Q3 and 2.14, 95% CI 1.50 to 3.06 for Q3 and above), statin use (2.43, 95% CI 1.84 to 3.22), and higher levels of triglyceride (1.01, 95% CI 1.01 to 1.02 per 5 mg/dL increase). A lower odds of CMM was associated with being physically active (0.75, 95% CI 0.57 to 0.97). A weak inverted J-shaped association between International Wealth Index and CMM was found (p for non-linear=0.058), suggesting higher risk in the middle than higher or lower socioeconomic strata.Conclusions: CMM is highly prevalent in rural South Asians affecting one in four individuals with hypertension. There is an urgent need for strategies to concomitantly manage hypertension, cardiometabolic comorbid conditions and associated determinants in South Asia

Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka

Background: COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multi-component hypertension management programme that is led by community health workers, has been shown to be efficacious at reducing systolic blood pressure in rural communities in Bangladesh, Pakistan, and Sri Lanka. In this study, we aimed to assess the budget required to scale up the programme and the incremental cost-effectiveness ratios.Methods: In a cluster-randomised trial of COBRA-BPS, individuals aged 40 years or older with hypertension who lived in 30 rural communities in Bangladesh, Pakistan, and Sri Lanka were deemed eligible for inclusion. Costs were quantified prospectively at baseline and during 2 years of the trial. All costs, including labour, rental, materials and supplies, and contracted services were recorded, stratified by programme activity. Incremental costs of scaling up COBRA-BPS to all eligible adults in areas covered by community health workers were estimated from the health ministry (public payer) perspective.Findings: Between April 1, 2016, and Feb 28, 2017, 11 510 individuals were screened and 2645 were enrolled and included in the study. Participants were examined between May 8, 2016, and March 31, 2019. The first-year per-participant costs for COBRA-BPS were US$10·65 for Bangladesh,$10·25 for Pakistan, and $6·42 for Sri Lanka. Per-capita costs were$0·63 for Bangladesh, $0·29 for Pakistan, and$1·03 for Sri Lanka. Incremental cost-effectiveness ratios were $3430 for Bangladesh,$2270 for Pakistan, and $4080 for Sri Lanka, per cardiovascular disability-adjusted life year averted, which showed COBRA-BPS to be cost-effective in all three countries relative to the WHO-CHOICE threshold of three times gross domestic product per capita in each country. Using this threshold, the cost-effectiveness acceptability curves predicted that the probability of COBRA-BPS being cost-effective is 79·3% in Bangladesh, 85·2% in Pakistan, and 99·8% in Sri Lanka.Interpretation: The low cost of scale-up and the cost-effectiveness of COBRA-BPS suggest that this programme is a viable strategy for responding to the growing cardiovascular disease epidemic in rural communities in low-income and middle-income countries where community health workers are present, and that it should qualify as a priority intervention across rural settings in south Asia and in other countries with similar demographics and health systems to those examined in this study.Funding: The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, Wellcome Trust

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 & 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.

Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka.

BACKGROUND: COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multi-component hypertension management programme that is led by community health workers, has been shown to be efficacious at reducing systolic blood pressure in rural communities in Bangladesh, Pakistan, and Sri Lanka. In this study, we aimed to assess the budget required to scale up the programme and the incremental cost-effectiveness ratios. METHODS: In a cluster-randomised trial of COBRA-BPS, individuals aged 40 years or older with hypertension who lived in 30 rural communities in Bangladesh, Pakistan, and Sri Lanka were deemed eligible for inclusion. Costs were quantified prospectively at baseline and during 2 years of the trial. All costs, including labour, rental, materials and supplies, and contracted services were recorded, stratified by programme activity. Incremental costs of scaling up COBRA-BPS to all eligible adults in areas covered by community health workers were estimated from the health ministry (public payer) perspective. FINDINGS: Between April 1, 2016, and Feb 28, 2017, 11 510 individuals were screened and 2645 were enrolled and included in the study. Participants were examined between May 8, 2016, and March 31, 2019. The first-year per-participant costs for COBRA-BPS were US$10·65 for Bangladesh,$10·25 for Pakistan, and $6·42 for Sri Lanka. Per-capita costs were$0·63 for Bangladesh, $0·29 for Pakistan, and$1·03 for Sri Lanka. Incremental cost-effectiveness ratios were $3430 for Bangladesh,$2270 for Pakistan, and $4080 for Sri Lanka, per cardiovascular disability-adjusted life year averted, which showed COBRA-BPS to be cost-effective in all three countries relative to the WHO-CHOICE threshold of three times gross domestic product per capita in each country. Using this threshold, the cost-effectiveness acceptability curves predicted that the probability of COBRA-BPS being cost-effective is 79·3% in Bangladesh, 85·2% in Pakistan, and 99·8% in Sri Lanka. INTERPRETATION: The low cost of scale-up and the cost-effectiveness of COBRA-BPS suggest that this programme is a viable strategy for responding to the growing cardiovascular disease epidemic in rural communities in low-income and middle-income countries where community health workers are present, and that it should qualify as a priority intervention across rural settings in south Asia and in other countries with similar demographics and health systems to those examined in this study. FUNDING: The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, Wellcome Trust

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Prenatal screening for beta-thalassemia major reveals new and rare mutations in the Pakistani population

beta-Thalassemia is the most common genetic disorder in Pakistan, where more than 6000 affected children are born annually, and the carrier population is around 10 million. The objective was to study beta-globin gene mutations in chorionic villous biopsy samples. Prenatal screening of 383 pregnant women between 2003 and 2010 was carried out using a panel of 13 mutation primers and amplification refractory mutations system (ARMS)-PCR. In addition, DNA sequencing was used to confirm uncharacterized mutations and in some cases fetal disease status was confirmed by linkage analysis. Families enrolled in this study represented major ethnic groups in Pakistan. Of the 13 mutations tested, three mutations accounted 71% of the total, including IVS1-5(G-C)[HBB:c.92+5G \u3e C], codon 8/9(+G) [HBB:c.27_28insG] and del 619[NG_000007.3:g71609-72227del619]. Mutations in four uncharacterized samples were later confirmed by DNA sequencing as -88(C-T)[HBB:c.-138C \u3e G], -90(C-T)[HBB:c.-140C \u3e T] and codon 59(+T)[HBB:c.178_179insT]. To our knowledge, this is the first report of these mutations in Pakistan. Moreover, 19.2% fetal samples were normal and 52.3% heterozygous, whereas 26.4% were affected with thalassemia major. IVS1-5:IVS1-5 was the most common genotype in fetal samples. Prenatal diagnosis of beta-thalassemia using ARMS PCR is an efficient approach for reducing the burden of this disease in Pakistan. In addition, rare mutations reported in this study should be incorporated in the diagnostic strategy

Screening of rice varieties based on remodeling of root architecture linked to enhanced phosphorus transporters and ethylene signaling for better phosphorous acquisition under limiting conditions

Root architectural modifications in response to altered nutrient level can be used as selection marker for better adapted rice varieties. In this study, we screened six local rice varieties commonly grown in Pakistan, using their unique root architecture and several molecular markers to identify best adapted local variety under phosphorus limiting conditions. Our data showed that rice variety with significant changes in its three-dimensional root architecture system (RSA) and enhanced expression of phosphorus transporters (OsPT2, OsPT4 and OsPT6) is the best variety to handle stress as compared to other varieties. Along with development of screening strategy/method, our data provided evidence that phosphorus starvation leads to upregulation of stress hormone ethylene, which regulates root elongation and root hair development therefore facilitating root architecture modification. We then further checked, how to mitigate or enhance phosphorus starvation responses by application of hormones exogenously, our results showed that ethylene application/ treatment enhances phosphorus starvation responses, whereas cytokinin on the other hand reverses deficiency effects which implicates hormonal cross talk is key to modulate P-deficiency responses in rice. This study provides an easy and quick method of analysis of root architecture as physiological marker for rice screening and improve crop yield by selecting best adapted variety for P deficient soils. In future, detail study for understanding phytohormone mediated transcriptomic changes in response to nutrient deficiency and in correlation with physiological response will help to select better adapted varieties that will eventually result in increase of rice yield

Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka

10.1016/S2214-109X(21)00033-4LANCET GLOBAL HEALTH95E660-E66