The Contagious Nature of SARS-CoV-2 Omicron Variant and Vaccine Efficacy

Background: Since the first COVID-19 outbreak, variants of SARS-CoV-2 have continued to dominate the global population. The repeated waves of emerging variants, each replacing the previous one with a greater rate of transmissibility and mutations, are the primary cause of the global pandemic. Public health concerns dramatically rose when a highly mutated variant (VOC) omicron (B.1.1.529) emerged in late 2021. omicron has more than 50 mutations, and over 30 mutations are in their spike protein that contributes to the virologic characteristics of the variant. Omicron is more contagious than previously reported SARS-CoV-2 strains and can re-infect people who have already contracted other SARS-CoV-2 infections. The variant has acquired a unique immune escape mechanism against monoclonal antibodies and vaccines. Currently, no therapeutic drug or vaccine is specifically available to prevent omicron infection and sublineage emergence. Method: The review was designed to search the recent research and literature and compile the most pertinent data on the virologic characteristics of the variant of concern. Result: The study reviewed and discussed the present prevalence, infectivity, dominance, immune evasion, therapeutic options, vaccine efficacy, and the future prospect of the omicron variant. Conclusion: Omicron variant has become a global public health concern due to the emergence of highly mutated sublineages. Developing variant-specific therapeutic drugs or vaccines is desirable to prevent the spread of these contagious variants globally.Keywords: COVID-19, SARS-CoV-2, Omicron variant, Vaccine efficacy, Immune evasion

USING HEALTH INSURANCE DATABASES FOR EPIDEMIOLOGICAL RESEARCH: A SCOPING REVIEW

OBJECTIVE: This scoping review aimed to appraise the existing literature on using the claims databases for epidemiological studies and to draw inferences for using data from Pakistan’s health insurance databases. METHODS: We conducted a scoping review of literature focusing on health insurance databases, querying MEDLINE, EMBASE and Google Scholar. We used the frameworks proposed by the Joanna Briggs Institute and Arksy and O’Malley for mapping our results. RESULTS:  There was a considerable chronological increase in studies published using data from health insurance databases. Most of the studies in our search were from economically developed countries. Most of the studies (n=84) focussed on chronic non-communicable diseases, while a limited number (n=09) focussed on communicable (infectious) diseases. Our findings suggest that insurance databases could be utilised to study rare diseases, prospects of prolonged follow-up, and minimal research costs. This is especially important for countries like Pakistan, having limited resources to conduct regular, population-level epidemiological studies. Several methodological approaches (for instance, disease, pharmacy or intervention classification codes) were presented in these studies to extract epidemiological data from the insurance database. CONCLUSION: Health insurance databases are utilised as sources for epidemiological studies, predominantly for chronic illnesses, in economically developed countries. Methodological approaches described in these papers could be used to extract data for epidemiological research from health insurance databases in Pakistan. This could be especially useful for following the patterns of infectious disease in the country

Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians

AIM: To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.Methods: Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs) during the period 1999 to 2004 were analyzed. Patient\u27s characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved (intestinal, peritoneal, visceral, and nodal) and response to treatment was also noted.Results: There were 209 patients enrolled. One hundred and twenty-three (59%) were females. Symptoms were abdominal pain 194 (93%), fever 134 (64%), night sweats 99 (48%), weight loss 98 (47%), vomiting 75 (36%), ascites 74 (35%), constipation 64 (31%), and diarrhea 25 (12%). Sub-acute and acute intestinal obstruction was seen in 28 (13%) and 12 (11%) respectively. Radiological evidence of pulmonary tuberculosis was found in 134 (64%) patients. Basis of diagnosis of abdominal tuberculosis were radiology (Chest and barium X-Rays, Ultrasound and CT scan abdomen) in 111 (53%) and histo-pathology (tissue obtained during surgery, colonoscopy, CT or ultrasound guided biopsy, laparoscopy and upper gastro intestinal endoscopy) in 87 (42%) patients. Mycobacterium culture was positive in 6/87 (7%) patients and response to therapeutic trial of anti tubercular drugs was the basis of diagnosis in 5 (2.3%) patients. Predominant site of involvement by abdominal TB was intestinal in 103 (49%) patients, peritoneal in 87 (42%) patients, solid viscera in 10 (5%) and nodal in 9 (4%) patients. Response to medical treatment was found in 158 (76%) patients and additionally 35 (17%) patients also underwent surgery. In a 425 +/- 120 d follow-up period 12 patients died (eight post operative) and no case of relapse was noted.CONCLUSION: Abdominal TB has diverse and non- specific symptomatology. No single test is adequate for diagnosis of abdominal tuberculosis in all patients. Abdominal TB in non-HIV patients remains an ongoing diagnostic dilemma requiring a high index of clinical suspicion

Efficiency of Virgin's Mantle (Fagonia cretica L.) as an Antibacterial and Antifungal Agent

Background: For medicinal purposes, biological activities are carried out on plant secondary metabolites in which common but very significant antimicrobial activities are focused. To evaluate the antimicrobial potential of Fagonia cretica L., different pathogenic microbial strains were obtained from KP, hospitals (already identified) to resolve the objectives of the current study.Methods: In the agar, well diffusion method, a total of eight strains (4 bacterial 4 fungal) Streptococcus mutans, MRSA (Methicillin resistance staphylococcus aureus), Serratia marcescens, and Staphylococcus aureus are the bacterial strains while the fungal strains are Alternaria alternate,  Aspergillus flavus, Fusarium oxysporum, and Polysphondylium pallidum pre-identified and isolated in hospitals, were used respectively to evaluate the potentiality of n-hexane, ethyl acetate, chloroform, aqueous, and crude methanolic fractions against these strains.Keywords: Virgin’s mantle; Fagonia cretica; Antibacterial; AntifungalResults: The highest significant (46-57% & 39-60%) antibacterial and antifungal activities were shown by the methanolic fraction while the lowest (28-35% & 25-35%) antibacterial and antifungal was shown by aqueous fraction against the selected microbial strains. Other fractions were also exhibited reasonable antimicrobial activities.Conclusion: The current study concluded that different fractions of F. cretica have significant antimicrobial potential and might be a source of antibiotics in future studies of that plant.Keywords: Virgin’s mantle; Fagonia cretica; Antibacterial; Antifungal

To study the procurement process and develop a conceptual framework model in the Pakistani construction industry

Procurement of equipment and materials in any construction project holds a tremendous significance for the project to be completed on time and within the budget. In this research, procurement in the Pakistan’s construction industry has been studied and a conceptual framework in terms of e-procurement portal has been suggested to smoothly execute the process of e-procurement by mitigating the barriers involved in the concerned process. A questionnaire survey form has been developed and 100 responses have been recorded to take the input from industry experts on the proposed procurement framework. A total of 84 respondents out of 100 thought that the proposed framework will be a better way to solve the problems that come up during the procurement process. Furthermore, it was also found that the main reason for procurement delays in construction projects is lack of communication and coordination among different departments within an organization, to which the suggested framework can be used as a potential tool to deal with

Low prevalence of the intact cag pathogenicity island in clinical isolates of Helicobacter pylori in Karachi, Pakistan

Clinical diseases that follow Helicobacter pylori infection are associated with expression of the cagA gene, a part of cytotoxin-associated gene pathogenicity island (cag-PAI). This study aims to determined whether or not the presence of cagA is associated with the presence of complete cag-PAI and to evaluate inflammatory changes associated with the five loci in the cag-PAI of H. pylori comprising cagA, cagA promoter region (cagAP), cagE, cagT and the left end of the cagA gene (LEC). H. pylori isolates were obtained from patients with dyspeptic symptoms. Clinical strains of H. pylori were screened by the polymerase chain reaction (PCR) for respective genes of the cag-PAI. Of 115 H. pylori isolates, 31 (28%) were positive for the five cag-PAI loci. H. pylori isolates with intact cag-PAI were associated with gastric carcinoma (GC; n=9[60%]) and gastric ulcer (GU; n=5[45%]) compared to non-ulcer dyspepsia (NUD; n=14[18%]) (P=0.001 and P=0.049, respectively). In patients with intact cag-PAI, acute on chronic inflammation was present in 25 (81%) and was more common than chronic inflammation (P=0.013). The cagE and cagAP had deletions in 25 (37%) and 23 (35%) cases, respectively. The cagAP region was significantly associated with GC (n=12[80%],

Designing EthAKUL: A mobile just-in-time learning environment for bioethics in Pakistan

In developing countries such as Pakistan, bioethics has not been included in mainstream thinking in medical education. The authors’ experiences suggest that current methods of teaching bioethics are problematic as students are unable to translate theory to practice. Alternative pedagogies, such as just-in-time learning (JiTL) using mobile devices, may be able to foster the development and implementation of ethical reasoning among nurses, doctors, and medical and nursing students. This research was conceived to determine the effectiveness of mobile JiTL – anytime, anyplace learning through mobile devices – for teaching bioethics. After obtaining ethical clearance, a participatory design (PD) approach was adopted to ensure input from all stakeholders for the design of ‘EthAKUL’, comprising a mobile app, five modules and just-in-time pedagogy. The name of the app is an acronym evoking ethics, learning and the university where the project originated. As a part of the design process, three PD workshops were held with junior doctors, nurses, nursing students, medical students and bioethics teaching faculty, and five meetings were held with faculty members, to discuss functional specifications and user-acceptance testing of the app. The feedback related to the nature of common ethical issues encountered in clinical settings, the existing process of teaching and learning bioethics, and the requested features of the app were recorded. These data sets were analyzed and synthesized into functional and technical specifications for the mobile app. The software programmers developed the app with the close involvement of the stakeholders. The development of teaching content continued alongside this process. While this enabled EthAKUL’s developers to incorporate needs of all stakeholders, challenges were encountered in the process relating to the pragmatic and conceptual aspects of JiTL, ML and PD. We discuss the implications of this research in bringing about transformative changes in higher education