The predictive validity of Bayley Scales of Infant and Toddler Development-III at 2 years for later general abilities: Findings from a rural, disadvantaged cohort in Pakistan

Using data from a rural cohort in Pakistan (N = 1298), the study examined the predictive validity of the Bayley Scales of Infant and Toddler Development (BSID) 3rd edition on later tests of general abilities. The BSID III subscales (cognitive, language and motor) were administered at 2 years; general ability was assessed using the Verbal, Performance and Full-Scale score from the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) III at 4 years, and the Fluid Reasoning Index (FRI) from the Wechsler Intelligence Scale for Children (WISC) V at 8 years. The combined BSID subscales explained 15% of the variation of the WPPSI III full scale, 16% of the Verbal scale, 7% of the Performance scale and 1% of the FRI. BSID III scores at 24 months should be used with caution to predict future intellectual abilities. Copyright: © 2023 Rasheed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.publishedVersio

Effects of responsive stimulation and nutrition interventions on children\u27s development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial

Background: A previous study in Pakistan assessed the effectiveness of delivering responsive stimulation and enhanced nutrition interventions to young children. Responsive stimulation significantly improved children\u27s cognitive, language, and motor development at 2 years of age. Both interventions significantly improved parenting skills, with responsive stimulation showing larger effects. In this follow-up study, we investigated whether interventions had benefits on children\u27s healthy development and care at 4 years of age.Methods: We implemented a follow-up study of the initial, community-based cluster-randomised effectiveness trial, which was conducted through the Lady Health Worker programme in Sindh, Pakistan. We re-enrolled 1302 mother-child dyads (87% of the 1489 dyads in the original enrolment) for assessment when the child was 4 years of age. The children were originally randomised in the following groups: nutrition education and multiple micronutrient powders (enhanced nutrition; n=311), responsive stimulation (n=345), combined responsive stimulation and enhanced nutrition (n=315), and routine health and nutrition services (control; n=331). The data collection team were masked to the allocated intervention. The original enrolment period included children born in the study area between April 1, 2009, and March 31, 2010, if they were up to 2·5 months old without signs of severe impairments. The primary endpoints for children were development and growth at 4 years of age. Interventions were given in monthly group sessions and in home visits. The primary endpoint for mothers was wellbeing and caregiving knowledge, practices, and skills when the child was 4 years of age. Analysis was by intention to treat. The original trial is registered with ClinicalTrials.gov, number NCT00715936.Findings: 1302 mother-child dyads were re-enrolled between Jan 1, 2013, and March 31, 2013, all of whom were followed up at 4 years of age. Children who received responsive stimulation (with or without enhanced nutrition) had significantly higher cognition, language, and motor skills at 4 years of age than children who did not receive responsive stimulation. For children who received responsive stimulation plus enhanced nutrition, effect sizes (Cohen\u27s d) were 0·1 for IQ (mean difference from control 1·2, 95% CI -0·3 to 2·7), 0·3 for executive functioning (0·18, -0·07 to 0·29), 0·5 for pre-academic skills (7·53, 5·14 to 9·92) and 0·2 for pro-social behaviours (0·08, 0·03 to 0·13). For children who received responsive stimulation alone, effect sizes were 0·1 for IQ (mean difference with controls 1·7, -0·3 to 3·7), 0·3 for executive functioning (0·17, 0·07 to 0·27), 0·2 for pre-academic skills (3·86, 1·41 to 6·31), and 0·2 for pro-social behaviours (0·07, 0·02 to 0·12). Enhanced nutrition improved child motor development, with effect size of 0·2 for responsive stimulation plus enhanced nutrition (0·56, -0·03 to 1·15), and for enhanced nutrition alone (0·82, 0·18 to 1·46). Mothers who received responsive stimulation (with or without enhanced nutrition) had significantly better responsive caregiving behaviours at 4 years of child age than those who did not receive intervention. Effect size was 0·3 for responsive stimulation plus enhanced nutrition (1·95, 0·75 to 3·15) and 0·2 for responsive stimulation (2·01, 0·74 to 3·28). The caregiving environment had a medium effect size of 0·3 for all interventions (responsive stimulation plus enhanced nutrition 2·99, 1·50 to 4·48; responsive stimulation alone 2·82, 1·21 to 4·43; enhanced nutrition 3·52, 1·70 to 5·34).Interpretation: Responsive stimulation delivered in a community health service can improve child development and care, 2 years after the end of intervention. Future analyses of these data are needed to identify which children and families benefit more or less over time.FUNDING: Grand Challenges Canada

Covid-19 Induced Anxiety and Depression in Healthcare Workers: Experiences of a Developing Country

Background: Healthcare workers all over the world are suffering physically, mentally and emotionally due to the Covid-19 pandemic. While psychological effects may be more pronounced in a country like Pakistan where such disorders are still considered taboo and remain unattended. The study aimed to identify the prevalence and association of anxiety and depression in healthcare workers in a tertiary care hospital in Karachi during Covid-19 pandemic. Methods: A descriptive, cross sectional study was performed from 1st June-31stAugust 2020 on n=361 healthcare staff. General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) tools were used to assess for anxiety and depression respectively. Association between demographic variables age, gender, education, designation, work experience, Covid-19 exposure with anxiety and depression was assessed using the Chi-squared test with p ≤ 0.05 was considered statistically significant. Results: Anxiety 221(61.5%) and depression 276(76.9%) were more common in doctors compared to other health care workers. The prevalence of severe anxiety 248(69.2%) and severe depression 276(76.9%) was significantly higher in males. Both anxiety and depression were more common with less than 2 years of work experience (p=0.00). Association between years of work experience was similar, with people having less than 2 years of work experience feeling more anxiety (p=0.012) and depression (p=0.003). Conclusion: Doctors working with Covid-19 patients are more prone to severe anxiety and depression. Early identification and supportive care are essential to ensure that the clinical and para medical staff members assigned to patient care has access to both physical and mental health services. Keywords: Covid-19; SARS CoV-2; Anxiety; Depression; Generalized Anxiety Disorder; Patient Health Questionnaire

Anaphylaxis: incidence, presentation, causes and outcome in patients in a tertiary care hospital in Karachi, Pakistan

Background: Anaphylaxis is a potentially fatal condition requiring immediate resuscitation. Data regarding the epidemiology of anaphylaxis are limited and inconsistent. A reason for the variability was unavailability of a universally acceptable case definition till 2005. We reviewed cases using this new definition Aim: To review the incidence, clinical presentation, cause and outcome of anaphylaxis at a tertiary care center in a low income country. Design: Retrospective, case series Methods: Chart review of all patients discharged from Aga Khan University Hospital between January 1988 - December 2012 (24 years) with anaphylaxis definition as per second National Institute of Allergy and Infection disease/Food Allergy and Anaphylaxis Network Symposium Results: Total of 129 cases were found with mean age of 41.6 years (SD 18.8). Majority of patients had cutaneous features (76.7 %), followed by respiratory (68.9 %), cardiac (64.3 %) and gastrointestinal (20.9 %) symptoms respectively. About 22.4 % of patients had positive history for allergens out of which 31% (n=9) were exposed to the same allergens. The common causes identified for anaphylaxis were drugs (60.5 %), food (16.3 %) and intravenous contrast (10.9 %) respectively. Only 22.5 % of cases received epinephrine as part of their initial management. In 4 patients (3.1 %) the cause of death was attributed to anaphylaxis. Conclusion: Anaphylaxis is a rare but life threatening condition. Though cutaneous features are most common, their absence does not exclude the diagnosis. Drugs were the most common cause and epinephrine was not commonly used as first line agent for its management

Physicochemical and pathological assessment of groundwater quality from Sargodha, Pakistan using hybrid multi-layer slow sand filter: pre and post treatment analysis

One of the main issues confronting humanity in the twenty-first century is the lack of potable water availability. Around half of the world’s consumers face drinking water scarcity. Industrially rich areas have a high population and high-water contamination risk factors. Modern technologies that are quite effective for water purification, present economical limitations that impede their usefulness in developing countries. Conventional methods involving low energy, low chemical demand, and prevention of water-borne disease are therefore significant for water purification in developing countries like Pakistan. These limitations have led to improvising the conventional method for facile water purification. Herein we report the water purification assembly based on allow sand filtration; involving the raw materials grass, clay, sand, silt, pebbles, gravel and coal/ fly ash carbon to obtain clean and quality-controlled water treatment. Ground water samples collected from various areas of Sargodha city were subjected to the developed design Hybrid Multi-Layer Slow Sand Filter (HMLSSF). Based on pre- and post-treatment water analysis, it was determined that the filtration assembly was quite effective at reducing pH, turbidity, dissolved and suspended solids, hardness, and heavy metals percent removal by 87%, 77.7%, 91.3%, 95.4%, 84.4%, and to promising levels, respectively. Moreover, 99 % biological contamination such as total coliform was also removed by this method

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

Serial population-based serosurveys for COVID-19 in two neighbourhoods of Karachi, Pakistan

Objective: To determine population-based estimates of coronavirus disease 2019 (COVID-19) in a densely populated urban community of Karachi, Pakistan. Methods: Three cross-sectional surveys were conducted in April, June and August 2020 in low- and high-transmission neighbourhoods. Participants were selected at random to provide blood for Elecsys immunoassay for detection of anti-severe acute respiratory syndrome coronavirus-2 antibodies. A Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district. Results: In total, 3005 participants from 623 households were enrolled in this study. In Phase 2, adjusted seroprevalence was estimated as 8.7% [95% confidence interval (CI) 5.1-13.1] and 15.1% (95% CI 9.4-21.7) in low- and high-transmission areas, respectively, compared with 0.2% (95% CI 0-0.7) and 0.4% (95% CI 0-1.3) in Phase 1. In Phase 3, it was 12.8% (95% CI 8.3-17.7) and 21.5% (95% CI 15.6-28) in low- and high-transmission areas, respectively. The conditional risk of infection was 0.31 (95% CI 0.16-0.47) and 0.41 (95% CI 0.28-0.52) in low- and high-transmission neighbourhoods, respectively, in Phase 2. Similar trends were observed in Phase 3. Only 5.4% of participants who tested positive for COVID-19 were symptomatic. The infection fatality rate was 1.66%, 0.37% and 0.26% in Phases 1, 2 and 3, respectively. Conclusion: Continuing rounds of seroprevalence studies will help to improve understanding of secular trends and the extent of infection during the course of the pandemic. &nbsp;</p

Dyeing of Organic Cotton Fabric using Conventional and Ultrasonic Exhaust Dyeing Method

In this research dyeing behavior of organic cotton woven fabric using ultrasonic technique and conventional dyeing method has been compared. The fabric samples were dyed with reactive dyes Drimarene Red Cl-5B and Drimarene Blue Cl-BR (0.5% owf) using exhaust dyeing method. The samples were ultrasonically dyed at varied temperature (60, 50 and 40oC) for 60, 50, 40 and 30 minutes and for conventional method at varied temperature but at recommended time, 60 minutes. For optimizing the dyeing behavior, the samples were causticized by pad-batch method and then dyed with ultrasonic technique at varied temperature and time. It has been observed organic cotton fabric dyed using ultrasonic exhaust method at 60oC for 50 minutes gives highest (K/S)?max value, excellent fastness property, deeper dye diffusion and less surface deterioration compared to the conventional dyeing method. Moreover, causticized and dyed sample with ultrasonic technique at 60oC for 30 minutes gives colour strength value almost equal to the conventional recommended dyeing method. Hence, dyeing of organic material using ultrasonic exhaust method saves energy and tim

Thyroid carcinoma in Pakistan

BACKGROUND AND OBJECTIVES: To address the need for epidemiologic data on thyroid carcinoma in Pakistan, we evaluated the frequency and types of thyroid carcinoma with respect to age and sex. METHODS: In a a retrospective study conducted at the Jinnah Postgraduate Medical Centre in Karachi, we reviewed thyroid lesions reported over a period of 5 years, from July 2000 to June 2005. Pathology slides were studied to determine the types and frequencies of malignant lesions of the thyroid. RESULTS: Of 998 thyroid lesions reviewed, 153 cases were malignant. Papillary carcinoma was the commonest malignant lesion with a frequency of 90.2%, followed by 4.5% for medullary carcinoma, 2% for follicular carcinoma, 2% for undifferentiated carcinoma and 0.7% each for mixed medullary and papillary carcinoma and poorly differentiated carcinoma. Females were predominant (82.4%) as compared with males (17.6%) for a female-to-male ratio 4.7:1. The maximum number of the patients were in the fourth decade of life followed by the third and second decades. CONCLUSION: The commonest malignant thyroid lesion was papillary carcinoma. Thyroid cancer was more common in females. Papillary, medullary and follicular carcinomas were found in patients in the third and fourth decades of life, while poorly and undifferentiated carcinomas were diagnosed from the fifth to seventh decades of life

ZnO Nanoneedle Based Efficient UV-Photodetector

This article reports the fabrication and characterization of nano-structured ITO/ZnO ultraviolet photodetector. A ZnO thin film was deposited by spray pyrolysis technique followed by interdigitated ITO as electrode deposition by RF sputter. Grazing angle x-ray diffraction (GIXRD) study indicates preferential growth along c-axis (002) of thin-film leading nanoneedle formation which was further confirmed by scanning electron microscopy (SEM) imaging. X-ray photoelectron spectroscopy (XPS) analysis of Oxygen 1s (O 1s) was carried out. A peak was observed at 531.8 eV indicating the presence of oxygen vacancy, 530 eV peak relates to the ZnO phase. The bandgap was determined by the Tauc plot; which was found to be 3.22eV. The donor carrier concentration is found to be 8.85x1018 cm-3 based on room temperature Hall measurement. A near ohmic behaviour was observed which can be interpreted by the existence of high carrier concentration in ZnO. This results in a very thin depletion width of the order of 5nm; therefore, charge transport through the junction is dominated by tunnelling of electrons through depletion width