Socio-environmental determinants of exposure to water and sanitation related hazards in Pakistan

Inadequatewater and sanitation infrastructure leads to increased health risks to the population, in particular, children. The lack of access to improved water and sanitation facilities is a major cause of diarrheal diseases.At present, access to safe drinking water, improved sanitation facilities, good personal and food hygiene and health education are the main focus of intervention strategies. The knowledge on socio-environmental determinants of exposure to water and sanitation hazards can play a pivotal role supporting and guiding preventive measures for reducing the risk of exposure to water and sanitation related hazards. The present study was carried out to identify socio-environmental determinants of exposure to water and sanitation related hazards in Pakistan by taking the incidence of diarrhoea in under five years old as an archetypical disease of lack of access to improved water and sanitation facilities. A logit model has been used to predict the determinants of diarrhoea in under fives. The results indicate that household location, household size, number of children in the family,age of the mother, education of the mother, household head's employment, drinking water sources and toilet facility are important correlates of diarrhoea in children. The findings of the study may inform to prioritize the resource mobilization in capacity building towards designing the most effective prevention intervention strategies to reduce the risk of exposure to sanitation hazards

Assessment of the determinant of choice of ‘over the counter’ analgesics among students of a university in Abbottabad, Pakistan

Purpose: To ascertain the preference of COMSATS Institute of Information Technology, Abbottabad, Pakistan (CIIT) students for various ‘over the counter’ analgesics.Methods: This cross-sectional survey study on self-medication of ibuprofen in students of CIIT was conducted in July - August 2013 using a self-administered questionnaire. Five hundred students with an average age of 20 - 25 years cooperated in this inquisition. The questionnaire contained 18 questions including socio-demographic queries, economical status, perception of the frequency of pain, their locality, and behavior and knowledge of participants on the use of ibuprofen regarding its therapeutic and adverse effects, and interactions.Results: Out of the 500 participants in the study, 70.4 % were female. The response rate was 68.2 %. Ibuprofen (54 %) was the most used analgesic of all the NSAIDs among the respondents. Approximately, 11.2 % of the respondents reported that they suffer from pain almost every day. The younger and more educated respondents had better level of awareness about the ibuprofen’s indications as compared to those who had low level of education. Of the respondents, 29.6 % were not aware of any side effect caused by ibuprofen. Approximately, 22.4 % of the respondents had no knowledge of the interactions of ibuprofen while 61.2 % of the participants consult a physician about painkillers.Conclusion: Although many of the students undergo almost daily pain and favor ibuprofen over other NSAIDs analgesics among but they still lack information on its appropriate handling and safety. The overall result of the survey indicates very low level of information about the drug interaction.Keywords: Pain, OTC, analgesic, ibuprofen, questionnaire based survey, awarenes

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Phenobarbital Pharmacokinetics and Optimal Dosing of Phenobarbital

Researchers from the Baylor College of Medicine in Houston, TX, USA, conducted a retrospective population pharmacokinetic analysis of 355 patients ages less than 19 years of age in the inpatient setting who were initiated on intravenous or oral phenobarbital therapy and had one or more serum phenobarbital concentrations sampled

Role of poverty in fuel choice and exposure to indoor air pollution in Pakistan

Indoor air pollution, due to household solid fuel use, is responsible for a significant burden of disease in developing countries. Fuel choice is often associated with household income. However, many other socio-economic and environmental factors also influence the choice of fuel and the resultant indoor air pollution exposure. The aim of this paper is to assess the role of poverty on indoor air pollution in Pakistan through fuel choice. Furthermore, a multinomial logit model has been used to predict the determinants of fuel choice. The results indicate that although poverty makes a significant contribution, other factors such as household location and area, household size, low level of human capital, asset ownership structure and access to basic utilities are the important correlates of fuel choice. Knowledge relating to the proximate determinants for fuel choice is crucial to inform policy and can play a pivotal role in designing sustainable intervention strategies to reduce the risk of exposure to indoor air pollution in Pakistan

A Comparative Data Analytic Approach to Construct a Risk Trade-off for Cardiac Patients\u27 Re-admissions

Purpose – The purpose of this paper is to formulate a framework to construct a patient-specific risk score and therefore to classify these patients into various risk groups that can be used as a decision support mechanism by the medical decision makers to augment their decision-making process, allowing them to optimally use the limited resources available. Design/methodology/approach – A conventional statistical model (logistic regression) and two machine learning-based (i.e. artificial neural networks (ANNs) and support vector machines) data mining models were employed by also using five-fold cross-validation in the classification phase. In order to overcome the data imbalance problem, random undersampling technique was utilized. After constructing the patient-specific risk score, k-means clustering algorithm was employed to group these patients into risk groups. Findings – Results showed that the ANN model achieved the best results with an area under the curve score of 0.867, while the sensitivity and specificity were 0.715 and 0.892, respectively. Also, the construction of patient-specific risk scores offer useful insights to the medical experts, by helping them find a trade-off between risks, costs and resources. Originality/value – The study contributes to the existing body of knowledge by constructing a framework that can be utilized to determine the risk level of the targeted patient, by employing data mining-based predictive approach

Developing a decision support system to detect material weaknesses in internal control

Wells Fargo employees set up 3.5 million fraudulent accounts over several years. Wells Fargo ended up paying $4.5 billion in fines. The Wells Fargo scandal highlights the importance of management actions to prevent misstatements and potential frauds on a timely basis. This study utilized the design science research paradigm to develop a predictive framework (IT artifact) in order to stratify firms into multiple risk groups for disclosing material weakness(es) in internal control (MWIC). The proposed methodology employed a hybrid heuristic optimization-based machine learning methodology. Synthetic minority over-sampling technique (SMOTE) was utilized to handle the learning problem with the imbalanced data. The best performing model was the proposed hybrid Genetic Algorithms (GA) and Support Vector Machines (SVM). The proposed methodology was internally validated via k-fold cross validation, and then externally validated using several separate datasets. The (GA) selected variables were ranked from the most important to the least through Information fusion (IF) sensitivity. A web-based decision support system was built to predict the firm-specific MWIC risk category. The web-based tool can be used to create an early warning system for predicting MWIC(s)

Morbidity and mortality associated with Plasmodium vivax and Plasmodium falciparum infection in a tertiary care kidney hospital

Malaria is a disease of tropical regions and both types of plasmodia, i.e. Plasmodium falciparum and Plasmodium vivax, cause significant morbidity and mortality. P. vivax was thought to be benign and cause less morbidity and mortality. Many reports showed the devastating effect of vivax malaria too. We compared the clinical symptoms, laboratory markers, treatment and outcome of both the plasmodia. This is a retrospective analysis of 95 patients admitted to The Kidney Center, Karachi in a duration of 15 years (1997-2012); 45 patients with falciparum malaria and 50 patients with vivax malaria, and compared the clinical presentation, laboratory workup, treatment and outcome in both groups. The two groups constitute a mixed population of diabetes, chronic kidney disease (CKD) and hemodialysis patients. Both plasmodia have an equal clinical impact in terms of fever and rigors, anorexia, nausea, feeling of dyspnea, change in the mental status, changes in the urine color, diarrhea, volume depletion and pedal edema. However, patients with falciparum had significantly more vomiting (P = 0.02), oliguria (P = 0.003) and jaundice (P = 0.003). Laboratory parameters also showed a severe impact of falciparum, as there was more severe anemia and kidney and liver dysfunction. More patients were treated with dialysis and blood transfusion in the falciparum group. The outcome in the two groups was not significantly different in terms of death and days of hospitalization. Falciparum malaria has a higher clinical impact than the vivax malaria, but vivax is not as benign as it was once thought to be. It also has devastating effects on vulnerable populations like patients with CKD and diabetes