Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan: protocol for a matched case-control study.

INTRODUCTION: In April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed with HIV, >80% below 16 years, the largest ever outbreak of HIV in children in Pakistan. In this protocol paper, we describe research methods for assessing likely modes of HIV transmission in this outbreak and investigate spatial and molecular epidemiology. METHODS AND ANALYSIS: A matched case-control study will be conducted with 406 cases recruited. Cases will be children aged below 16 years registered for care at the HIV treatment centre at Shaikh Zayed Children Hospital in Larkana City. Controls will be children who are HIV-uninfected (confirmed by a rapid HIV test) matched 1:1 by age (within 1 year), sex and neighbourhood. Following written informed consent from the guardian, a structured questionnaire will be administered to collect data on sociodemographic indices and exposure to risk factors for parenteral, vertical and sexual (only among those aged above 10 years) HIV transmission. A blood sample will be collected for hepatitis B and C serology (cases and controls) and HIV lineage studies (cases only). Mothers of participants will be tested for HIV to investigate the possibility of mother-to-child transmission. Conditional logistic regression will be used to investigate the association of a priori defined risk factors with HIV infection. Phylogenetic analyses will be conducted. Global positioning system coordinates of participants' addresses will be collected to investigate concordance between the genetic and spatial epidemiology. ETHICS AND DISSEMINATION: Ethical approval was granted by the Ethics Review Committee of the Aga Khan University, Karachi. Study results will be shared with Sindh and National AIDS Control Programs, relevant governmental and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals

The association of body composition with quality of life in adult patients with end stage renal disease on hemodialysis visiting a tertiary care hospital in Karachi, Pakistan

The perception of patients with end stage renal disease (ESRD) has received considerable attention in recent years as they are facing devastating medical, social, and economic problems. A large body size in HD patient is associated with poor quality of life (QOL). It is not clear whether body fat or muscle mass confers a better QOL. The research on QOL has emerged as valuable tool in measuring the outcome of patient receiving healthcare. In this study, we hypothesized that increase muscle mass and lower body fat percentage are independently associated with a better QOL score. Objective: To assess the relationship of body fat (%) and muscle mass with QOL in patients with ESRD on HD visiting tertiary care hospital in Karachi, Pakistan. Methods: We conducted an analytical cross-sectional study on 72 patients with ESRD, visiting Aga Khan University Hospital (AKUH) twice or thrice per week for HD during 8 months of data collection, from November 23, 2015 to June 8, 2016. These patients underwent a detail assessment of body compositions, body fat and muscle mass using Bio Scan, along with that socio-demographic and medical related information was assessed through a questionnaire. The outcome variable quality of life (QOL) was assessed using WHOQOL-BREF questionnaire. As the outcome variable overall WHOQOL-BREF is based °ha. continuous scale, we used multiple linear regression technique for the analysis. For continues variables, we calculated means and standard deviation. Frequencies with percentages were reported for categorical variables. For all important associations B coefficients with 95% confidence interval were reported. iv Results: Out of 92 ESRD patients 72 were recruited for the study. The mean score of overall WHOQOL-BREF was 84.5 ± 12.50. Out of all 4 domains, mean QOL of environmental domain scored highest. ESRD patients had a mean age of .57.9 ± 14.2 years. Around 52.78% were male and 47.22% were female of which majority 49 patients were on thrice per week HD and few 23 were on twice per week HD. Among all ESRD patients those who were employed, the mean estimated overall WHOQ0LBREF score was 7.77 higher as compared to unemployed (95% CI: 0.41, 15.12). There was an interaction between muscle mass and hypertension as a cause of kidney disease. The estimated mean score increase by 27.93, for every one kg/m2 increase in muscle mass among patients who complained hypertension as the cause for kidney disease as compared to patients who did not complained hypertension as the cause of kidney disease. According to another interaction between body fat % add frequency of I-ID, patients who undergo HD thrice per week, for every one percent increase in body fat percentage, the estimated mean overall WHOQOL-BREF score decreases by 10.86 when compared with patients undergoing HD twice per week. There was an interaction between depression and duration in months for HD. The mean estimated score also decreases by15.99, for every one month increase in duration for HD among patients diagnosed with depression as compared to patients not having depression. Moreover another interaction was between sex and marital status. Among all ESRD patients, females who were currently married, the estimated mean score decreases by 9.18 as compared to males and single, divorced, widow patients. Conclusion: For ESRD patient\u27s assessment of QOL is a useful and important clinical measure to monitor patient\u27s well-being. Assessment of body fat % and muscle mass are also valuable in clinical practice for health professionals to advise their patient accordingly. In future controlled trials are warranted to examine weather intervention to improve nutrition status along with muscle mass improve QOL in HD patients

Factors associated with Diabetes Empowerment among patients with type 2 diabetes, at OPD setting, Karachi, Pakistan

Abstract Diabetes Empowerment is important for diabetic control as it postpones the onset of complications. This study aimed to investigate the association of medication adherence, self-care behaviors, and diabetes knowledge with Diabetes Empowerment among patients with type II diabetes. A cross-sectional study was conducted on 451 type II diabetes patients attending Endocrinology clinics at OPD setting in Karachi. Data was collected electronically using a structured questionnaire comprising of tools to measure Diabetes Empowerment, medication adherence, self-care behaviors, diabetes knowledge, and socioeconomic scale. It also included health-related information from patients’ medical record. As outcome variable was continuous, so multiple linear regression analysis was used to assess the independent effect of Diabetes Empowerment on medication adherence, self-care behaviors and diabetes knowledge with other co-variates. The mean Diabetes Empowerment score was 3.62 (SD = 0.31). The mean age of the participants was 56.68 (SD = 11.76). 53.88% were females, 80.71% were married, 77.56% were obese, and 66.30% were upper-middle class with average diabetes duration of 11.7 years (SD = 7.89). HbA1c values were ≥ 7 in 63.41% of study participants. Diabetes Empowerment was significantly associated with medication adherence (P = 0.001), general diet (P < 0.001), special diet (P = 0.011), smoking status (P = 0.001), and socioeconomic status (upper lower, P = 0.085). A comprehensive strategy for the treatment of type II diabetes is essential to enhance clinical results, improve patient quality of life, and prevent diabetes-related comorbidities. People with type II diabetes should be encouraged to embrace an empowerment-based approach by healthcare providers. It is critical to do research that promotes empowerment

Fibrin glue in managing intractable gingival bleeding in patients with inherited bleeding disorders-a quasi-experimental pilot study

This study presents the clinical outcomes of using inhouse prepared fibrin glue for controlling gingival bleeding in patients with inherited bleeding disorders (IBD). The objective of the study was to assess the reduction in transfusion days and improvement in compliance for dental evaluation over a one-year period in a low-to-middle-income country. The quasiexperimental pilot study included 40 IBD patients with gingival bleeding. These were divided into two groups: Group A received fibrin glue (n=20), while Group B did not (n=20). The study compared outcome metrics, including the number of treatment days and blood components transfused, using non-parametric tests with a significance threshold of p\u3c0.05. Results showed that Group A required fewer blood components (n=154) as compared to Group B (n=204) (p\u3c0.001). Patients in Group A with Glanzmann thrombasthenia (GT) had a shorter treatment duration (one day) than those in group B (three days) (p\u3c0.01). In conclusion, the application of fibrin glue effectively managed intractable gingival bleeding in IBD patients

Anthropometric measurements in children having transfusion-dependent beta thalassemia

Objectives: The aim of this study was to determine the anthropometric measurements in transfusion-dependent beta-thalassemia children in Pakistan. The secondary aim was to correlate serum ferritin with the physical growth.Methods: We enrolled 367 children (aged 5-17 years) with transfusion-dependent beta-thalassemia major in the study. Anthropometric measurements, serum ferritin levels, and pre-transfusion hemoglobin levels were measured. Serum ferritin was correlated with the height z-score for age.Results: Laboratory evaluation showed that patients had significantly low mean pre-transfusion hemoglobin of 7.66 ± 1.34 g/dl (range 2.5-10.5) and high median (Q3-Q1) serum ferritin of 5012 ng/ml (6829-3532). The median (Q3-Q1) height-for-age z-score of children was low at -2.69 and (-1.46 to -3.80) and 65.4% children had stunted growth (height for age z-score \u3c-2). There was a significant negative correlation between height for age z-score and serum ferritin levels (p \u3c 0.000). Stunting of growth began early during 5-10 years of age but increased markedly with the progress of time.CONCLUSIONS: The study showed that children with beta thalassemia major had delayed physical growth possibly secondary to iron overload. Effective and early iron chelation is needed for preventing growth failure in transfusion-dependent beta thalassemia