An Assessment of Knowledge, Attitude and Practices (KAP) towards Diabetes Mellitus and Diabetic Retinopathy among Patients of Nishter Medical University Hospital Multan, South-Punjab Pakistan

Objective: This study aimed to determine the Knowledge, Attitude and Practices (KAP) towards diabetes mellitus and diabetic retinopathy among the patients of a tertiary care hospital. Study design This study was an observational, cross-sectional study. Place and duration of study The current study was conducted at department of General Medicine, Nishtar Medical University Hospital Multan, Pakistan. The time span of the study was from March 2016 to February 2017. Method After taking approval from Ethical Review Committee, a questionnaire based descriptive study was conducted on 692 patients.  The technique of convenient sampling was used. All the gathered data were retrieved into MS Excel. The data were analyzed by using computer program SPSS 21 version. Results: Six hundred ninety two adults were interviewed. Of these, 271 (39.2%) were suffering from diabetes mellitus. Lowest mean knowledge score (5.28 ± 6.09) was seen in illiterate study population. Male’s Mean Knowledge score (5.61 ± 5.56) was better than female’s (4.46 ± 5.21). Over all mean score of Attitudes towards diabetes was 4.43 ± 2.37. It was higher (6.62 ± 2.03) in diabetic respondents as compared with non-diabetic respondents (4.70 ± 2.59) with p < 0.000. In Practice module majority of the respondents (69.9%) did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination. Conclusion Poor knowledge of diabetes was found in the community. The problem was more marked in females, illiterate and the individuals not having diabetes mellitus. Key Words: Diabetes mellitus, Diabetic retinopathy, Diabetic Education Program, Knowledge, Attitude and Practices (KAP

Some Immunologic Evaluations of Toxoplasmosis in Iraqi Aborted Females

Forty-eight aborted women (Iraqi Arab Muslims) at the first trimester with a serological evidence of toxoplasmosis were investigated. Two age- and ethnic-matched control groups were included: 40 aborted women due to accidental events (Control I), and 40 unmarried (virgin) women (Control II). The subjects were evaluated for the following parameters: HLA-class I antigens (A, B and Cw), blood groups, total and differential counts of leukocytes, lymphocyte subpopulations (CD3+, CD4+ and CD20+ cells), phagocytosis of heat-killed yeast (phagocytic index and NBT index), and total serum levels of immunoglobulins (IgA, IgG and IgM) and complement components (C3 and C4). The HLA-A2 and -Cw8 antigens were significantly increased in the patients, while A3 antigen was significantly decreased. Blood group phenotypes in patients and controls also showed significant variations. The total and differential counts of leukocytes showed no significant differences between patients and controls, with the exception of lymphocytes, which showed a significant decreased count in the patients compared to control II. However, the lymphocyte subpopulations showed a significant increased percentage in patients. The phagocytic index was approximated in patients and controls, while NBT index was significantly decreased. Total serum level of IgG was significantly increased in the patients, while IgA, IgM, C3 and C4 levels did not maintain such variation

Peritonitis – Etiology and Treatment Options: A Systematic Review

Peritonitis is an infection with a substantial source of morbidity and death. The mortality rate is 10% to 60%. Its etiology may be infection of bacteria, viruses, or fungi. The objective of the current systematic review is to identify the causes of peritonitis and discuss available treatment options. A systematic review was conducted from the literature from January 2012 to December 2022. More than 60 articles were downloaded; after abstracting relevant information from the studies and assessing quality, data was synthesized and presented by PRISMA flow diagram. The most common cause was bacterial infection; followed by fungal and viral infections. Reported organisms were E. coli, Klebsiella spp., Streptococcus spp., M. tuberculosis, C. trachomatis, Pseudomonas spss., C. albicans, C. glabrata, C. krusei, Cryptococcus spp., and Aspergillus spp., and Feline-infectious-corona-virus. Empiric antibiotics therapy covers broad-spectrum antibacterials; antifungal and surgical interventions are treatment options. The acutely ill patient requires combined medical and surgical methods; culture sensitivity is highly advisable to reduce the chances of failure

Impact of foreign direct investment on economic growth: A case study of Pakistan

Purpose- This research paper aims to analyze the impact of foreign direct investment (FDI) in Pakistan for the period 1981 to 2010. It evaluated the GDP growth performance and assessed the historical trends of the FDI and CPI in Pakistan. Methodology/Sample- The link between gross domestic product (GDP,) foreign direct investment and Inflation is measured with the help of multiple regression models. GDP in this model is used as dependent variable whereas FDI and inflation (CPI) are measured as independent variables. Findings- According to the results, the model is overall significant with the positive and significant association of GDP and FDI while a negative and significant relationship found between GDP and inflation. Practical Implications- On the basis of the empirical results acquired, Policy proposals are advised to attract FDI in Pakistan. Foreign direct investment (FDI) is an essential factor for economic growth in the developing countries. FDI allows the transfer of technology, uplift competition in the domestic input market, contributes to human capital development and Profits created by FDI contribute to corporate tax revenues in the host country

Impact of foreign direct investment on economic growth: A case study of Pakistan

Purpose- This research paper aims to analyze the impact of foreign direct investment (FDI) in Pakistan for the period 1981 to 2010. It evaluated the GDP growth performance and assessed the historical trends of the FDI and CPI in Pakistan. Methodology/Sample- The link between gross domestic product (GDP,) foreign direct investment and Inflation is measured with the help of multiple regression models. GDP in this model is used as dependent variable whereas FDI and inflation (CPI) are measured as independent variables. Findings- According to the results, the model is overall significant with the positive and significant association of GDP and FDI while a negative and significant relationship found between GDP and inflation. Practical Implications- On the basis of the empirical results acquired, Policy proposals are advised to attract FDI in Pakistan. Foreign direct investment (FDI) is an essential factor for economic growth in the developing countries. FDI allows the transfer of technology, uplift competition in the domestic input market, contributes to human capital development and Profits created by FDI contribute to corporate tax revenues in the host country

Prevalence and risk of hepatitis E virus infection in the HIV population of Nepal

Background: Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal. Methods: We prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. All individuals were on antiretroviral therapy and healthy blood donors were used as controls. Results: We found a high prevalence of HEV IgG (39.4%) and HEV IgM (15.3%) in HIV-positive subjects when compared to healthy HIV-negative controls: 9.5% and 4.4%, respectively (OR: 6.17, 95% CI 4.42-8.61, p \u3c 0.001 and OR: 3.7, 95% CI 2.35-5.92, p \u3c 0.001, respectively). Individuals residing in the Kathmandu area showed a significantly higher HEV IgG seroprevalance compared to individuals residing outside of Kathmandu (76.8% vs 11.1%, OR: 30.33, 95% CI 18.02-51.04, p = 0.001). Mean CD4 counts, HIV viral load and presence of hepatitis B surface antigen correlated with higher HEV IgM rate, while presence of hepatitis C antibody correlated with higher rate of HEV IgG in serum. Overall, individuals with HEV IgM positivity had higher levels of alanine aminotransferase (ALT) than IgM negative subjects, suggesting active acute infection. However, no specific symptoms for hepatitis were identified. Conclusion: HIV-positive subjects living in Kathmandu are at higher risk of acquiring HEV infection as compared to the general population and to HIV-positive subjects living outside Kathmandu

Prevalence and risk of hepatitis e virus infection in the HIV population of Nepal

Background: Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal. Methods: We prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. All individuals were on antiretroviral therapy and healthy blood donors were used as controls. Results: We found a high prevalence of HEV IgG (39.4%) and HEV IgM (15.3%) in HIV-positive subjects when compared to healthy HIV-negative controls: 9.5% and 4.4%, respectively (OR: 6.17, 95% CI 4.42-8.61, p < 0.001 and OR: 3.7, 95% CI 2.35-5.92, p < 0.001, respectively). Individuals residing in the Kathmandu area showed a significantly higher HEV IgG seroprevalance compared to individuals residing outside of Kathmandu (76.8% vs 11.1%, OR: 30.33, 95% CI 18.02-51.04, p = 0.001). Mean CD4 counts, HIV viral load and presence of hepatitis B surface antigen correlated with higher HEV IgM rate, while presence of hepatitis C antibody correlated with higher rate of HEV IgG in serum. Overall, individuals with HEV IgM positivity had higher levels of alanine aminotransferase (ALT) than IgM negative subjects, suggesting active acute infection. However, no specific symptoms for hepatitis were identified. Conclusions: HIV-positive subjects living in Kathmandu are at higher risk of acquiring HEV infection as compared to the general population and to HIV-positive subjects living outside Kathmandu

Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>In Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates.</p> <p>Methods</p> <p>Three hundred and sixty-six mother-infant pairs, with infants aged <b>≤ </b>6 weeks, were enrolled and randomized into either the intervention or control arm between August - November 2008. The intervention, administered by trained community health workers, consisted of three targeted pictorial messages regarding vaccines. The control group received general health promotion messages based on Pakistan's Lady Health Worker program curriculum. Assessment of DPT/Hepatitis B vaccine completion (3 doses) was conducted 4-months after enrollment. A Poisson regression model was used to estimate effect of the intervention. The multivariable Poisson regression model included maternal education, paternal occupation, ownership of home, cooking fuel used at home, place of residence, the child's immunization status at enrollment, and mother's perception about the impact of immunization on child's health.</p> <p>Results</p> <p>Baseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother-infant pairs in the intervention group, 129 (72.1%) had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7%) had received all 3 doses. Multivariable analysis revealed a significant improvement of 39% (adjusted RR = 1.39; 95% CI: 1.06-1.81) in DPT-3/Hepatitis B completion rates in the intervention group.</p> <p>Conclusion</p> <p>A simple educational intervention designed for low-literate populations, improved DPT-3/Hepatitis B vaccine completion rates by 39%. These findings have important implications for improving routine immunization rates in Pakistan.</p

Phylogenetic and Drug-Resistance Analysis of HIV-1 Sequences From an Extensive Paediatric HIV-1 Outbreak in Larkana, Pakistan.

INTRODUCTION: In April 2019, an HIV-1 outbreak among children occurred in Larkana, Pakistan, affecting more than a thousand children. It was assumed that the outbreak originated from a single source, namely a doctor at a private health facility. In this study, we performed subtype distribution, phylogenetic and drug-resistance analysis of HIV-1 sequences from 2019 outbreak in Larkana, Pakistan. METHODS: A total of 401 blood samples were collected between April-June 2019, from children infected with HIV-1 aged 0-15 years recruited into a case-control study to investigate the risk factors for HIV-1 transmission. Partial HIV-1 pol sequences were generated from 344 blood plasma samples to determine HIV-1 subtype and drug resistance mutations (DRM). Maximum-likelihood phylogenetics based on outbreak and reference sequences was used to identify transmission clusters and assess the relationship between outbreak and key population sequences between and within the determined clusters. Bayesian analysis was employed to identify the time to the most recent common recent ancestor (tMRCA) of the main Pakistani clusters. RESULTS: The HIV-1 circulating recombinant form (CRF) 02_AG and subtype A1 were most common among the outbreak sequences. Of the treatment-naïve participants, the two most common mutations were RT: E138A (8%) and RT: K219Q (8%). Four supported clusters within the outbreak were identified, and the median tMRCAs of the Larkana outbreak sequences were estimated to 2016 for both the CRF02_AG and the subtype A1 clusters. Furthermore, outbreak sequences exhibited no phylogenetic mixing with sequences from other high-risk groups of Pakistan. CONCLUSION: The presence of multiple clusters indicated a multi-source outbreak, rather than a single source outbreak from a single health practitioner as previously suggested. The multiple introductions were likely a consequence of ongoing transmission within the high-risk groups of Larkana, and it is possible that the so-called Larkana strain was introduced into the general population through poor infection prevention control practices in healthcare settings. The study highlights the need to scale up HIV-1 prevention programmes among key population groups and improving infection prevention control in Pakistan