School-based injury outcomes in children from a low-income setting: results from the pilot injury surveillance in Rawalpindi city, Pakistan

Background School-based injuries account for one in five unintentional childhood injuries. Little is known about the epidemiology of school-based injuries in low-income settings. The objective of our study was to compare emergency department (ED) outcomes of the school-based injuries with respect to age, sex, and injury mechanisms in a Pakistani urban setting. Findings A pilot injury surveillance study was conducted at the EDs of three major tertiary-care hospitals of Rawalpindi city from July 2007 to June 2008 and included children of less than 15 years injured at school. The World Health Organization’s questionnaire for injury surveillance was used. There were 923 school injury cases. Mean age of children involved was 8.3 years (SD ± 3.3) with male female ratio 2.9:1. Most injuries occurred while playing 85.6% (n = 789); of which the most common mechanism was falls (n = 797, 86.4%). Nineteen of twenty cases were directly discharged home from the ED (N = 861). Compared to ED discharged cases, injury characteristics overrepresented in hospital admitted cases (n = 46) were age 10–14 years (65.2% vs. 40.9%, p = 0.005), male (88.6% vs. 25.9%), involved in educational activities (39.1% vs. 5.3%), injured from fire/heat (37.8% vs. 0.6%), had burns (39.5% vs. 0.9%) and head injuries (27.9% vs. 6.4%). Conclusion Falls while playing are the commonest injury mechanism in school-based injuries reported in our ED sample. School officials need to prevent these injuries. Studying injury hazards present in school environment in Pakistan might facilitate developing specific prevention strategies

Effectiveness of Ivermectin among COVID-19 patients: A Randomized Controlled Trial

Objectives: To determine the effectiveness of Ivermectin among COVID-19 patients in terms of mortality and biochemical / hematological attributes. Materials and Methods:  A Randomized Controlled Trial (RCT) was carried out in Department of Infectious Diseases (DID) of Holy Family Hospital Rawalpindi during March 2021 through concurrent parallel study design. Apart from seeking Ethical approval for this research, DID was also licensed from Drug Regulatory Authority of Pakistan (DRAP) for this trial. Total 90 PCR positive COVID-19 patients were enrolled in this study via 1:1 randomization in experimental and control group without blinding. The control group received Standard of Care (SOC) starting from day 1 while experimental group was given SOC along with Ivermectin (200µg/kg) for 5 days. Study participants were assessed on day 0, 4, 7 and 10 for general symptoms through physical examination, blood oxygen saturation and diverse hematological and biochemical indicators in addition to adverse events. Data analysis was done by means of SPSS version 25.0. and Microsoft Excel 2010. Mean ± SD for age, length of hospital stay and time to PCR negativity were calculated. Independent sample t-test was applied to determine the mean difference in age, duration of hospital stay, time to PCR negativity, SpO2, oxygen supply, serum Hemoglobin, TLC, platelet count, Clinical Severity Score (CSS), urea and creatinine levels of both groups. The difference in secondary outcome (expiry / discharge) of both groups was compared by means of chi-square test. P-value ≤ 0.05 was considered significant. 95% Confidence Interval was also computed. Relative Risk (RR) was also measured to verify the effectiveness of Ivermectin in COVID patients Results: Males constituted the majority (56.7%) of our study participants. Statistically insignificant difference in mean age (P = 0.42) and mean length of hospital stay (P= 0.32) between experimental and control group subjects was observed. Mean time to PCR negativity was reported to be significantly less (P= 0.002) in experimental group. Significant improvement was seen in PCR negativity (P<0.05), mean Clinical Severity Score (CSS) (P0.02), mean hemoglobin level (P=0.03) and mean platelet count (P=0.03). Difference in health outcome of both groups was determined to be statistically insignificant (P<0.2, 95% CI (-0.20 – 0.12)). Relative Risk of 0.8 proved the protective effect of Ivermectin in COVID. Conclusion: Ivermectin was quite effective in reducing mortality and improving the health outcome in COVID-19 patients

Effectiveness of Ivermectin among COVID-19 patients: A Randomized Controlled Trial

Objectives: To determine the effectiveness of Ivermectin among COVID-19 patients in terms of mortality and biochemical / hematological attributes. Materials and Methods:  A Randomized Controlled Trial (RCT) was carried out in Department of Infectious Diseases (DID) of Holy Family Hospital Rawalpindi during March 2021 through concurrent parallel study design. Apart from seeking Ethical approval for this research, DID was also licensed from Drug Regulatory Authority of Pakistan (DRAP) for this trial. Total 90 PCR positive COVID-19 patients were enrolled in this study via 1:1 randomization in experimental and control group without blinding. The control group received Standard of Care (SOC) starting from day 1 while experimental group was given SOC along with Ivermectin (200µg/kg) for 5 days. Study participants were assessed on day 0, 4, 7 and 10 for general symptoms through physical examination, blood oxygen saturation and diverse hematological and biochemical indicators in addition to adverse events. Data analysis was done by means of SPSS version 25.0. and Microsoft Excel 2010. Mean ± SD for age, length of hospital stay and time to PCR negativity were calculated. Independent sample t-test was applied to determine the mean difference in age, duration of hospital stay, time to PCR negativity, SpO2, oxygen supply, serum Hemoglobin, TLC, platelet count, Clinical Severity Score (CSS), urea and creatinine levels of both groups. The difference in secondary outcome (expiry / discharge) of both groups was compared by means of chi-square test. P-value ≤ 0.05 was considered significant. 95% Confidence Interval was also computed. Relative Risk (RR) was also measured to verify the effectiveness of Ivermectin in COVID patients Results: Males constituted the majority (56.7%) of our study participants. Statistically insignificant difference in mean age (P = 0.42) and mean length of hospital stay (P= 0.32) between experimental and control group subjects was observed. Mean time to PCR negativity was reported to be significantly less (P= 0.002) in experimental group. Significant improvement was seen in PCR negativity (P<0.05), mean Clinical Severity Score (CSS) (P0.02), mean hemoglobin level (P=0.03) and mean platelet count (P=0.03). Difference in health outcome of both groups was determined to be statistically insignificant (P<0.2, 95% CI (-0.20 – 0.12)). Relative Risk of 0.8 proved the protective effect of Ivermectin in COVID. Conclusion: Ivermectin was quite effective in reducing mortality and improving the health outcome in COVID-19 patients

COVID-19 among Healthcare Workers of Teaching Hospitals Affiliated with Rawalpindi Medical University

Objectives: To overview COVID-19 scenario among healthcare workers in teaching hospitals of Rawalpindi Medical University Subjects & Methods: A cross-sectional descriptive research was done among 482 coronavirus infected healthcare professionals from three teaching hospitals (Holy Family Hospital, Benazir Bhutto Hospital and District Head Quarters) that were affiliated with Rawalpindi Medical University during January 2021. Healthcare workers with COVID confirmation via RT-PCR testing reports were included in the study through consecutive sampling. Their demographic profile, workplace attributes, clinical manifestations, oxygen saturation, source of infection, re-infection, hospitalization, requirement for oxygen supply and disease severity according to COVID-19 adult cases categorization were inquired. Data analysis was done by means of SPSS version 25.0. Results: Mean age of 482 healthcare workers was 29.6 ± 5.7 years. Mainstream (69.1%) of our study participants was constituted by female healthcare staff. Majority (34%) were postgraduate trainees followed by 29% nurses and 20% house officers. Mean duration of sickness was 13.6 ± 6.4 days. About 63.1% of study subjects were COVID infected during July –December 2020. About 4.8% healthcare personnel were asymptomatic and 78% caught infection from their workplace. Approximately 82% suffered from fever while 71.4% and 55.8% went through bodyaches and cough respectively. Out of 39 hospitalized workers, 23 required oxygen supply for their vitality. Severe COVID infection was determined only among 5.4% healthcare professionals. Conclusion: Healthcare workers are more susceptible to acquire COVID infection from their workplace. In view of this vulnerability, firm compliance to preventive measures against coronaviurs infection by healthcare staff and general public is deemed necessary for their viability

Comparison of Efficacy of Double Dose Oral Terbinafine versus Itraconazole in the Treatment of Dermatophyte Infections of Skin

Objective: To compare the efficacy of double-dose oral Terbinafine and Itraconazole in treating dermatophytic infections. Study Design: Randomized controlled trial (ClinicalTrials.gov: NCT04880980). Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2021 to Mar 2022. Methodology: One hundred and twenty patients with dermatophyte infections of the skin (i.e., tinea corporis and cruris) diagnosed by clinical presentation and KOH mount were included in this study. After randomization, patients were divided  into two groups. Group-A was managed with double-dose oral Terbinafine, while Group-B was managed with double-dose oral Itraconazole. Clinical response and side effects were seen and recorded initially at two weeks and then at four weeks.Efficacy and adverse effects were compared in both groups at the end of four weeks. Results: Out of 120 patients with dermatophyte infections of the skin included in the study, 59(49.2%) took double-dose oral Terbinafine while 61(50.8%) took double-dose oral Itraconazole after randomization. It was revealed that Itraconazole was more efficacious in achieving cure at the end of 4-weeks as compared to double dose Terbinafine (p-value=0.001), while adverse effects studied were not statistically significant or different in both the groups (p-value>0.005). Conclusion: This randomized controlled trial showed that double dose oral Itraconazole was more efficacious in treating dermatophyte infections of the skin (i.e., Tinea corporis and cruris) compared to double dose oral Terbinafine. Adverse effects were minimal in both groups and were not specially related to any of these medications

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe