Issues in Pakistan's Health Sector

The health sector in Pakistan is riddled with numerous problems, constraints and contradictions. There is the problem of a lack of health facilities in rural areas, of unemployed doctors despite the acute shortage of trained medical personnel in the country, of 'brain drain' of medical graduates, of the inability of medical graduates to work in simple rural settings and their dependence on “sophisticated” technology of pharmaceutical companies enriching themselves at the expense of the common man, and of a lack of potable water and adequate sewerage in slums and rural areas. The list can be expanded but the stark fact is that most of the people have little or no access to adequate health facilities and are faced with a high incidence of disease

Contested identities and the Muslim Qaum in northern India : c. 1860-1900

Using primarily published sources in Urdu from the second-half of the nineteenth century, my thesis presents evidence with regard to north Indian Muslims, which questions the idea of a homogenous, centralising, entity, at times called the Muslim community, qaum, ummah or nation. Using a large number of second-tier publicists' writings in Urdu, the thesis argues that the self-perceptions and representations of many Muslims, were far more local, parochial, disparate, multiple, and highly contested. The idea of a homogenous, levelling, sense of collective identity, or an imagined community, seem wanting in this period. This line of evidence and argumentation, also has important implications for locating the moment of separatism and identity formation amongst north Indian Muslims, and argues that this happened much later than has previously been imagined. Based on this, the thesis also argues against an anachronistic or teleological strain of historiography with regard to north Indian Muslims of this period. The main medium through which these arguments are debated, is through the Urdu print world, where a large number of new sources have been presented which underscore this difference, more than this uniformity. Whether it was in religious debates, debates around the attempt to unify - as part of a qaum - or around the reasons for Muslims to be at a point of zillat - utter humiliation - the literature points to multiple and diverse interpretations, causes and solutions. Moreover, the question of who a Muslim was', was always bitterly contested by those who claimed to be Muslims themselves. The thesis also examines the forum of the munäzara, and how pre-print forms of public engagement helped in emphasising individual identity, authority and reputation. The interplay between oral representation and the subsequent written accounts after the event, also raise questions about the fixity of print'. and about sources for historians. Using this new print material, the thesis engages broadly, with notions related to the imagined community and the public sphere, arguing that in a colonial context, much of the theory based on the European experience, needs to be rethought, for the nature and development of the public sphere/s and of the formation of communities, may have been somewhat different in this context

Revisiting νμ(νˉμ)\nu_\mu(\bar\nu_\mu) and νe(νˉe)\nu_e(\bar\nu_e) Induced Quasielastic Scattering from Nuclei in Sub-GeV Energy Region

We present the results of charged current quasielastic(CCQE) scattering cross sections from free as well as bound nucleons like in $^{12}C$, $^{16}O$, $^{40}Ar$ and $^{208}Pb$ nuclear targets in $E_\nu(_{\bar\nu})~\le~$1 GeV energy region. The results are obtained using local Fermi gas model with and without RPA effect. The differences those may arise in the electron and muon production cross sections due to the different lepton mass, uncertainties in the axial dipole mass $M_A$ and pseudoscalar form factor, and due to the inclusion of second class currents have been highlighted for neutrino/antineutrino induced processes.Comment: Published in Journal of the Physical Society of Japan (NuInt-2015

Elevated ex vivo monocyte chemotactic protein-1 (CCL2) in pulmonary as compared with extra-pulmonary tuberculosis

BACKGROUND: Tuberculosis causes 3 million deaths annually. The most common site of tuberculosis is pulmonary however; extra-pulmonary forms of the disease also remain prevalent. Restriction of Mycobacterium tuberculosis depends on effective recruitment and subsequent activation of T lymphocytes, mononuclear and polymorphonuclear cells to the site of infection. Tumor necrosis factor (TNF)-α is essential for granuloma formation and is a potent activator of monocyte chemotactic protein (MCP-1, CCL2). CCL2 is essential for recruitment of monocytes and T cells and has been shown to play a role in protection against tuberculosis. Interleukin -8 (CXCL8) is a potent activator of neutrophils. Increased levels of CCL2, CXCL8 and TNFα are reported in tuberculosis but their significance in different forms of tuberculosis is as yet unclear. We have used an ex vivo assay to investigate differences in immune parameters in patients with either pulmonary or extra-pulmonary tuberculosis. METHODS: Serum levels of CCL2, CXCL8 and TNFα were measured in patients with pulmonary tuberculosis (N = 12), extra-pulmonary tuberculosis (N = 8) and BCG-vaccinated healthy volunteers (N = 12). Whole blood cells were stimulated with non-pathogenic Mycobacterium bovis bacille-Calmette Guerin (BCG) vaccine strain or bacterial lipopolysaccharide (LPS) and cyto/chemokines were monitored in supernatants. RESULTS: Circulating serum levels of CXCL8 and TNFα were raised in all tuberculosis patients, while CCL2 levels were not. There was no difference in spontaneous cytokine secretion from whole blood cells between patients and controls. M. bovis BCG-induced ex vivo CCL2 secretion was significantly greater in pulmonary as compared with both extra-pulmonary tuberculosis patients and endemic controls. In response to LPS stimulation, patients with pulmonary tuberculosis showed increased CCL2 and TNFα responses as compared with the extra-pulmonary group. BCG-, and LPS-induced CXCL8 secretion was comparable between patients and controls. CONCLUSION: CCL2 is activated by TNFα and is essential for recruitment of monocytes and T cells to the site of mycobacterial infection. Increased CCL2 activation in pulmonary tuberculosis may result in a stronger cellular response as compared with extra-pulmonary tuberculosis patients, and this may contribute to the localization of infection to the pulmonary site

Minor Oral Surgery with Out Stopping the Daily Low Dose of Aspirin Therapy

OBJECTIVES Patients with the low-dose long-term aspirin regime have a severe risk of excessive bleeding during surgery, placing them at risk of "adverse thrombotic events". This study aims to evaluate the bleeding in patients undergoing minor oral surgery procedures without stopping daily low-dose aspirin therapy. METHODOLOGY A descriptive cross-sectional hospital-based investigation involved the patient with minor oral surgery at "Altamash Institute of Dental Medicine, Karachi, Pakistan" from mid-April 2021 to mid-June 2021, who were between the age group 30 to 75 with a low-dose aspirin regime. The data was collected via a questionnaire to record the variables, i.e. duration of aspirin, postoperative medications, platelets count, clotting time, normal bleeding time, and intraoperative bleeding time.  RESULTS 51 patients, of which 32 were males while 19, were females. The normal bleeding time was comparatively analyzed with the intraoperative bleeding time using SPSS statistical software version 22. The results revealed that the mean bleeding time for the patients with a low-dose aspirin regime during minor oral surgery was 5.49 ± 1.07, while for the patients with a stopped aspirin dose was 4.57 ± 1.07. The comparative analysis using a t-test doesn't reveal significant statistical differences of p<0.05 between both groups. CONCLUSION We concluded that minor oral surgical procedures could safely be done without altering or stopping the low-dose, long-term aspirin regime.

Common Genotypes of Hepatitis B virus prevalent in Injecting drug abusers (addicts) of North West Frontier Province of Pakistan

<p>Abstract</p> <p>Background</p> <p>The epidemiological significance of Hepatitis B virus genotypes has been well established and becoming an essential concern day by day however, much little is known about the mixed infection with more than one Hepatitis B virus genotypes and their clinical relevance.</p> <p>Methods</p> <p>Intravenous drug abusers are considered as a major risk group for the acquisition and transmission of blood borne infections like hepatitis B, however, in Pakistan, no such data has ever been reported about the epidemiology of HBV and its genotypes in Injecting Drug Users. 250 individuals were analyzed for hepatitis B virus genotypes after prior screening with serological assay for the detection of HBsAg.</p> <p>Results</p> <p>56 (22.4%) individuals were found positive on ELSIA for HBsAg. The genotype distribution was found to be as: genotype D, 62.5%; genotype A, 8.92% while 28.57% individuals were found to be infected with a mixture of genotype A and D.</p> <p>Conclusion</p> <p>There is an urgent need of the time to develop public health care policies with special emphasis towards the control of HBV transmission through high risk groups especially Injecting Drug Users.</p

Optimization of predictive performance of intrusion detection system using hybrid ensemble model for secure systems

Network intrusion is one of the main threats to organizational networks and systems. Its timely detection is a profound challenge for the security of networks and systems. The situation is even more challenging for small and medium enterprises (SMEs) of developing countries where limited resources and investment in deploying foreign security controls and development of indigenous security solutions are big hurdles. A robust, yet cost-effective network intrusion detection system is required to secure traditional and Internet of Things (IoT) networks to confront such escalating security challenges in SMEs. In the present research, a novel hybrid ensemble model using random forest-recursive feature elimination (RF-RFE) method is proposed to increase the predictive performance of intrusion detection system (IDS). Compared to the deep learning paradigm, the proposed machine learning ensemble method could yield the state-of-the-art results with lower computational cost and less training time. The evaluation of the proposed ensemble machine leaning model shows 99%, 98.53% and 99.9% overall accuracy for NSL-KDD, UNSW-NB15 and CSE-CIC-IDS2018 datasets, respectively. The results show that the proposed ensemble method successfully optimizes the performance of intrusion detection systems. The outcome of the research is significant and contributes to the performance efficiency of intrusion detection systems and developing secure systems and applications

Serology based disease status of Pakistani population infected with Hepatitis B virus

<p>Abstract</p> <p>Background</p> <p>The infection rate of hepatitis B virus is continuously increasing in Pakistan. Therefore, a comprehensive study of epidemiological data is the need of time.</p> <p>Methods</p> <p>A total of 1300 individuals were screened for HBV infection markers including HBsAg, anti-HBsAg, HBeAg and anti-HBcAg. The association of these disease indicators was compared with patients' epidemiological characteristics like age, socio-economic status and residential area to analyze and find out the possible correlation among these variables and the patients disease status.</p> <p>Results</p> <p>52 (4%) individuals were found positive for HBsAg with mean age 23.5 ± 3.7 years. 9.30%, 33.47% and 12% individuals had HBeAg, antibodies for HBsAg, and antibodies for HBcAg respectively. HBsAg seropositivity rate was significantly associated (<it>p </it>= 0.03) with the residing locality indicating high infection in rural areas. Antibodies titer against HBsAg decreased with the increasing age reflecting an inverse correlation.</p> <p>Conclusion</p> <p>Our results indicate high prevalence rate of Hepatitis B virus infection and nationwide vaccination campaigns along with public awareness and educational programs are needed to be practiced urgently.</p

Molecular epidemiology of Hepatitis B virus genotypes in Pakistan

<p>Abstract</p> <p>Background</p> <p>Eight genotypes of Hepatitis B virus designated A-H, have been known but in Pakistan, no such data is available on the prevalent HBV genotypes. Therefore, the subject study was conducted to determine HBV genotypes in the indigenous Pakistani population.</p> <p>Methods</p> <p>A total of 690 individuals were enrolled for HBV screening with EIA and nested PCR. Positive samples were further analyzed to determine HBV genotypes (A-F) by multiplex-PCR using type specific primers.</p> <p>Results</p> <p>110 (15.94%) individuals were positive for HBV, including 64% males and 36% females. Out of these, 66 samples (65.34%) were classified into genotype D, 27 (26.73%) were of genotype B while 5(4.95%) had genotype A. In 3 (2.98%) samples, multiple genotypes were detected (genotype A+B; 2(1.99%) and genotypes B+D; 1(0.99%). Nine (8.18%) samples remained untyable.</p> <p>Conclusion</p> <p>In Asia, genotypes B and C are the most prevalent but our study reveals that genotype D is predominant and HBV infection constitutes a significant health problem in Pakistan.</p

Epidemiology of injuries from fire, heat and hot substances : global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study

Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.Peer reviewe