Estimation of inorganic constituents in the seeds of blue and white flowering capitulum of Silybum marianum

Silybum Marianum commonly known as milk thistle contains flavonolignans, collectively known as silymarin. The main components of silymarin are silybine, isosilybine, silychristin and silydinine. This study was aimed to estimate inorganic constituents in blue and white capitulum’s seeds from different areas of KPK. Concentration of Na was found to be high (6 mg/kg) in white capitulum seeds from Karak area, while K concentration was high (6 mg/kg) in the blue capitulum seeds from Khyber agency. High concentration of Ca (20 mg/kg) was seen in both white and blue capitulum’s seeds of Khyber agency. Less concentration of NO3 (0.09 mg/kg) was detected in white capitulum seeds from Kohat district and high concentration of SO4 (22.14 mg/kg) was recorded in blue capitulum seeds collected from Peshawar.Key words: Silybum marianum, capitulum’s seeds, inorganic profile

Analysis of chemical constituents in medicinal plants of selected districts of Pakhtoonkhwa, Pakistan

Alkaloids, flavonoids and saponins were determined in the Teraxacam officinale, Cichorium intybus and Figonia tritica. Quantative determinations of crude alkaloids, flavonoids and saponins (g kg-1) and their percentages (%) were determined in C. intybus, T. officinale and F. critica collected from Kohat, Mardan, Nowshera and Peshawar regions. Thin layer chromatography (TLC) study of the alkaloids, flavonoids and saponins were carried out with different solvent systems and color of the spot and Rf value of each constituent was determined. Among the samples of C. intybus, relatively higher contents of alkaloids (14 g kg-1) were found in the sample collected from Mardan region, followed by the sample gathered from Nowshera which is equal to 13.8g kg-1. Higher contents of flavonoids were found in C. intybus collected from Kohat region which was 23.48 g kg-1. The other remaining samples of C. intybus ranged in the decreasing order of 19.7, 17.2 and 10.0 g kg-1 for the ones collected from Nowshera, Mardan and Peshawar, respectively. The overall saponin contents remained almost low as compared to the alkaloid and flavonoid contents.Key words: Alkaloids, flavonoids, saponins, TLC study, medicinal plants

Oral health behind the bars: oral health seeking behavior among jail prisoners at central jail of Peshawar, Pakistan: a cross-sectional study

Background: The oral health care-seeking behavior among prison inmates is an overlooked area, often leading to deteriorating general health due to the prisoners’ limited awareness of oral hygiene practices. It is crucial to address this issue and understand the factors associated with oral healthcare-seeking behavior in prisons. Objective: To assess the oral healthcare-seeking behavior of prison inmates at Central Prisoner Jail, Peshawar Pakistan and to look the factors associated with their dental care utilization. Material and Methods: This cross-sectional study was conducted at Central Prisoner Jail, Peshawar Khyber Pakhtunkhwa, Pakistan from November 2021 to April 2022. A consecutive sampling technique was used to collect data from both convicted and under-trial prisoners by using a pre-tested WHO Basic Oral Health Survey 2013 tool. Our outcome variable was “Visit to a dentist in the last 12 months (Never/Once or more than one visit). Chi-square test was used to determine univariate association with other explanatory variables while multivariable logistic regression was performed to adjust for potential confounders. Result: A total of 225 participants were recruited to the study with a mean (SD) age of 32.9(11.4). More than two-thirds of 200(88.9%) of the participants were males. One-third of the sample never visited the dentist75(33.3). Participants who completed college/university education and never visited the dentist in the last 12 months constituted a smaller proportion (17.6%) compared to those who visited the dentist once or more than once n = 28(82.4%, p-value = 0.003). Individuals who were using toothbrushes were most frequently visiting the dentist n = 130(72.6%=p value = 0.001) as compared to never visitors. Multivariate logistic regression analysis revealed that Participants who experienced teeth pain or discomfort had 0.42 times lower odds of visiting the dentist compared to those who did not experience any pain or discomfort [AOR 0.42 (95% CI 0.17–0.80), p = 0.04]. Similarly, Participants who do not use any denture have 4.06 times higher odds[AOR 4.06(95% CI 1.76–9.36), p = 0.001] of visiting the dentist compared to those who use a denture. Conclusion: Our result demonstrates that those prisoners who were experiencing tooth pain or discomfort and not using dentures were the strong predictors with lower dental visit frequency to seek oral health care

Heavy metals and inorganic constituents in medicinal plants of selected Districts of Khyber Pakhtoonkhwa, Pakistan

Heavy metals such as Cr, Fe, Zn, Mn, Ni, Pb, Cu and Cd, and inorganic ions like HCO3-, CO32-, Ca2+, Mg2+, Cl-, Na+, SO42-, NO3-, Fe2+ and F- were investigated in medicinally important plants: Taraxacam officinale, Cichorium intybus and Figonia critica, applying atomic absorption spectrophotometer techniques. In the studied herbs, there were variable amounts of heavy metals and inorganic ions. The purpose of this study was to standardize heavy metals contamination in various indigenous medicinal plants and to create awareness among the public regarding its safe use at collection areas (containing high level of heavy metals) and their adverse health effects.Key words: Medicinal plants, inorganic constituents, heavy metals, atomic absorption spectrophotometer

Phytochemical analysis of selected medicinal plants

Four medicinal plants including Ranunculus arvensis, Equisetum ravens, Carathamus lanatus and Fagonia critica were used for the study. All the plants were biologically active and were used for different types of ailments. Keeping in view their importance, this work was carried out to investigate the quantitative determination of their crude phytochemicals, vitamins and protein contents. The quantitative determination of crude phytochemicals (alkaloids, total phenols, flavonoids and saponins) vitamins (riboflavin, vitamin C, niacin and pectin) and protein were determined in the aforementioned herbs. The phytochemicals including alkaloids, total phenols, flavonoids and saponins were determined quantitatively using literature methods. Vitamins were measured using a UV/ visible spectrophotometer (UV- 1601 Shamidzu) and the protein was determined by the Micro KJeldahl’s method (Horwitz et al., 2000). The studied plants showed variable amounts of phytochemicals, vitamins and protein contents. The study is very important, in that it intended to show the contents of the studied medicinal herbs and also provide a scientific data base line which is of particular importance for the local practioners as well as for the local people using these herbs for a variety of body disorders.Key word: Phytochemical analysis, medicinal plants, Pakistan

Analysis of associated risk factors among recurrent cutaneous leishmaniasis patients: A cross-sectional study in Khyber Pakhtunkhwa, Pakistan

Background Leishmaniasis is the second and fourth highest cause of mortality and morbidity respectively among all tropical diseases. Recurrence in the onset of leishmaniasis is a major problem that needs to be addressed to reduce the case fatality rate and ensure timely clinical intervention. Here we are investigating the association of risk factors with recurrent cutaneous leishmaniasis to address this issue. Material and methods Patients received by Nasser Ullah Khan Babar Hospital in Peshawar, Pakistan from March 2019 to July 2020 were enrolled in this study. Those patients who developed symptoms after completion of treatment were included in Group-A while those who had atypical scars like leishmaniasis but were negative for cutaneous leishmaniasis were included in the comparison group tagged as Group B. All those individuals who had completed six weeks of treatment for CL but had normal complete blood counts (CBC) were included to avoid other underlying immunological pathologies, while we excluded those participants who had co-morbidities like diabetes, liver disease, cardiac disease, and pregnant and lactating women through their history Association was tested between Group-A and Group-B with other explanatory variables through chi-square test. The regression model was proposed to determine the predictors. Result A total of 48 participants of both sexes were included in the study with a mean age of 32.2 ± 15.10. The data suggest that females are overrepresented among the patients with recurrent leishmaniasis [21(53.8 %,); p = 0.07]. Compared to patients; healthy participants had a higher proportion of adults (19–59 years) versus adolescents (13–18 years) [26(66.7 %) vs 07(17.9), p = 0.004]. Multivariate logistic regression analysis shows that females are 2.1 times more prone to infections among cases as compared to healthy individuals [unadjusted OR 2.20, 95 % confidence interval (CI) 1.5–10.6, p = 0.02; adjusted OR 2.1, 95 % CI 1.50–10.69, p = 0.02]. We propose that patients receiving intradermal were less likely to be infected as compared to those receiving intralesional injections [unadjusted OR 0.07.0, 95 % confidence interval (CI) 1.18–3.37, p = 0.03; adjusted OR 0.06, 95 % CI 1.18–3.38, p = 0.03]. Conclusion Old age (adults) and sex (females) were the strongest predictors to be associated with recurrent leishmaniasis. Similarly, the choice of intradermal as compared to intralesional injection and the prolonged treatment duration were strongly associated with greater chances of recurrence

Prevalence of Parental refusal rate and its associated factors in routine immunization by using WHO Vaccine Hesitancy tool: A Cross sectional study at district Bannu, KP, Pakistan

Objective To determine the parents refusal rate, associated factors and the perceptions of refusal parents in routine immunization by using “WHO SAGE Working Group on Vaccine Hesitancy survey tool”. Material and Methods A cross sectional survey was conducted by using multi stage cluster sampling at the remote district Bannu Khyber Pakhtunkhwa Province, Pakistan from March 2019 to July 2019.A WHO validated questionaire was used. Our outcome variable was “Ever refusal from routine immunization (yes/No)”.logistic regression was run for association and multi regression was applied to see counfounders. Result Out of total 610 parents, the refusal rate was 170(27.9%).Mostly the mother of the children has no education 145(85.3%,P 0.03).Mother has no mobile but the father has 152(89.4%, p=<.001) higher frequency to have mobile. The refusal rate was high in those having secure food 88(51.8%) as compare to minimal 62(36.5%) and highly insecure food 20(11.8%,P=<.05).On multivariate logistic regression, those father who were employee (adjusted OR = 0.59; 95% CI 0.37 to 0.94; p = 0.02) and having higher education (adjusted OR = 0.21; 95% CI 0.08 to 0.50; p=<.001) were less likely to refuse to vaccinate their children while in contrast those having highly insecure food were more likely to refuse (adjusted OR = 2.2; 95% CI 1.0 to 0.50; p = 0.04) as compare to minimal insecure food (adjusted OR = 1.6; 95% CI 1.0 to 2.5; p = 0.02). Conclusion Refusal rate among parents was very high while those parents who’s can’t read or write and with no education, having mobile phone, unemployment and secure food were more to be associated with refusal

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The Impact of COVID-19 Pandemic on the Psychological Health and Dental Practice of Oral Healthcare Workers: A Scoping Review

Farooq Ahmad Chaudhary,1 Ayesha Fazal,1 Basaruddin Ahmad,2 Osama Khattak,3 Mawra Hyder,1 Muhammad Mohsin Javaid,1 Azhar Iqbal,3 Rakhi Issrani4 1Department of Community Dentistry, School of Dentistry (SOD), Federal Medical Teaching Institution (FMTI)/PIMS, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan; 2School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia; 3Department of Restorative Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia; 4Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi ArabiaCorrespondence: Farooq Ahmad Chaudhary, Department of Community Dentistry, School of Dentistry (SOD), Federal Medical Teaching Institution (FMTI)/PIMS, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan, Tel +92 3325560644, Email [email protected]: This study aims to identify the impact of the COVID-19 pandemic on the psychological health and dental practice of oral health-care workers (OHCWs). The search for relevant literature was carried out online using PubMed, Web of science, and science direct databases from January 2020 to February 2021. Those articles were included that provided complete information about the impact of the COVID-19 pandemic on oral health-care workers during covid-19 and were original articles and reviews. Those articles were excluded from the current study that was not in English Language and involved case reports/book chapters/short communications. Finally, only 8 articles were selected for the scoping review considering that complete information regarding the provision of dental care in the time of COVID-19 was provided. Increased psychological distress (especially those with existing comorbidities) was noted among the OHCWs during this pandemic. They had enough knowledge about COVID-19 and showed concern regarding the future of dentistry. Either complete or partial closure of dental clinics had introduced financial constraints among them. However, the majority of them did not switch their profession. The institutions were not prepared for any such situation and no training was conducted to control the spread of COVID-19 infection. OHCWs are fully aware of the knowledge regarding COVID-19 and showed concerns for dentistry and dental health-care workers during this pandemic. Complete or partial closure of dental clinics has had adverse effects on the future of dentistry, economically as well as psychologically. Institutions need to upgrade and strengthen their systems to cater to any such situation efficiently. Proper counseling sessions should be conducted for the OHCWs to monitor, identify and treat the cases found.Keywords: dental practice, oral healthcare workers, COVID-19, psychological health, comorbiditie

Diabetic ketoacidosis amongst patients with COVID-19: a retrospective chart review of 220 patients in Pakistan

Objectives To determine the frequency of diabetes mellitus and diabetic ketoacidosis and associated factors in COVID-19-positive patients. Background High mortality amongst SARS-Cov2 patients may be attributed to diabetes and diabetic ketoacidosis. Methods A total of 220 COVID-19 positive patients, hospitalized in North West General Hospital & Research Center, Peshawar, KP, Pakistan, from April to September 2020, were analysed using STATA 14. Patients with positive PCR were labelled as COVID-19 positive and were included in the study. Patients with a clinical picture of COVID-19 and negative PCR were excluded from the study. Those having ketonemia >0.6 and random blood glucose level >250mg/dl, while HCO3 (bicarbonate) ≤18, were labelled as diabetic ketoacidosis. The statistical significance level was set at p < .05. Results A total of 220 COVID-19 patients were admitted; 166 (75.4%) were male and 54 (24.5%) were female. The mean age in years of the patients was 55.95 (SD13.9). About 57.7% of patients had diabetes mellitus, and 15 (6.8%) patients developed diabetic ketoacidosis. Amongst those with DKA, 5 patients died during hospital admission. The use of steroids was significantly higher (p < .001) in the DKA group compared with non-DKA patients. Hypertension (103,46.8%) and fever (170,77.3%) were the most reported comorbidity and symptom respectively. Conclusion The proportion of diabetes mellitus is high in patients with COVID-19. Diabetic ketoacidosis is a frequent complication in this group associated with in-hospital mortality. Steroid administration for COVID-19 should be balanced with strict glycemic control to prevent diabetic ketoacidosis and increase hospital survival