Clino-pathological features of urinary tract infection: a study at Nishtar University Hospital Multan, Punjab, Pakistan

Background: Urinary tract infection (UTI) is a common clinical issue among pediatric population and might progress into renal scaring, hypertension as well as end stage kidney disease. This study was aimed at finding clino-pathological features of UTI and antibiotic sensitivity against most common causative agents involved at a tertiary care hospital of South Punjab, Pakistan.Methods: This descriptive case series study was conducted at department of Paediatric Medicine, Nishtar University Hospital Multan from July to December 2019. A total of 100 children fulfilling the inclusion criteria, presenting in outpatient department or emergency section of paediatric medicine department, having positive urine culture and sensitivity were selected. Their detailed history, clinical examination and relevant investigations were done.Results: Out of the 100 children, 73 (73.0%) were female and 27 (27.0%) were male. There were 57 (57.0%) children from 1 year to 4 years age group and 43 (43.0%) were of more than 4 years. Most common clinical presentations were fever 83 (83.0%), urinary symptoms, vomiting 52 (52.0%) and pain abdomen 48 (48.0%). Most common aetiological agents were Escherichia coli 74 (74.0%) and Klebsiella pneumoniae 9 (9.0%).Conclusions: UTI is more common in female children. Most common presentation observed was fever and/or urinary symptoms while most common aetiological agent was E. coli

ENHANCING CLIMATE RESILIENCE IN AGRICULTURAL PRACTICES: THE ROLE OF AGRICULTURAL EXTENSION WORKERS IN DISTRICT RAHIM YAR KHAN, PUNJAB, PAKISTAN

Abstract In recent years, the intricate relationship between climate change and its profound impact on agricultural productivity has garnered increasing attention, particularly concerning the pivotal role played by agricultural extension workers. This study delves into climate change mitigation strategies within the realm of agriculture, with a specific focus on the instrumental contributions of agricultural extension workers. Climate change presents a multifaceted challenge to global agricultural systems, exerting significant influences on productivity, crop yields, and food production. Amid these challenges, agricultural extension workers emerge as central figures bridging the chasm between technical knowledge and practical adaptation methods for farmers. This qualitative investigation draws upon a synthesis of existing research and incorporates insights from key informant interviews. By shedding light on the intricate interplay between climate change, agricultural productivity, and the pivotal function of agricultural extension workers, this research aspires to provide a comprehensive understanding of the dynamic relationships between these variables. By facilitating the adoption of climate-resilient techniques, such as cultivating drought-resistant crop varieties, implementing water-efficient irrigation methods, and promoting agroforestry, extension workers empower farmers to mitigate the severe impacts of climate change. Furthermore, extension workers play a pivotal role in bolstering farmers' adaptive capabilities and equipping them with essential skills to navigate increasingly volatile climatic conditions. Studies underscore that farmers who receive training from extension workers report heightened confidence in successfully implementing climate-adaptive strategies

Does academic assessment system type affect levels of academic stress in medical students? A cross-sectional study from Pakistan

Introduction Stress among medical students induced by academic pressures is on the rise among the student population in Pakistan and other parts of the world. Our study examined the relationship between two different systems employed to assess academic performance and the levels of stress among students at two different medical schools in Karachi, Pakistan. Methods A sample consisting of 387 medical students enrolled in pre-clinical years was taken from two universities, one employing the semester examination system with grade point average (GPA) scores (a tiered system) and the other employing an annual examination system with only pass/fail grading. A pre-designed, self-administered questionnaire was distributed. Test anxiety levels were assessed by The Westside Test Anxiety Scale (WTAS). Overall stress was evaluated using the Perceived Stress Scale (PSS). Results There were 82 males and 301 females while four did not respond to the gender question. The mean age of the entire cohort was 19.7±1.0 years. A total of 98 participants were from the pass/fail assessment system while 289 were from the GPA system. There was a higher proportion of females in the GPA system (85% vs. 59%; p \u3c 0.01). Students in the pass/fail assessment system had a lower score on the WTAS (2.4±0.8 vs. 2.8±0.7; p=0.01) and the PSS (17.0±6.7 vs. 20.3±6.8; p \u3c 0.01), indicating lower levels of test anxiety and overall stress than in students enrolled in the GPA assessment system. More students in the pass/fail system were satisfied with their performance than those in the GPA system. Conclusion Based on the present study, we suggest governing bodies to revise and employ a uniform assessment system for all the medical colleges to improve student academic performance and at the same time reduce stress levels. Our results indicate that the pass/fail assessment system accomplishes these objectives

PREVLANCE AND PRESCRIBING TRENDS OF ANTI-DIABETIC DRUGS IN TYPE 2 DIABETES MELLITUS ACCORDING TO STANDARD TREATMENT GUIDELINES IN DIFFERENT HOSPITALS OF LAHORE

The objective of study was to identify the prevalence and prescribing trends of anti-diabetic drugs in type 2 diabetes mellitus according to standard treatment guidelines in different hospitals of Lahore. In this retrospective observational study, data was collected from prescriptions of ambulatory diabetic patients by different physicians practicing in different public sector hospitals of Lahore, from February 2016 to April 2016. For this purpose 100 prescriptions were evaluated from various hospitals of Lahore, Pakistan. Type 2 Diabetes Mellitus is more prevalent in 40-50years age group. Mono oral therapy which includes Metformin is more prescribed by physician as compared to any other groups of drugs. According to our study, standard guidelines were followed for biguanides which is first line therapy type 2 diabetes mellitus.&nbsp

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

The Pakistan risk of myocardial infarction study: A resource for the study of genetic, lifestyle and other determinants of myocardial infarction in south Asia

The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March 2009, PROMIS had recruited over 5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over 5,000 matched controls aged 30-80 years. For each participant, information has been recorded on demographic factors, lifestyle, medical and family history, anthropometry, and a 12-lead electrocardiogram. A range of biological samples has been collected and stored, including DNA, plasma, serum and whole blood. During its next stage, the study aims to expand recruitment to achieve a total of about 20,000 cases and about 20,000 controls, and, in subsets of participants, to enrich the resource by collection of monocytes, establishment of lymphoblastoid cell lines, and by resurveying participants. Measurements in progress include profiling of candidate biochemical factors, assay of 45,000 variants in 2,100 candidate genes, and a genomewide association scan of over 650,000 genetic markers. We have established a large epidemiological resource for CHD in South Asia. In parallel with its further expansion and enrichment, the PROMIS resource will be systematically harvested to help identify and evaluate genetic and other determinants of MI in South Asia. Findings from this study should advance scientific understanding and inform regionally appropriate disease prevention and control strategies

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Study of the ornamentation of Bhong Mosque for the survival of decorative patterns in Islamic architecture

Islamic architecture is rich in decorative patterns. Mosques were constructed in the past as simple buildings for offering prayers five times a day. However, in subsequent periods, various features of ornamentation in the form of geometry and arabesque were applied to the surfaces of mosques to portray paradise symbolically. This research applied descriptive approaches to examine the surviving patterns of the Aga-Khan-awarded Bhong Mosque and categorized these patterns as geometric and arabesque. This categorization was achieved by photography, use of software for patterns, and conducting interviews with local elderly persons in the region. The geometric patterns were simple 6- and 8-point star patterns. Several of the earliest examples of rosette petals exhibited 8- and 10-point star patterns and were categorized by incorporating the geometric style and location of mosques. This research investigated different arabesque categories and inscription types and determined the aesthetic and cultural reasons for their placement on various surfaces. Frescoes had different types of flowers, fruits, and leaves, and a few of them belonged to the local region. Keywords: Bhong Mosque, Decorative patterns, Categorization, Geometry, Arabesqu

Laboratory Diagnosis of Malaria: Comparison of Manual and Automated Diagnostic Tests

Malaria is the second most prevalent disease in Pakistan resulting in ~30,000 annual deaths. In endemic countries like Pakistan precise and timely diagnosis of malaria is imperative to overcome the associated risks of fatal outcomes. Malarial parasite was screened in 128 malaria suspected patients and 150 healthy controls, by species-specific PCR, microscopy of blood smears, hemoanalyzer Sysmex XE-2100, and rapid test devices (First Response Malaria® and ICT Malaria Combo®). The microscopy detected MP in 126 samples (parasite load/µl 386–53712/µl); 71.094% were infected with Plasmodium vivax and 14.844% with P. falciparum while 14.062% had mixed P. vivax and P. falciparum infection. The mean parasite load for P. vivax and P. falciparum was 14496/µl and 24410/µl, respectively. The abnormal scattergrams of DIFF, WBC/ Baso, IMI channel, and RET-EXT on Sysmex XE-2100 supported 99.2% parasite detection, whereas only 93% of confirmed malaria cases were detected by both rapid tests. About 127 samples were positive by PCR. Since Sysmex XE-2100 automatically detected the presence of malarial parasite with high sensitivity, it can be a good option for presumptive diagnosis in endemic areas. Microscopy remains the gold standard to confirm MP in suspected patients. Rapid diagnostic tests have acceptable sensitivity and specificity

Rural Women Contribution in Providing and Increasing Domestic Food and Nutrition Security. A Correlational Study of Rural Areas of South Punjab, Pakistan

Women play a crucial role in sustainable rural development and agriculture. Despite suffering severe inequalities, worldwide women are crucial for ensuring security of food. Women have a variety of roles in the food system including as producers, entrepreneurs, leaders, and consumers. It is essential to be taken into consideration when discussing gender equity and gender mainstreaming. Rural women play a significant role in each of the four components of food security: availability, accessibility, utilization, and stability. Therefore, this study explores the different contributions that rural women make as the key contributor of achieving and enhancing domestic food security. Women who currently reside in rural south Punjab, Pakistan, aged 18 to 60, make up the study's population. A well-structured interview schedule was used to obtain primary data from 200 houses in the research area. For the purpose of gathering data, a multistage random sampling technique was used. Dera Ghazi Khan and Jampur were the two randomly chosen districts. Two tehsils were randomly chosen for the second stage. In the third step, five villages were selected at random from each tehsil. The data analysis employed both descriptive statistics and the logit regression model. Results show that women contributed to domestic food security through their involvement in food production and preparation, the purchase of food products for intake and storage. According to empirical findings, 40% of households were food secure while 60% of households experienced food insecurity. The outcome also shows that household food security in the research area was significantly influenced by age, education, income, and household size. Study suggested that women's education, knowledge about food consumption and paid employment status should be improved for increasing domestic food security.KEYWORDSRural women, providing and increasing, domestic food and nutrition security, south Punjab Pakistan.