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Urinary tract infections (UTIs) are one of the major healthcare concerns causing an alarmingly high medical and financial burden in both developing and developed countries. There is a significant rise in multidrug-resistant (MDR) uropathogens, both in hospitalized and community settings, which threatens safe and effective therapy of these infections. The increased rates of resistance in UTIs requires the continuous surveillance of uropathogens in the specific area to inform safe and effective therapy. The present, retrospective, cross-sectional, descriptive study was carried out using samples collected between 01/06/2019 and 31/05/2020 in Karachi, Pakistan, during which, n = 1500 urine samples were collected. The samples were processed on Cystine Lactose Electrolyte Deficient (CLED) agar, identification was carried out by using standard biochemical tests and API 20E/20NE strips. Antimicrobial susceptibility testing was performed using standard disk diffusion test protocol, as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Overall, n = 1189 urine samples (79.27%) showed significant bacterial growth. The median age of affected patients was 56 years (range: 1-100) with n = 811 females (68.21%), with patients between 61-80 years (n = 384; 32.29%) as the most numerous age group. Regarding uropathogen distribution, the overwhelming majority were Gram-negative bacteria (n = 986; 82.93%), the most common causative agent being Escherichia coli (n = 648; 54.49%), followed by Klebsiella spp. (n = 206; 17.33%) and Enterococcus spp. (n = 118; 9.92%). Resistance rates were highest for the tested fluoroquinolones (>70% for most species), trimethoprim-sulfamethoxazole, broad-spectrum penicillins, and cephalosporins, while fosfomycin, carbapenems and colistin largely retained their efficacy. The mitigation of UTIs and the emergence of resistance may be impeded by taking appropriate measures for the better management of patients; these interventions include improvements in the treatment recommendations, provision of health education, and continuous antimicrobial surveillance. [ABSTRACT FROM AUTHOR]

Antimicrobial stewardship is a systematic approach for promoting and monitoring responsible antimicrobial use globally. We conducted a prospective point prevalence survey of antimicrobial utilization among hospitalized adult patients during September 2021. The survey instrument was adapted from the WHO methodology for point prevalence surveys, and it was conducted at The Indus Hospital and Health Network, Karachi. Among the 300 admitted patients, 55% were males and the mean age was 44 (±18) years. At least 67% of the patients received one antimicrobial agent and the most common indication was surgical prophylaxis (40%). The most frequently used were antibacterial agents (97%) among all antimicrobials. Amoxicillin/Clavulanic acid and Ceftriaxone were the most frequently used antibacterial agents, i.e., 14% each. At least 56% of the antibacterial agents were amenable to antimicrobial stewardship when reviewed by infectious disease (ID) experts. Reasons for stewardship were: antibacterial not indicated (n = 39, 17.0%), unjustified prolonged duration of antibacterial (n = 32, 13.9%), extended surgical prophylaxis (n = 60, 26.2%), non-compliance to surgical prophylaxis guidelines (n = 30, 13.1%), and antibacterial not needed on discharge (n = 27, 11.7%). Median days of therapy (DOT) per agent was 3 days (IQR 2–4), while median DOT per patient was 2 days (IQR 1–4). These data have described the pattern of antimicrobial utilization in our institute. We found a higher prevalence of antimicrobial use overall as compared to the global figures, but similar to other low- and middle-income countries. Two important areas identified were the use of antimicrobials on discharge and extended surgical prophylaxis. As a result of these data, our institutional guidelines were updated, and surgical teams were educated. A post-intervention survey will help us to further determine the impact. We strongly recommend PPS at all major tertiary care hospitals in Pakistan for estimating antimicrobial utilization and identifying areas for stewardship interventions. [ABSTRACT FROM AUTHOR]

Objective: To determine deficiency of vitamin B12 among patients on metformin due to type II diabetes mellitus. Study Design: Cross Sectional Observational study. Setting: Department of General Medicine, Naz Memorial Hospital, Karachi. Period: April 2020 to March 2021. Material & Methods: After ethical approval and informed consent patients of type II diabetes on single oral hypoglycemic drug metformin for at least six months, in-between 25-60 years of age, on 850 mg metformin twice a day were included. Patients with history of metformin use in addition to another oral hypoglycemic drug were excluded. SPSS was used for data analysis. Quantitative data was expressed as mean and standard deviation and qualitative variables as frequency and percentages. Chi-square test was applied keeping p-value <0.05 as statistically significant. Results: Among 240 patients, mean age of patients was 44.62 ± 5.5 years with a mean BMI of 30.91 ± 2.74 kg/m2. Mean hemoglobin was 11.5 ± 1.3 g/dl and mean hematocrit of 34.77 ± 5.58%, mean glycosylated hemoglobin 7.34 ± 0.73%, mean duration of diabetes mellitus 2.60 ± 0.7 years and mean use of metformin was 1.99 ± 0.7 years. Mean level of vitamin B12 was 240 ± 76.6 pg/ml. Normal vitamin B12 level, >300 pg/ml was observed in 41 (17.1%), borderline level in 97 (40.4%) while deficiency in 102 (42.5%) of patients. Conclusion: Majority of patients were found to have either borderline or deficiency of vitamin B12. Furthermore, amongst the patients having vitamin B12 deficiency, a significant difference in-between the deficiency of vitamin B12 was found among females when compared to males. [ABSTRACT FROM AUTHOR]

Fifty five percent of the Pakistani population is still unvaccinated with the two-dose protocol of COVID-19 vaccines. This study was undertaken to determine the seroconversion rate and antibody titers following the two-dose BBIBP-CorV protocol, and to compare these variables in unvaccinated, COVID-19 recovered individuals (total n = 180) at Indus Hospital and Health Network, Karachi. Pseudotyped lentivirus antibody neutralization assays and SARS-CoV-2 IgG Quant II (Abbott) immunoassays were performed 4-8 weeks following the second dose of the BBIBP-CorV or PCR positivity/onset of symptoms of COVID-19. Seroconversion rate, using neutralization assays, in vaccinated individuals was lower (78%) than that in unvaccinated, COVID-19-recovered individuals with moderate to severe infection (97%). Prior PCR positivity increased serocoversion rate to 98% in vaccinated individuals. Immunoassays did not, however, reveal significant inter-group differences in seroconversion rates (≥95% in all groups). Log10 mean antibody neutralizing titers following the two-dose BBIBP-CorV protocol (IC50 = 2.21) were found to be significantly less than those succeeding moderate to severe COVID-19 (IC50 = 2.94). Prior SARS-CoV-2 positivity significantly increased post-vaccination antibody titers (IC50 = 2.82). Similar inter-group titer differences were obtained using the immunoassay. BBIBP-CorV post-vaccination titers may, thus, be lower than those following natural, moderate to severe infection, while prior SARS-CoV-2 exposure increases these titers to more closely approximate the latter. [ABSTRACT FROM AUTHOR]

Objectives: To assess the clinical, environmental, and socio-demographic characteristics leading to gender disparity in tuberculosis in Pakistan. Study Design: Prospective Comparative study. Study Setting and Duration: The Indus Hospital, Karachi Pakistan, from Jul 2020 to Dec 2020. Methodology: A sample of 200 patients with diagnosed tuberculosis (detected on an acid-fast bacillus (AFB) smear with radiographic abnormalities) irrespective of gender, sensitivity, or site of tuberculosis, were included in the study. Data of gender, personal history, substance abuse history, and dietary habits was documented. Results: Pulmonary tuberculosis was significantly more common in female patients than in males (p<0.001). The mean age of male patients was 30.16 ± 9.47 years. Male patients were significantly older than their female counterparts (p=0.003). The diabetes mellitus in male patients was significantly higher than in female patients with TB (p=0.01). Similarly, substance abuse history was more frequently positive in male patients as compared to female patients, 28 (40.60%) vs 9 (6.70%); p-value <0.001. There was no significant difference in the occurrence of drug-resistance tuberculosis between the two genders. However, pulmonary tuberculosis was significantly more common in female patients than in males (p<0.001). Conclusion: We reported some distinctive differences between male and female tuberculosis patients. Young females had more predilections toward tuberculosis as compared to men. Diabetes mellitus and substance abuse history were more common in male tuberculosis patients than in females. [ABSTRACT FROM AUTHOR]

Background: Workaholism (WH) is related with high mental trouble and physical objections, low employment and family fulfillment, and low occupation execution; however, work commitment is related with job and life satisfaction. This study aimed to assess the impact of WH and work engagement (WE) on medical university employee job stress and satisfaction. Methods: This descriptive analytical study was conducted on workers employed in medical universities using validated questionnaires for data collection. The sample size was 330, from which 305 responded with completed questionnaire. The employees were the direct workers of different accessible medical universities in Karachi, Pakistan. The employee enrolment and distribution of the questionnaire was performed using non-probability convenient sampling. The Brief Job Questionnaire (BJQ), Dutch Work Addiction Scale (DUWAS) and Utrecht Work Engagement Scale (UWES) were used to assess the impact of job stress on job satisfaction and WE. The data was analyzed by applying descriptive statistics, Spearman correlation and regression analysis. A p-value of = 0.05 was taken as significant. Results: The study consisted of 117 (38.4%) male and 188 (61.6%) female participants; the mean age of participating employee was 28.50 ± 6.192. The mean score for WE was 3.78 ± 0.467, that of WH was 3.42 ± 0.559, for JS was 4.29 ± 0.400, whereas JSF was 3.10 ± 0.591. A positive correlation was observed between job stress, WH and WE. WH had a strong correlation with job stress and weak correlation with job satisfaction and performance. A significant difference was observed between WE and WH among males and females. Conclusions: The study presented with a significant effect of job satisfaction with WH and WE with job stress. Hence, indicating the importance of social skills and WE with fellow employees to increase the work productivity and performance. However, in case of over work and WH, an increase of job stress is inevitable. [ABSTRACT FROM AUTHOR]

Background and Objective: Unceasing rise in cases of enteric fever, in particular extensively drug resistant (XDR) strain of Salmonella enterica, has led to a growing threat, leaving only carbapenems and azithromycin as the precious option. In this regard, we determined the burden and clinical course of XDR salmonella in comparison to multidrug-resistant (MDR) and drug sensitive (DS) strains. Methods: A retrospective chart review of 1515 Salmonella Typhi (S.typhi) culture positive patients was conducted at Indus Hospital and Health Network, Karachi from July 2017 to December 2018. Results: During our study, we observed children at the age of 5-6 years and adults at the age of 20-22 years were the chief targets of S.typhi. Further, we witnessed a rapid shift of drug resistance from MDR to XDR over the one year of study. Almost all patients presented with fever. However other signs and symptoms like malaise, body aches, anorexia, diarrhea, vomiting and abdominal pain were more common in XDR Typhoid patients. Further, the need of hospitalization, total hospital stay and mortality was also greater for XDR typhoid patients. Conclusion: There is a crucial requirement for consolidated steps to curtail the spread of XDR Salmonella tyhi disease as its management is challenging, and it is associated with increased morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the mental health status of undergraduate’s students of three different programs. To correlate the related factors influencing GAD-7 score and to assess the coping methods practiced by undergraduates during COVID-19 outbreak. Study Design: Cross-sectional survey. Place and Duration of Study: COVID-19 lock down period among public and private universities in Karachi, from 10th May to 30th May 2020. Methodology: It was conducted among the medical, dental and engineering students of private sector universities of Karachi. The GADS-7 (Generalized anxiety disorder scale 7-items) validated tool was used along with the demographic variables, related stress factors and the coping skills practiced. Total 571 questionnaires were found completed in all sections. Results: From the total students 132 (23.1%) experienced mild, 343 (60.1%) moderate and 78 (13.7%) had severe anxiety level on GADS-7. All related stressors were significantly associated with GAD-7 scale at p-value of <0.01. Moreover the results depicted that there was a moderate positive correlation found (0.489, 0.342, 0.310 and 0.328) for all related stressors. Taking breaks from watching, reading news about outbreak of COVID-19, meditation and engaging in some other activities were the most frequently used coping strategies among undergraduates’. Conclusion: Study has shown 96.9% drastically augmented level of anxiety. There was significant difference found in mental health of all three cohorts. There was a moderate positive correlation found for all related stressors. Taking breaks from watching, reading news about the outbreak of COVID-19 was the most frequent coping behavior practiced by all students. [ABSTRACT FROM AUTHOR]

The research is about an evaluation of financial performance of cement companies of Karachi through debt financing. The research comprises of listed companies in the Pakistan stock exchange, from year 2010 to 2017. The data when analyzed statistically reveals that the firms have an impact on firm level variables. The keywords used in this paper is financial performance and debt. Cement companies of Karachi include Lucky Cement Ltd, Power Cement Ltd, Attock Cement Ltd, Deewan Cement Ltd, Thatta Cement Ltd &Cherat Cement Ltd. Variables study in this research are independent variables and dependent variable. Short term debt, Long term debt & Total debt are the independent variables whereas Debt to Asset or Debt to Equity is the dependent variable of this research. The technique use in this research is regression. It shows that debt has a significant negative relationship with firm performance. [ABSTRACT FROM AUTHOR]

The ecosystem of earth, the habitation of 7.53 billion people and more than 8.7 million species, is being imbalanced by anthropogenic activities. The ever-increasing human population and race of industrialization is an exacerbated threat to the ecosystem. At present, the global average waste generation per person is articulated as 494 kg/year, an enormous amount of household waste (HSW) that ultimately hits 3.71 × 10 12 kg of waste in one year. The ultimate destination of HSW is a burning issue because open dumping and burning as the main waste treatment and final disposal systems create catastrophic environmental limitations. This paper strives to contribute to this issue of HSW management that matters to everyone's business, specifically to developing nations. The HSW management system of the world's 12th largest city and 24th most polluted city, Karachi, was studied with the aim of generating possible economic gains by recycling HSWs. In this regard, the authors surveyed dumping sites for sample collection. The sample was segregated physically to determine the content type (organic, metals, and many others). Afterward, chemical analysis on AAS (Atomic Absorption Spectrophotometry) of debris and soil from a landfill site was performed. HSW is classified and quantified into major classes of household materials. The concentrations of e-waste [Cu], industrial development indicator [Fe], and the main component of lead-acid storage batteries [Pb] are quantified as 199.5, 428.5, and 108.5 ppm, respectively. The annual generation of the aforementioned metals as waste recovery is articulated as 1.2 × 106, 2.6 × 106 and 6.5 × 105 kg, respectively. Significantly, this study concluded that a results-based metal recovery worth 6.1 million USD is discarded every year in HSW management practices. [ABSTRACT FROM AUTHOR]

The study was carried out to evaluate the awareness among the diabetic patients about oral hygiene maintenance because these patients are immunocompromised and more susceptible to periodontal disease. This study was conducted on patients who came for their dental checkup at Altamash Institute of Dental Medicine, Karachi from 22nd January to 2nd March 2019.The structured questionnaire was filled by 120 diabetic patients. A structured questionnaire was used to asked their name, age, gender, occupation, employment, education and residential area and were recorded in the questionnaire. Complete medical and dental history of every patient was taken. It was further categorized to assess the knowledge and awareness of oral hygiene. The outcomes of the questionnaire were analyzed using SPSS 20. [ABSTRACT FROM AUTHOR]

Solid waste management needs re-evaluating in developing countries like Pakistan, which currently employs landfilling as a first option. Over time, increasing population will result in decreasing space for landfill sites, ultimately increasing the cost of landfilling, while increasing accumulated waste will cause pollution. Locating and preparing a sanitary landfill includes the securing of large sectors and also everyday activity with the end goal to limit potential negative impacts. Energy production from municipal solid waste (MSW) is a perceptive idea for large cities, such as Karachi, as waste, which is an undesirable output that adds to land and air pollution, is transformed into a vital source of energy. The current study strives to provide a destination to solid waste by evaluating the energy potential that waste provides for power generation by the process of incineration. A sustainable energy generation plant based on the Rankine cycle is proposed. This study evaluates the various landfill sites in the case study area to determine their sustainability for a waste to energy (WtE) plant. The implementation of the proposed plant will not only provide an ultimate destination to waste but also generate 121.9 MW electricity at 25% plant efficiency. Thus, the generated electricity can be used to run a WtE plant and meet the energy requirements of the residents. [ABSTRACT FROM AUTHOR]