Search

Background: Pakistan is a multi-cultural country with different ethnic groups living in both rural and urban communities. There is a significant occurrence of congenital and hereditary neurodevelopmental disorder (NDD) contributing to mortality and morbidity rates., Objectives: This study aims to explore the prevalence, patterns, and phenotypic spectrum of NDD in district Lakki Marwat population of Khyber Pakhtunkhwa, Pakistan., Methodology: From 2022 to 2023, a cross-sectional study was conducted and subjects or families with NDD were recruited from district hospitals, rural and urban areas. Door to door survey was also carried out to collect appropriate data. The study gathered phenotypic and descriptive data, clinical information including age, gender, family history, consanguinity and bio-demographic features were recorded., Results: A total of 276 independent cases/families with NDD were ascertained. The malformations were grouped into major and minor categories. Most of the case/families (58.69%) were sporadic, and 38.04% of the population was classified as having a low-income status. The most frequent family type was a single spouse with children (27.89%), while extended families made up 21.37% of all cases. Demographic variables such as parental consanguinity, syndromic/non-syndromic, familial/sporadic nature, economics status, age of disease onset and pedigree structures showed conspicuous heterogeneity among the major and minor categories of NDD., Conclusion: The high incidence of NDD indicates that nongenetic factors may play a vital role in their etiology which could be diminished by improving the healthcare system., Competing Interests: Declarations. Ethics approval and consent to participate: All participants provided written informed consent at the time of participation. Ethical review and approval for this study were waived, as secondary analysis did not necessitate additional institutional review board approval. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Skeletal dysplasias are a heterogeneous group of disorders presenting mild to lethal defects. Several factors, such as genetic, prenatal, and postnatal environmental may contribute to reduced growth. Fourteen families of Pakistani origin, presenting the syndromic form of short stature either in the autosomal recessive or autosomal dominant manner were clinically and genetically investigated to uncover the underlying genetic etiology. Homozygosity mapping, whole exome sequencing, and Sanger sequencing were used to search for the disease-causing gene variants. In total, we have identified 13 sequence variants in 10 different genes. The variants in the HSPG2 and XRCC4 genes were not reported previously in the Pakistani population. This study will expand the mutation spectrum of the identified genes and will help in improved diagnosis of the syndromic form of short stature in the local population., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Strain NCCP-691 T was isolated from a soil sample collected from an arid soil in Karak, Khyber Pakhtunkhwa, Pakistan. Phenotypically, the cells were Gram-stain-negative, aerobic and motile rods. The organism was able to grow between 20-40 °C (optimum at 30-37 °C), at pH 5.5-8.0 (optimum at pH 7.0-7.2) and tolerated 0-1.5% NaCl (w/v) (optimum at 0-0.5). Based on 16S rRNA gene sequences, strain NCCP-691 T formed a distinct phylogenetic clade with Noviherbaspirillum arenae , N . agri , N . denitrificans and N . autotrophicum (having sequence similarities of 99.0; 98.1; 98.0 and 97.7% respectively). Phylogenetic analyses based on the whole genome sequences confirmed that strain NCCP-691 T should be affiliated to the genus Noviherbaspirillum . The average nucleotide identity values compared to other species of Noviherbaspirillum were below 95-96 % and digital DNA-DNA hybridization values were less than 70 %. Chemotaxonomic analyses showed that the strain had ubiquinone-8, as the only respiratory quinine. The major cellular fatty acids were summed feature 3 (C 16 : 1  ω 7  c /C 16 : 1  ω 6 c, 35.9 %), summed feature 8 (C 18 : 1  ω 7  c /C 18 : 1  ω 6 c, 26.9 %) and C 16 : 0 (22.9 %) and the polar lipid profile was composed of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine and phosphatidylcholine. The genomic DNA G+C content was 65.5 mol% (from draft genome). Genome analyses showed that strain NCCP-691 T had terpene and arylpolyene biosynthetic genes clusters and genes related to resistance against heavy metals. Based on phylogenetic analyses, phenotypic features and genomic comparison, it is proposed that strain NCCP-691 T is a novel species of the genus Noviherbaspirillum and the name Noviherbaspirillum aridicola sp. nov. is proposed. Type strain is NCCP-691 T (=KCTC 52721 T =CGMCC 1.13600 T ).

In this technologically developed scenario, many organizations in developing countries including Pakistan have expanded the enthusiasm for understanding and creating an encouraging administrative and managerial environment. Numerous organizations are struggling for structural changes by deserting the old-fashioned organizational management style and implementing an empowering leadership where leaders give more authority to subordinates in decision making and responsibilities with the aim to increase organizational productivity. Therefore, the study examined the leadership empowering behaviour as a predictor of employees' psychological well-being of the educational institutions at secondary level in Kohat Division, Pakistan. A total sample of 564 secondary school teachers (male n = 379; female n = 185) was carefully chosen through a stratified random sampling technique. In this study, a non-experimental predictive correlational design was adopted. In order to collect data from the participants, two different standardized research tools i.e., the Leader Empowering Behaviour Questionnaire and Ryff's Psychological Well-being Scale were used. After the collection of data, it was analyzed on the basis of mean, standard deviation, Pearson's product-moment correlation, and multiple linear regression model. In conclusion, the study confirmed a significant positive correlation between leadership empowering behaviour and employees' psychological well-being. Leadership empowering behaviours predict employees' psychological well-being positively. Therefore, it was recommended that empowering behaviour might be adopted by the school leaders to improve the employees' psychological well-being for better organizational productivity., Competing Interests: The authors have declared that no competing interests exist.

A Gram-staining positive, non-spore forming, non-pigmented and non-motile bacterium, designated strain NCCP-1664 T , was isolated from Cholistan desert, Pakistan. Cells of strain NCCP-1664 T were strictly aerobic, catalase positive and oxidase negative with a rod to coccus growth cycle and can grow at pH 6.0-9.0 (optimum pH 7-8) at 28-45 °C (optimum 37 °C) and could tolerate 0-16% NaCl (optimum 2%). Phylogenetic analyses based on 16S rRNA gene sequence revealed that strain NCCP-1664 T belongs to the family Micrococcaceae and was related to members of the genus Arthrobacter having highest sequence similarities with Arthrobacter ginkgonis (98.9%), A. halodurans (97.7%) and A. oryzae (97.1%) and less than 97% with other related taxa. DNA-DNA relatedness values of strain NCCP-1664 T with above mentioned type strains were found to be less than 54%, whereas digital DDH and average nucleotide identity (ANI) values with A. oryzae were 20.9 and of 74.3%, respectively. DNA G + C content of strain NCCP-1664 T was 70.0 mol%. Chemotaxonomic data of strain NCCP-1664 T showed the peptidoglycan type as A3α L-Lys-L -Ala; menaquinones as MK-9(H 2 ) (67%), MK-8(H 2 ) (32%) and MK-7(H 2 ) (1%), major fatty acids as anteiso -C 15:0 (51.2%), anteiso-C 17:0 (9.6%) and C 18:1 ω9c (6.9%) and polar lipids profile comprising of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylinositol, digalactosyldiacylglycerol, small amounts of monogalactosyldiacylglycerol, trimannosyldiacylglycerol and three unidentified lipids. The phylogenomic analyses along with chemotaxonomic data, physiological, biochemical characteristics allowed to describe it as representative of a novel genus, for which the name Zafaria cholistanensis gen. nov. sp. nov. is proposed with the type strain NCCP-1664 T (= DSM 29936 T  = KCTC 39549 T ).

The release of natural radioactive materials with the emission of fly ash as a result of coal burning in power generation plants is considered amongst the sources that elevate the technologically environmental radioactivity level. This research mainly concerns the assessment of various radiological parameters including excess lifetime cancer risk due to natural radioactive contents associated with fly ash emitted to the surrounding environment from the stack of 1320 Mw Sahiwal coal-fuelled power generation plant (CFPP). For this purpose, fifty-four soil samples were collected in a radius of 4 Km from CFPP and a highly background radiation-shielded HPGe system is used to measure radioactivity in the collected samples. The activity concentrations of radium-226, potassium-40, and thorium-232 in collected samples was found to be in the range of 20 to 138, 43 to 860, and 27 to 127 Bq/kg with average values of 66, 409, and 67 Bq/kg respectively. Activity concentrations of radium-226 and thorium-232 were observed significantly higher than UNSCEAR reported typical global average values. A significant decrease in the level of the aforementioned radionuclides in the collected soil samples was observed with increasing distance from the power plant, which is a clear indication for the elevation of radioactivity concentrations in the surrounding environment as a result of the operation of the CFPP. To assess the radiation dose delivered to the occupational workers and inhabitants living next to Sahiwal CFPP, absorbed γ-dose rate (D γ ), outdoor annual effective dose rate (E Outdoor ), and excess lifetime cancer risk (ELCR) were estimated and these were found higher than the UNSCEAR recommended values of 59 nGy/h, 0.07 mSv/y, and 2.9 × 10 -4 respectively. The outcome of this first systematic study is the assessment of potential radiological health risk to the occupational workers as well as the inhabitants living in the proximity of this CFPP.

Background/aim/aim: Smokeless tobacco has been associated with oral cavity cancer for several decades. The incidence of oral cavity cancer is higher in some parts of the world especially South and South-East Asia including Pakistan. The aim of current study was to evaluate the risk of oral cavity cancer among smokeless tobacco users in our country., Materials and Methodsand Methods: A case-control study was conducted between November 2016 and September 2017. Patients diagnosed with oral cavity cancer receiving treatment were included as cases and the attendants of various cancer patients visiting the hospital during the study period were included in the study as controls. Odds ratios (OR) and 95% confidence intervals (CI) were calculated and all reported P-values were considered significant at < 0.05., Results: The crude OR for the “ever smokeless tobacco users” among cases and controls came out to be 4.98 (95%CI; 2.76–9.01). The OR for snuff users among cases and controls was 4.82 (95%CI; 2.37–9.80) and that for betel leaf users was 4.42 (95%CI; 1.66–11.91) after adjusting for smoking and age., Conclusion: Our study provided strong evidence for snuff and betel leaf to be independent risk factors for oral cavity cancer., Competing Interests: All authors have read the manuscript and agreed with the submission with no conflicts of interest to disclose., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: Since 2008, dengue fever outbreaks had occurred repeatedly in various districts of Khyber Pakhtunkhwa (KP) province of Pakistan. Most importantly the outbreak of 2017 caused 70 deaths, about 121,083 suspected and 24,938 confirmed cases in 23 districts of KP. In 2018, an abrupt decline in suspected and confirmed dengue cases was observed and 2018 was declared as dengue outbreak free. This study characterizes and explores the control and response measure activities of the outbreak. In addition, we explored the challenges faced and lessons learned for control of future dengue outbreaks from the perspectives of health authorities and dengue response staff in the KP province of Pakistan., Methods: This was a mixed methods study with quantitative data on dengue outbreaks obtained from health department in KP followed by qualitative study to explore activities and responses that enabled the Dengue Response Unit (DRU) for a successful dengue outbreak control in 2018. In-depth interviews were conducted with the key informants from the department of health and the dengue response unit., Results: The quantitative data analysis revealed a huge decline of suspected and confirmed dengue cases in comparison with the previous year in most of the KP districts. A similar decline in dengue reported cases was also observed from previously high dengue burden 14 union counsels of Peshawar district. Among the 70 verified deaths in 2017, 44 (63%) were males and 26 (37%) were females. The cases were about 20% each from age groups of 21-30, 41-50, and 51-60 years. The qualitative study findings showed four prominent major themes for successful control: (1) control and response strategy; (2) organizing specific dengue control and response intervention activities; (3) addressing dengue control and response challenges; and (4) generating lesson for future dengue control and response., Competing Interests: The authors declare they have no conflicts of interest., (© 2019 Atlantis Press International B.V.)

Background: Nurse educators are required to equip students with adequate theoretical and practical knowledge to provide effective nursing care. Limited studies have explored educators' challenges while teaching students. Existing studies are limited because of small sample, overreliance on qualitative approaches, and unreliable instruments that have not been tested., Objectives: To explore nurse educators' perspectives about their clinical and academic teaching, to develop a questionnaire to determine educators' challenges, and to develop a comprehensive understanding of educators' challenges., Design: A sequential exploratory mixed-methods study., Settings: Twelve nursing institutions in five cities of Pakistan., Participants: A purposive sample of 12 educators for interviews and 112 for the survey., Methods: Semi-structured interviews and survey for data collection and expert consultations for questionnaire development. Thematic analysis for qualitative analysis, descriptive analysis for quantitative, and joint display tables for mixed methods., Results: Educators experience workload and time constraints and struggle to effectively teach students due to inadequate student-educator ratio; underdeveloped curriculum; inadequate resources; inadequate clinical teaching settings for skills, simulation labs; inadequate professional development opportunities; lack of autonomous decision making; lack of educational, management, and research support from the regulatory bodies; and lack of educational research., Conclusions: Nurse educators' issues and challenges are persistent and require support from regulatory bodies and educational authorities. There is a need to develop policies to improve teaching and learning conditions for educators, provide them with the opportunities to enhance their own learning, and opportunities to collaborate with other educators in order to better prepare student nurses., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the efficacy of concurrent chemoradiation in patients with locally advanced inoperable squamous cell carcinoma of oral cavity in terms of local control and toxicity., Study Design: Case series., Place and Duration of Study: Institute of Nuclear Medicine and Oncology (INMOL), Lahore, from January 2008 to December 2013., Methodology: Sixty-nine patients with locally advanced inoperable oral cavity cancer, registered in INMOL hospital from January 2008 to December 2013 who fulfilled a pre-defined eligibility criteria, were enrolled in the study. Concurrent chemoradiation protocol consisted of conventional fractionation delivering 70 Gy with weekly Cisplatin (50 mg/m2) during the course of radiation. Tumor response was calculated by RECISTcriteria version 1.1 along with the median overall survival and disease-free survival. Acute treatment related toxicities were graded as (G)., Results: Thirty-six (52.17%) patients showed complete response; while 19 (27.54%), 8 (11.59%) and 6 (8.7%) were observed with partial response, stable and progressive disease, respectively. Treatment response was significant (p<0.001) in terms of responders vs. non responders to treatment. Median overall survival was 18.00 months; whereas, median disease-free survival remained 14.00 months. Main toxicities included mucositis (G3 and G4, 71%), xerostomia (G2 and G3, 82.5%), vomiting (G3 and G4, 51%), myelosuppression (G3 and G4, 26.2%), dermatitis (G3 and G4, 49.2%), and fatigue (G3 and G4, 57.9%)., Conclusion: Platinum based CCR Tremained effective for inoperable oral cancer patients.

Malaria is wide spread in poor world and its burden has been assessed by the enumeration of malarial parasites in blood of patients. This study was designed to find a relationship between social structure, and spread of malaria in Khyber agency. The average parasite density was 2050 parasite/μl in Khyber Agency. Due to economic and social setup most of the people have habit of sleeping in open air thus playing role in high malaria prevalence and Plasmodium vivax remains the prevalent species. Genetic study performed on 110 Blood samples showed less genetic diversity for both Plasmodium vivax and Plasmodium falciparum. Eight alleles were distinguished both for Pvmsp 3α and Pvmsp 3β in total of 20 and 39 amplified samples of P. vivax respectively. Out of 17 samples amplified for P. falciparum 11 showed genotype K1 and 10 for MAD at Pfmsp-1 while 14 alleles were identified for 3D7/1C and two for FC27 of corresponding families of Pfmsp-2 gene. This shows that Plasmodium parasites are not genetically diverse in Khyber agency.

Malaria is one of the serious diseases threatening human health in Pakistan and contributes to a large proportion of the total malaria deaths in South Asia. However, little is known about the nature and extent of genetic diversity of the malarial parasites circulating in Pakistan. This study was designed to assess the infection status of Plasmodium and the genetic diversity of Plasmodium vivax and Plasmodium falciparum by analyzing msp-3α, msp-3β and msp-1, msp-2 genes respectively using allele specific nested PCR and RFLP assays. For this purpose, 130 field isolates were collected from the individuals who exhibited clinical symptoms associated with malaria in the Kohat region of Khyber Pakhtoonkhwa (KPK), Pakistan. Among 130 blood samples collected, P. vivax was detected in 105/130 (80.8%) and P. falciparum in 21/130 (16.2%). Mixed infections with both parasites were detected in 4/130 (3%) of the isolates. A large number of distinguishable alleles were found for msp genetic markers: 10 alleles for msp-3α and seven for msp-3β with one mixed infection in case of msp-3β. The genotyping of P. falciparum showed that K1+MAD20 mixed genotype was dominant in msp-1 and FC27 in msp-2. The results collectively suggest that P. vivax and P. falciparum populations in this region are highly polymorphic and mixed infections are prevalent.

Background: First dose oral co-trimoxazole and referral are recommended for WHO-defined severe pneumonia. Difficulties with referral compliance are reported in many low-resource settings, resulting in low access to appropriate treatment. The objective in this study was to assess whether community case management by lady health workers (LHWs) with oral amoxicillin in children with severe pneumonia was equivalent to current standard of care., Methods: In Haripur district, Pakistan, 28 clusters were randomly assigned with stratification in a 1:1 ratio to intervention and control clusters by use of a computer-generated randomisation sequence. Children were included in the study if they were aged 2-59 months with WHO-defined severe pneumonia and living in the study area. In the intervention clusters, community-based LHWs provided mothers with oral amoxicillin (80-90 mg/kg per day or 375 mg twice a day for infants aged 2-11 months and 625 mg twice a day for those aged 12-59 months) with specific guidance on its use. In control clusters, LHWs gave the first dose of oral co-trimoxazole (age 2-11 months, sulfamethoxazole 200 mg plus trimethoprim 40 mg; age 12 months to 5 years, sulfamethoxazole 300 mg plus trimethoprim 60 mg) and referred the children to a health facility for standard of care. Participants, carers, and assessors were not masked to treatment assignment. The primary outcome was treatment failure by day 6. Analysis was per protocol with adjustment for clustering within groups by use of generalised estimating equations. This study is registered, number ISRCTN10618300., Findings: We assigned 1995 children to treatment in 14 intervention clusters and 1477 in 14 control clusters, and we analysed 1857 and 1354 children, respectively. Cluster-adjusted treatment failure rates by day 6 were significantly reduced in the intervention clusters (165 [9%] vs 241 [18%], risk difference -8·9%, 95% CI -12·4 to -5·4). Further adjustment for baseline covariates made little difference (-7·3%, -10·1 to -4·5). Two deaths were reported in the control clusters and one in the intervention cluster. Most of the risk reduction was in the occurrence of fever and lower chest indrawing on day 3 (-6·7%, -10·0 to -3·3). Adverse events were diarrhoea (n=4) and skin rash (n=1) in the intervention clusters and diarrhoea (n=3) in the control clusters., Interpretation: Community case management could result in a standardised treatment for children with severe pneumonia, reduce delay in treatment initiation, and reduce the costs for families and health-care systems., Funding: United States Agency for International Development (USAID)., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

A new, quick and economical decolorization assay based upon the generation of a radical cation made from promethazine hydrochloride (PMZH) is described for screening of antioxidant activity of plants/herbal extracts. PMZH radical cations, produced through a reaction between PMZH and potassium persulfate (K(2)S(2)O(8)) in phosphoric acid medium, have maximum absorption at 515 nm in their first-order derivative spectrum. Theconcentrations of chromagen and K(2)S(2)O(8) were optimized (final concentration of PMZH and K₂S₂O₈ were 0.166 mM and 0.11 mM, respectively) for better stability and sensitivity of the radical cation produced. Agood linear correlation was found between the percentage inhibition and the increasing amounts of standard antioxidants, with correlation coefficients ranging from 0.989 to 0.999. The newly developed assay was employed to evaluate the antioxidant capacity of Citrullus colocynthes L. and Artemisia absinthium extracts. The proposed assay involved a more stable radical cation and required only 1 h for preparation of a working solution in comparison to the 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical cation decolorizaion assay, which was reported to be less sensitive at low pH and almost 12-16 h were required for preparation of a working ABTS solution. Other assays employed to evaluate the antioxidant potential andradical-scavenging capacities of the extracts were the ferric-reducing antioxidant power, 2,2'-diphenyl-1-picrylhydrazyl radical scavenging, total phenolic contents assay, total flavonoid contents and metal-chelating activity assays, and the lipid peroxidation value in linoleic acid emulsion systems. The results indicate that boththe plants have potent free radical-scavenging activity and the ability to prevent lipid peroxidation and radical chain reactions.

Objective: To compare the outcome of intralesional corticosteroid injection and surgical treatment of chalazia., Design: An interventional comparative study., Place and Duration of Study: PNS Shifa, Naval Hospital, Karachi from 1st September 2002 to 31st August 2003., Patients and Methods: During a 9-month recruitment period all patients attending PNS Shifa, Naval Hospital, Karachi, for treatment of chalazia were inducted in the study. A 141 patients with chalazia completed the study. Patients received either incision-curettage (surgical treatment/ ST group) or intralesional corticosteroid injection treatment (steroid injection/ SI group). The same procedure was repeated in unsuccessful cases only once. Z-test of proportion was used as appropriate statistical test of significance at p <0.05 for the comparison of the results between the two groups., Results: The success was achieved in 59 out of 75 patients (79%) in ST group and 41 of 66 patients (62%) in SI group at first visit after two weeks (p-value <0.01). The success in ST group improved to 89% (67 out of 75 patients) after second operation and to 80% (53 out of 66 patients) in SI group after second injection of the steroid given at second week (p-value < 0.14)., Conclusion: Intralesional steroid injection is an effective and safe alternative procedure for the treatment of chalazia. The results are comparable to surgical treatment especially after second injection. It is not associated with any serious complications although skin depigmentation is relatively common in coloured population.

A study of 53 Pakistani patients with pilomatricoma diagnosed at AFIP during 1985-1989 is presented. It constituted 37.2% of all benign adnexal tumors, during the same period. 56.2% of patients were more than 30 years of age. Differences in site, sex, and age distribution from Western reports were observed. Unusual clinical presentations were also noted. This study outlines the clinicopathologic features of pilomatricoma in Pakistan.

Cadmium concentrations were measured in the whole blood of six different groups of persons living in and around the city of Lahore. The cadmium concentrations in the blood of normal persons of both sexes were distributed log normally. The values were lower among the young and increased gradually to reach a plateau at an average age of 45 years and then decreased. There was a trend of a gradual increase of cadmium blood concentrations with age in male industrial workers and female exposed groups. Cadmium-blood concentrations in cancer patients were significantly lower when compared to the rest of the groups, however no statistical correlation between Cd-blood concentration and age of cancer patients was observed.