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Background: The objective is to determine the impact of lockdown in TB care services in Pakistan and to provide suggestion for future recommendations. Methods: Extensive literature review of published articles along with NTP reports was done. The TB case detection data for the year 2020 along with the impact of COVID-19 on TB infrastructure and resources were also reviewed. Results: There was a drop in the TB notification rate during 2020 due to COVID-19 and its ramifications on the Health Sector. Health care workers being on the frontline are more prone towards acquiring COVID-19, particularly with a marked deficiency of personal protective equipment (PPEs) that has had a demoralizing effect among health professionals. Besides this the diagnostic and treatment facilities for Tuberculosis were also interrupted badly. Conclusion: The lockdown has adversely affected the health services, particularly routine immunization and TB care services, including diagnosis and case notification which declined significantly. Moreover, upgradation of strategies for the provision of services will prove to be extremely beneficial for both COVID-19 and the people with Tuberculosis. [ABSTRACT FROM AUTHOR]

Introduction: It could be challenging for healthcare workers to diagnose patients with factitious disorder who present with rare ophthalmologic manifestations such as haemolacria, because of the unavailability of adequate literature and associated guidelines. The present case report aims to fulfill this knowledge gap. Case Presentation: A 20‐year‐old tribal illiterate married female patient with symptoms of bleeding episodes from her left eye was admitted to the hospital. An extensive workup was done for diagnosing possible bleeding disorders but all the parameters were normal. Later on, she was diagnosed with factitious disorder presenting haemolacria after sufficient evidence at the psychiatric unit observations. The patient was treated accordingly, counseled and discharged, but lost‐out to follow‐ups. Practical Implications: The present case is reported from a developing country, Pakistan, for the first‐time may help in diagnosing patients suffering from factitious disorder with unusual ophthalmologic problems. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension is a widely recognized public health problem worldwide. Its further complications lead to cardiovascular diseases, stroke, retinal and renal diseases. DASH diet has been recommended to control raised blood pressure among hypertensive patients. However; limited evidence exists for it in Asian countries. This study aimed to review published research articles on DASH diet for hypertension control. Methods: Studies on hypertension and DASH diet (N=54) were searched using PubMed Central from 2012 to 2019 including all countries. The search strategy consisted of keywords "hypertension OR raised blood pressure OR blood pressure" and "Dietary Approaches to Stop Hypertension OR DASH diet". Whereas; no limitation was used for searching the literature and further references of the relevant studies were also analyzed. Full text articles of 31 researches were retrieved and analyzed for this review article. Results: Findings of this review suggests that DASH diet is significantly effective in lowering the blood pressure as well as for prevention of cardiovascular diseases (CVDs). In addition, a low-sodium diet is beneficial for individuals and hypertensive patients in reducing CVD related events. However; evidence suggests that adherence to DASH diet for a longer duration is effective along with lifestyle modifications in the population. Conclusion: Consuming a DASH diet as recommended can be a useful preventive measure to reduce blood pressure. Country-specific dietary recommendations are thus required. DASH diet along with pharmacological therapy and lifestyle modifications are proven to be effective. Further, longitudinal studies establishing temporal associations between consumption of DASH diet and its effect on blood pressure will be essential for clinical and public health practice. [ABSTRACT FROM AUTHOR]

Ischemic stroke leading to bilateral vision loss in COVID-19 patient - A rare case report Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the main causative agent of coronavirus disease 2019 (COVID-19).1 Besides, progressive atypical respiratory system involvement, other organ systems including the central nervous system have also been affected due to the discernable affinity of the virus towards the angiotensin-converting enzyme 2 (ACE2) receptors2,3 that may result in meningitis, encephalitis or stroke. As a result, we recommended that stroke teams should be cautious of the fact that patients with COVID-19 can present with cerebrovascular accidents or events. [Extracted from the article]

Higher rates of nuclear anomalies in buccal cells of coffee workers exposed to pesticides in comparison to their unexposed peers were detected in our field study. Here, we extend our findings by examining other exposure indicators in this sample. Occupational exposure of 38 exposed and 33 non-exposed farmworkers was assessed as exposure days in the last month (0–25 days) and as years of exposure (0–47 years). Genotoxic and cytotoxic markers in buccal cells were analysed following standard procedures for buccal micronucleus cytome assay. Both exposure markers were associated with a higher frequency of nuclear anomalies with odds ratios more than 1. After restricting the analysis to the exposed workers only, this association remained only with the marker of recent exposure. In a secondary analysis also environmental exposure defined as proximity of the home to the nearest sprayed field (distance <1000 m) was assessed. Proximity led to increased rates (with odds ratios more than 3) of genotoxic but not cytotoxic nuclear anomalies. Reported recent frequency and intensity of pesticide use and application are a valid exposure marker relevant for cytological pathologies in the buccal mucosa. The exposure metric for environmental exposure was rather crude and confounding by some unmeasured factor cannot be fully excluded. Nevertheless, simple exposure indicators that can even be obtained under rather difficult field conditions do provide health-relevant and valid information. [ABSTRACT FROM AUTHOR]

Objectives: In the cotton industry of Pakistan, 15 million people are employed and exposed to cotton dust, toxic chemicals, noise and physical hazards. The aim of this study was to determine the prevalence of health symptoms, particularly respiratory symptoms, and to measure cotton dust and endotoxin levels in different textile factories of Faisalabad, Pakistan. Methods: A cross-sectional investigation was performed in a representative sample of 47 cotton factories in the Faisalabad region in Punjab, Pakistan. Respiratory symptoms of 800 workers were documented by questionnaire. Occupational safety in the factories was assessed by a trained expert following a checklist, and dust and endotoxin levels in different work areas were measured. Results: Prevalence of respiratory disease symptoms (fever, shortness of breath, chest tightness and cough) was generally high and highest in the weaving section of the cotton industry (20-40% depending on symptoms). This section also displayed the poorest occupational safety ratings and the highest levels of inhalable cotton dust (mean±SD 4.6±2.5 vs 0.95 ±0.65 mg/m³ in compact units). In contrast, endotoxin levels were highest in the spinning section (median 1521 EU/m³), where high humidity is maintained. Conclusions: There are still poor working conditions in the cotton industry in Pakistan where workers are exposed to different occupational hazards. More health symptoms were reported from small weaving factories (power looms). There is a dire need for improvements in occupational health and safety in this industrial sector with particular focus on power looms. [ABSTRACT FROM AUTHOR]

The present study is aimed to assess the fluctuations that have taken place in expenditures of health indicators in Pakistan during 1998-2006 and to forecast the public health expenditure in Pakistan, with testing the hypothesis that public expenditure on health has an increasing trend in Pakistan. Secondary data about major indicators of health expenditure are number of hospitals, number of dispensaries, number of basic health units and sub health centres, maternity and child health centres, rural health centres, number of total beds etc have been taken from economic survey of Pakistan 2006-2007. The study shows that on average the total public health expenditure on health sector in Pakistan during 1998-2006 was Rs 31354.4 (million). During 1998-2006 the average of number of hospitals is 900.5, dispensaries is 4607.1, basic health units and sub health centres is 5256.6, maternity and child health centres is 881.1, rural health centres is 542.8, TB centres is 279.2, total beds is 9723.7, and total population per bed is 1465.22. There is a continuous rising tendency observed in all variables. Based upon the study as there is an increasing tendency for the demand of such types of facilities, therefore the Government should take into consideration the increasing demand for these facilities. The government should focus on this issue and should increase the shares of budget allocated for this end. [ABSTRACT FROM AUTHOR]

It has been suggested that pulmonary arterial hypertension (PAH) could be a potential sequela of coronavirus disease 2019 (COVID-19) in particular in those with hypertension; however, development of PAH after the course of COVID-19 in normotensive individuals are rarely reported. Here, we report a patient who developed PAH two months post-COVID-19. The patient was a 55-year-old female and normotensive, tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), developed mild respiratory distress syndrome and necessitated continuous positive airway pressure during the treatment in the hospital. After two months discharged from the hospital with RT-PCR negative for SARS-CoV-2, the patient presented with exertional dyspnea, dry cough, fatigue and episodes of syncope during exertion. Based on clinical presentation, electrocardiography, computed tomography, and transthoracic echocardiography assessment, PAH diagnosis was made. To our knowledge, this is a rare PAH case and this highlights the possible of PAH as sequala that might present in post COVID-19 patients. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to analyze the temporal trends and demographic/geographical disparities in acute myocardial infarction (AMI)-related mortality among individuals aged 15 and older across the United Sates (US)., Material and Methods: We evaluated death records from 1999 to 2020 that were obtained from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APC) were computed, with stratification by year, sex, race/ethnicity, and geographic region., Results: Between 1999 and 2020, 3,016,546 AMI-related deaths were reported in the United States. The overall AAMR was 51.9 per 100,000 (95% CI: 51.8-52.0). Over the course of the study, the crude mortality rate (CMR) increased with age. Males exhibited a consistently higher overall annual AAMR (67.4, 95% CI: 67.3, 67.5) than females (39.5, 95% CI: 39.4, 39.6). In comparison to other races, Black (or African American) people had the highest death rates, with an AAMR of 58.9 (95% CI: 58.7, 59.1). The South region mortality rate (AAMR = 57.7; 95% CI: 57.6, 57.8) was higher than that of the Northeast, Midwest, and West. Specifically, Kentucky had the highest death rate (87.7, 95% CI: 87.0, 88.3), followed by Missouri (80.3, 95% CI: 79.8, 80.8) and Mississippi (85.6, 95% CI: 85.0, 86.6)., Conclusions: During the period from 1999 to 2020, males, Black/African American adults and those living in the South and other nonmetropolitan areas of the country typically had the highest AAMRs., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Termedia & Banach.)

Introduction: The rising incidence of heart failure (HF) among the U.S. population has become a major concern for healthcare providers. This study aims to assess mortality trends related to HF across different age groups, racial demographics, and geographic locations from 1999 to 2020., Material and Methods: This descriptive analysis uses death certificate data from the CDC WONDER database to track mortality trends among HF patients from 1999 to 2020. Log-linear regression models were used to delineate trends. The study used deidentified public data, complying with ethical standards., Results: Over 21 years, 1,426,657 HF-related deaths were recorded in individuals aged 15 and older, with a slight overall increase in mortality (AAPC = 0.11). Mississippi recorded the highest age-adjusted mortality rates (AAMRs) at 58.0 per 100,000. The Midwest showed the highest regional mortality rates, while the oldest individuals (≥ 85) exhibited the highest crude mortality rate (CMR) of 663.9. Males consistently demonstrated higher AAMRs than females, despite females accounting for 57.6% of the deaths. Black ancestry individuals experienced the highest mortality rates, with rising trends, particularly in non-metropolitan areas. After 2012, significant increases in mortality were noted, especially in individuals over 85, with stable rates in younger demographics., Conclusions: Males and Black ancestry individuals are disproportionately affected, demonstrating the need for targeted interventions., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Termedia & Banach.)

The liver is one of the most common sites of cancer in the world, hepatocellular carcinoma (HCC) predominating. HCC is the sixth most common cancer and the third leading cause of cancer related death overall. Hepatitis C is a major risk factor and HCV is a rapid spreading virus which has become a problem globally, including in Pakistan. Interferon alpha therapy is used against HCV disease to regulate cell reproduction and to boost the immune system. In minute amounts interferon alpha is produced naturally by the immune system in HCV patients in response to hepatitis C virus and binds to receptors in the target cells and starts transcription of 20-30 genes due to which it develops an antiviral influence. Interferon is also administered artificially to overcome HCV disease and remove the biological effect of the virus from the infected site. The use of interferon or Peg-IFN plus Ribavirin treatment is also associated with adverse effects on body. For the current study, a convenient sample of 156 HCV positive patients of both males and females were taken. To collect blood CP and ALT, a reduction of level data and other important information were collected from the patients at regular intervals. Findings were 11.4 % in the red blood cells (RBC), 9.64 % in the total leukocyte count (WBC), 8.4 % in the hemoglobin levels (HB), 30.3 % in the platelet (Plt) count in both sexes. There was significant reduction in ALT levels due to Pegylated interferon plus ribavirin therapy. Hence strict haemotological monitoring of blood CP and ALT levels is necessary at regular intervals to reduce severe side effects which may lead to morbidity and mortality.

Objectives: To identify contextual barriers (social, cultural, geographic and economic), faced by Lady Health Workers (LHWs) and to assess their strategies at different levels (individual, community and system) in the provision of family planning services to their clients in Tehsil Gujar Khan., Methods: The mixed model cross-sectional study was conducted from April 1 to July 10, 2010, in Tehsil Gujar Khan, Punbjab, Pakistan. It was carried out in two phases: in the first phase 10 in-depth interviews were conducted with the workers, followed by two focus group discussions. On the basis of findings, a structured questionnaire was developed and administered to 111 workers in the second phase. Of the total, 97 responses were used for analysis. Data analysis was done by SPSS-16., Results: Majority of the respondents reported barriers at the community level: religious barriers 69% (n = 67), sociocultural barriers 58% (n = 56), transport 54% (n = 52), communication and economic reasons 25% (n = 24). Individual level barriers were female gender, experience and low education. System-level barriers were increased workload, National immunization days/sub-national immunization days, late supply, stock shortage (especially injectables), problems for referred clients and lack of proper incentives., Conclusion: Lady health workers still face barriers at individual, family, community and system level in the delivery of Family Planning services.