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Abstract Background Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan. Methods Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D. Results The mean time (minutes) spent in sun over 4 days (±SD) was 69.5 (±32) for low, 83.5 (±29.7) for moderate and 329 (±115) for high exposure group. The correlation between average time (minutes) spent in sun over 4 days and mean change in absorbance of UV dosimeters for 4 days was 0.60 (p Conclusions The sunlight exposure measurement questionnaires were valid tools for use in large epidemiological studies to quantify sunlight exposure.

Objective: To assess the impact of structured counselling on the knowledge of patients and families attending the Tuberculosis (TB) clinic at the Indus Hospital, Karachi. Methods: This was a case control study conducted from 17th December 2018 to 28th December 2018 at The Indus Hospital, Karachi. We evaluated the baseline knowledge regarding TB in 60 patients and families, 30 of whom had undergone at least one counselling session at the TB clinic. We then compared the scores achieved by each group in three main categories of tuberculosis: disease, treatment and prevention. Results: The average scores in all three categories of TB knowledge were higher in counselled participants compared to non-counselled participants. Conclusion: We found that structured counselling resulted in improved patient knowledge and clarified common misconceptions about TB which has been shown to result in improved patient outcomes. Effective counselling is an easy to implement strategy in a low resource setting. A trained psychosocial counsellor is essential for every TB program in Pakistan. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan. Methods: Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D. Results: The mean time (minutes) spent in sun over 4 days (±SD) was 69.5 (±32) for low, 83.5 (±29.7) for moderate and 329 (±115) for high exposure group. The correlation between average time (minutes) spent in sun over 4 days and mean change in absorbance of UV dosimeters for 4 days was 0.60 (p<0.01). Correlation between average score and vitamin D levels was found to be 0.36 (p = 0.01) for short term questionnaire score, 0.43 (p = 0.01) for long term questionnaire score in summers and 0.48 (p = 0.01) in winters. Conclusions: The sunlight exposure measurement questionnaires were valid tools for use in large epidemiological studies to quantify sunlight exposure. [ABSTRACT FROM AUTHOR]

Introduction The first outbreak of dengue viral fever (DVF) in Pakistan was detected in 1994-95 and second in 2005-06. Since then, it has become endemic and has been recurring annually during summer months. Objective To study the clinical profile and management of all patients with suspected or confirmed DVF seen at the Liaquat National Hospital, Karachi in 2005-2006. Method All cases that met the WHO case definition of DVF during this period were documented on a pre-designed proforma. Patient demographics, clinical presentation, management, complications, mortality and relevant laboratory tests were included. Results Out of 336 cases of probable or confirmed cases of DVF, 71% were male. Mean age of the patients was 28.1 ± 13.4 years. Out of the 294 tests sent for Dengue IgM antibodies, 190 (64.6%) were positive while 104 (35.4%) were negative. Mean hemoglobin was 13.9 ± 2.4 g/dL, and mean platelet count was 49.3 ± 39.7 × 109/mm³. The mean duration of hospitalization was 4.1 ± 3.3 days. Fifteen patients (4.5%) died during the course of their hospital stay. Discussion Majority of patients were males. Fever was the most consistent symptom, other features being skin rash and bleeding. Thrombocytopenia was a hall mark of the infection but was not always associated with serious bleeding. Treatment of DVF remains symptomatic. Mortality in our series was 4.5%. [ABSTRACT FROM AUTHOR]

The article presents the discussion on COVID-19 pandemic taking a distinct toll on routine health service provision. Topics include dedicating to the spirit of intense courage and personal sacrifice about health staff displaying throughout the difficult COVID-19 waves; and showing virtual conferences and online meetings as well as a reflection of Indus' paperless hospital concept.

This cluster-randomized interventional trial at periurban settings of Karachi was conducted to evaluate the impact of maternal educational messages regarding appropriate complementary feeding (CF) on the nutritional status of their infants after 30 weeks of educational interventions delivered by trained community health workers. Mothers in the intervention group received three education modules about breastfeeding (BF) and appropriate CF at a baseline visit and two subsequent visits 10 weeks apart. The control group received advice about BF according to national guidelines. Infants' growth [weight, length, and mid-upper arm-circumference (MUAC), stunting, wasting, and underweight] were measured at four time points. At the end of the study, infants in the intervention group had a higher mean weight of 350 g (p=0.001); length of 0.66 cm (p=0.001), and MUAC of 0.46 cm (p=0.002) compared to the controls; proportionate reduction of stunting and underweight were 10% (84% vs. 74%; OR(adj) 8.36 (5.6-12.42) and 5% (25% vs. 20%; OR(adj) 0.75 (0.4-1.79) in the intervention compared to the control group. For relatively food-secure populations, educational interventions about appropriate CF to mothers had a direct positive impact on linear growth of their infants. [ABSTRACT FROM AUTHOR]

Accurate and rapid diagnosis of coronavirus disease 2019 (COVID-19) is critical for proper care and identification of affected individuals. This led to early availability of many serological assays in the market, but with limited validation. In this study, we aimed to validate the serological assays based on different techniques. We evaluated 15 different assays based on four immunoassay techniques in 235 patients. The most sensitive kits employed were as follows: immunochromatography (Zybio severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] IgM/IgG Antibody Assay Kit - 83%), ELISA (Aeskulisa SARS-CoV-2 NP IgG -88.1%), chemiluminescence (Alinity SARS-CoV-2 IgG - 82.2%), and immunofluorescence (Lifotronic FA160 (Shenzhen SARS-CoV-2 Assay Kit [IgG]) - 88.9%). The kits by Uniper (Singuway Biotec COVID-19 IgM/IgG Presumptive Kit), Genrui 2019-nCoV IgM/IgG Test Kit, Wondfu SARS-CoV-2 Antibody Test, and Aeskulisa SARS-CoV-2 NP IgG exhibited 100% specificity, whereas IgG assay using Lifotronic FA160 (Shenzhen SARS-CoV-2 Assay Kit) exhibited the lowest specificity at 58%. Maximum agreement was observed between Aeskulisa SARS-CoV-2 NP IgG and Alinity SARS-CoV-2 IgG at 94%. Serological tests are practical alternatives, but their reliability depends on critical validation. The COVID-19 pandemic warranted investment in healthcare research at both the national and international levels.

To our knowledge, this is an unusual case of a community-acquired pneumonia (CAP) with sepsis secondary to Streptococcus pneumoniae that required lung resection for a non-resolving consolidation. A 74 year old previously healthy woman, presented with acute fever, chills and pleuritic chest pain in Emergency Department (ED). A diagnosis of CAP was established with a Pneumonia Severity Index CURB-65 score of 5/5. In the ER, she was promptly and appropriately managed with antibiotics and aggressive supportive therapy. She remained on ten days of intravenous antibiotics. However, 48 hours post antibiotic course, she returned to ER with fever and signs of sepsis. Despite timely and appropriate management, the consolidated lobe remained the focus of sepsis for over four weeks. The patient recovered after the offending lobe was resected. Histopathology of the lung tissue revealed acute and chronic inflammation. However, no malignancy, bacterial infection or broncho-pleural fistula was found. Eighteen months post-surgery, the patient remains well.