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This study was designed to identify Enterococcus faecalis from clinical mastitis of cattle and determine their antimicrobial resistance and virulence determinants to evaluate their potential public health significance. A total of 105 composite milk samples (80 from cattle with clinical mastitis and 25 from apparently healthy cattle) were analyzed. E. faecalis were isolated by culturing on enterococcal selective media and identified by PCR and sequencing. Antimicrobial resistance phenotype was elucidated by the disc diffusion method, and MIC was determined by broth microdilution method according to CLSI guidelines. Detection of antimicrobial resistance and virulence genes was done by PCR. E. faecalis were isolated from 11.25% (9/80) of the clinical mastitis and 4% (1/25) of the apparently healthy cattle milk samples. The disc diffusion test revealed 40% isolates as resistant to tetracycline and azithromycin, respectively. Among them, 20% (2/10) of isolates showed resistance to both tetracycline and azithromycin. Tetracycline-resistant isolates showed MIC ranging from ≥64 to >128 μg/ml and carried tetracycline-resistant genes tetK, tetL, and tetM in 25%, 25%, and 50% of the resistant isolates, respectively. On the other hand, all the isolates were sensitive to amoxicillin, ampicillin, bacitracin, chloramphenicol, gentamicin, penicillin, and vancomycin. In addition, the isolates carried at least one of the nine virulence genes screened with pil having the highest frequency, followed by fsrB, fsrC, ace, sprE, gelE, and agg genes. Positive correlations were evident between ace, fsrC, gelE, and sprE genes that are associated with the attachment and biofilm formation in E. faecalis. E. faecalis isolated in this study carried antibiotic resistance and virulence determinants which explain their competence to be potential human pathogens.

Objective: To examine the impact of 30-day hospital readmission for non-communicable diseases on limited health-care resources of a low-income country like Pakistan in the light of available data from Pakistan’s Sehat Sahulat Program. Study Design: Retrospective analytical cross-sectional study. Place and Duration of Study: Health Services Academy, Islamabad Pakistan, from Jan 2016 to Jul 2020. Methodology: Secondary data of patients readmitted with non-communicable diseases in Sehat Sahulat Program, Islamabad, Pakistan. Universal sampling technique was utilized. Data was analyzed using SPSS version 27. Results: Islamabad (ICT) stands second highest for readmissions (n=1270) in which the 30-days readmission rate was 13.69%. Maximum number of readmissions were found in 50-59 years (344, 27.12%). Of 1270 ICT readmissions, 559 (44%) cases were readmitted with non-communicable diseases while rest of 711 (56%) cases were readmitted for acute infectious diseases or surgical procedures. Of 559 non-communicable diseases cases, 236 (42.21%) readmissions were having one non-communicable disease, 63 (11.27%) readmissions exhibited two or more non-communicable diseases and 260 (46.51%) were readmitted because of cancers (CA). Among males, the most common malignancy was CA lungs/ bronchus 24 (19.8%) while among females, CA Breast 80 (56.3%). Conclusion: Non-communicable diseases represent a significant burden on resource constrained, low-income countries. In view of the recurrent admissions that these chronic diseases inevitably incur, better resource allocation may help lessen this burden on fragile health systems creating better clinical outcomes for the penurious strata of Pakistan’s population.

Background: Out of pocket (OOP) spending on health contributes significantly to levels of poverty in developing countries such as Pakistan. In poor countries there is reduced or limited access to health services, the issue of affordability and availability which all lead to impaired health status and increased morbidity and mortality rates in developing countries. Catastrophic health expenditure is not always synonymous with high health care costs; even small Out of pocket expenses may cause catastrophic condition for poor people. Methods: This is a cross sectional study that determined the out of pocket cost of computed tomography scan test (CT scan). The study was conducted from April to June 2015. The study population was those patients who came for CT scan at Hira medical center in district Sukkur Sindh Pakistan. The study sample was one hundred and seventy patients. (n=150). From the perspective of consumer the methodology was adopted, various recurrent costs were determined under different levels of input and cost canters. The data was entered and analyses using SPSS 20 to provide the results as percentages and averages for the different variables in this study. Results: Through this research we found that out of pocket payments are way too high while putting alot of burden on lower socioeconomic groups. Health expenditure Average cost per patient calculated were Rs. 11000 which means people spend more than 40% of their monthly income on health. There should be a government health facility in the city to compensate the huge cost which people pay for health especially low monthly income people. Conclusion: Government should introduce a health coverage insurance system in Pakistan in order to cover all health care needs of the people irrespective of their socioeconomic status. Keeping in view high out of pocket spending on health, the Government should subsidize the prices of diagnostic test to give relief to its Population. Community participation is also essential for sustainable solutions.

Aim: To compare the length of hospital stay (primary) and improvement of clinical (secondary) severity indices in children with bronchiolitis nebulized with 3% hypertonic saline or 0.9% saline. Design: Randomized double-blind controlled trial. Place and Duration: In the Pediatric department of Khyber Teaching Hospital Peshawar for six-months duration from January 2020 to July 2020. Methods: Hospitalized children (1-24 months) with moderate acute bronchiolitis were included. Nebulize 4 ml of 3% hypertonic saline or 4 ml of 0.9% saline with 2.5 mg of salbutamol at 4-hour intervals until the patient is ready for discharge. Results: Baseline characteristics were similar in the two groups. The median clinical grade on admission was 6 (IQR-1) in both groups. Clinical severity markers monitored 12 hours to discharge (132 hours) showed no statistically significant differences in the 3% and 0.9% salt groups. The mean hospital stay (time to the predefined clinical severity score Conclusion: Nebulized 3% saline does not exceed 0.9% saline in infants with clinically diagnosed acute bronchiolitis. Key words: nebulization with 3% saline, bronchiolitis, management

Background: To expose high proportions of large populations, Mass media campaigns are widely used. This research study was conducted to explore the role of media including print and electronic regarding their health promotion of masses. Some ‘life threating report ‘or some sudden outbreak of disease is considered as Health news. Objective: To determine the contributions of journalists of Islamabad in the last 06 months in health related issues and the barriers faced by the journalists in promoting public health. Methodology: Primary data collection was done through a semi structured questionnaire using the mix method study design which was distributed among 62 journalists of Islamabad through convenient sampling. The study was completed in two [02] months. Data analysis was done through SPSS version 20 and transcription and thematic content analysis for qualitative part. In inferential analysis students t-test and while chi-square or fisher’s exact test for grouped data was carried out. 95% confidence interval with a significance level of p-value Results: A semi structured questionnaire was used. Qualitative study was also used to get the in depth results along with quantitative part. When it came towards contributions in health promotion in various fields e.g. in health policy, Global health, healthy life styles and exercises etc. These areas have got much coverage. There are different stake holders who play their roles and take initiative for health related programs on media. Some important facts came forward about reporting of certain diseases, and this research study showed that most of them have been frequently reported. Polio 82%, HIV aids 74%, vector born [dengue] 73%. Diarrheal diseases 73%, as most frequently reported diseases Diabetes, family abuse/violence & environmental issues have been reported too. Electronic media has talked and shown a lot about smoking and exercises. Print Media has written a lot about obesity, child health, female health, cold and fevers as well in their weekly regular supplements too. So far mental health, stress, depression, and cancers have been the areas less covered Conclusion: Mass media campaigns can produce positive changes or prevent negative changes in health-related behaviors across large populations. Over all the mass media, is an effective way to persuade target audiences to adopt new behaviors, and to remind them of critical information.

Medical profession works within thin lines of professionalism and trust. Faith of the patients often breached but less reported among the Low and Middle-Income Countries (LMICs). In Pakistan, though the Pakistan Medical and Dental Council (PMDC) have its own code of medical ethics but there isn't much evidence on regulating ethical misconducts. Apart from the gross violations of the code of conduct, the "insensible" misuse of informed consent, confidentiality and privacy is very common. This study is an effort to explore practices of informed consent, confidentiality and privacy among health care providers along with assessment of perceptions of patients about ethical practices in two tertiary care hospitals of Islamabad, Pakistan.We conducted eight homogenous Focus Group Discussions (FGDs), four each in both the public and private sector hospitals till the saturation was achieved.Informed consent, in clinical practice, was found not being practiced. Confidentiality was not being uniformly applied in practices. Patients perceived the practices being contrary to the ethics. According to patients, ethical measures were found satisfactory in private hospitals. However, patients were not gratified fully with both the systems of healthcare delivery.There is insufficient adherence to the ethical principles in clinical practice, in both public and private sector hospitals in Islamabad, Pakistan. Informed consent, privacy and confidentiality are time and time again unheeded due to lack of robust system of monitoring and penalties by the responsible authorities.