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Background: To determine the frequency of general public compliant to face mask and also to evaluate knowledge and practice of using face mask in accordance with World Health Organization (WHO) and National Institute of Health (NIH) guidelines in our community. Methods: A cross-sectional descriptive design was adopted. A sample of 190 people was recruited from public areas in Islamabad during the COVID-19 pandemic. The study was conducted over a period of two months between November and December 2020. Knowledge and etiquettes of face mask use were evaluated with the help of a self-developed questionnaire based on WHO and NIH guidelines. Statistical tests were applied to understand the association of knowledge with etiquettes and also to see the effects of demographic variables on them. Results: This study revealed that one fourth of the sample population was not wearing face masks in public. More than half were not concerned about COVID-19 pandemic and only one third knew about the national policy related to face mask usage. Only one-tenth of the population wore the correct type of mask recommended for general public use (cloth mask). The participant’s performance in the etiquette aspect of using face mask was also poor. Conclusion: The general public is unaware of Pakistan’s national policy on face masks. Although majority of the study population was compliant with wearing masks in public, results were unsatisfactory in terms of their etiquette. Effort is needed to increase the general public’s concern in value of using face mask and awareness about correct techniques.

Objective To examine the prevalence, types and temporal trends of reported financial conflicts of interest (FCOIs) among authors of drug therapy randomized controlled trials (RCTs) for RA and their association with study outcomes. Methods We identified original, non–phase 1, parallel-group, drug therapy RA RCTs published in the years 2002–03, 2006–07, and 2010–11. Two investigators independently obtained trial characteristics data. Authors’ FCOIs were classified as honoraria/consultation fees receipt, employee status, research grant, and stock ownership. Multivariable logistic regression was performed to identify whether FCOIs were independently associated with study outcome. Results A total of 146 eligible RCTs were identified. Of these, 83 (58.4%) RCTs had at least one author with an FCOI [employee status: 63 (43.2%), honoraria/consultation fees receipt: 49 (33.6%), research grant: 30 (20.5%), and stock ownership: 28 (19.2%)]. A remarkable temporal increase in reporting of honoraria/consultation fees receipt, research grant, and stock ownership was seen. The reporting of any FCOI itself was not associated with positive outcome [50/73 (68.5%) with author FCOI vs 36/52 (69.2%) without author FCOI, P = 0.93]. However, honoraria/consulting fees receipt was independently associated with increased likelihood of a positive outcome [adjusted odds ratio (95% CI) of 3.24 (1.06–9.88)]. In general, trials with FCOIs were significantly more likely to be multicentre, have larger enrolment, use biologic or a small molecule as the experimental intervention, and have better reporting of some methodological quality measures. Conclusion FCOI reporting in RA drug RCT authors is common and temporally increasing. Receipt of honoraria/consulting fees was independently associated with a positive study outcome.

Different individuals use different coping styles to cope with their problems. In patients with anxiety and/or depression, these have important implications. The primary objective of our study was to estimate the frequency of different coping mechanisms used by patients with symptoms of anxiety and depression. A descriptive, cross-sectional survey was conducted and patients with symptoms of anxiety and depression were identified using the Aga Khan University’s Anxiety and Depression Scale (AKUADS). Coping styles were determined by using the 28-item Brief COPE inventory. We were able to recruit 162 people. The prevalence of anxiety and depression was found to be 34%. Females were more than 2 times likely to have anxiety and depression (P value , ). In patients screening positive for AKUADS, “religion” was the most common coping mechanism identified. “Acceptance”, “Use of instrumental support”, and “Active coping” were other commonly used coping styles. Our findings suggest that religious coping is a common behavior in patients presenting with symptoms anxiety and depression in Pakistan. Knowledge of these coping styles is important in the care of such patients, as these coping methods can be identified and to some extent modified by the treating clinician/psychiatrist.

The growing debate regarding long working hours of postgraduate trainees has been receiving considerable attention recently. This greater workload contributes to increasing stress. Our objective was to specifically study the association between long working hours, stress and the greater use of 'maladaptive' coping strategies.A cross-sectional descriptive study was carried out on all interns and residents at the Aga Khan University Hospital during February to May, 2005. Level of stress was measured by use of General Health Questionnaire (GHQ-12) and the use of maladaptive coping mechanisms through Brief Cope-28.55.1% scored over the threshold for mild stress i.e. GHQ3, while more than 46% of the trainees scored over the threshold of more than 4 for morbid stress. Trainees under stress reported more working hours on average as compared to those not under stress, 83.8 and 74.7 hours respectively. At the same time, those working for longer hours were more likely to have used these negative coping mechanisms, which would further contribute to more stress rather than relieving it.Significant levels of stress have been identified. Along with this, those working for longer hours were more likely to have used these negative coping mechanisms. Reduction of working hours is important. Simultaneously, interventions need to be planned at imparting knowledge, awareness and skills to cope with various kinds of stressors encountered by a trainee during his/her training. Additionally, limits need to be devised for the working hours of the trainees.

Cutaneous Leishmaniasis (CL), a disfiguring disease, is prevalent in many parts of Pakistan and neighboring Afghanistan. Leishmaniasis is second only to malaria in terms of the number of people affected; it is a major public health issue with significant social stigma. Although the different methods to diagnose and treat the disease are well discussed in the literature, the role of vector control in the prevention of CL has been underemphasized. Both Pubmed and Ovid search engines were used to obtain articles on prevention and control of cutaneous leishmaniasis. These materials were then screened for articles pertaining to vector control only. The World Health Organization's website along with the Cochrane database were also searched for relevant text. From this qualitative review, it can be seen that many effective interventions exist. Considering the multitude of factors involved in transmission of CL and the various effective control measures tried and tested by investigators, an interdisciplinary approach involving more than one of the above interventions would make sense. The interventions selected would then depend on the incidence of CL in that particular area, the population being targeted, the reservoir, the particular vector, the environment, the acceptability/popularity of the intervention, and the availability of funds.

We would like to congratulate Kenneth R. Fernandez Taylor for bringing up such an important but avoided issue in developing countries like Pakistan [1]. The growing debate regarding long working hours of postgraduate trainees has been receiving considerable attention recently [2]. This greater workload contributes to increasing stress and decreases the overall performance and the quality of life of the affected individuals [3,4]. In Pakistan, physicians, after having done a five-year medical degree (MBBS) course, are supposed to do their “internship”, or “house job” as it is often referred to. The salaries speak a sorry tale as the typical monthly salary of an intern starts from 8,000 rupees (US$129); even lower than what is mentioned by the author in El Salvador. The author very rightly describes a typical tiring working week for an intern with little or no time for any educational activities. Some of the specialties are known for the fact that their working hours are “killing” for their residents and interns; unfortunately, some may even pride themselves on this. This inhumane approach is not often criticized by the interns working in a hospital; probably because they are too tired at the end of a day or even two or three continuous days to do so. We know of two specialties (neurosurgery and urology) in which the on call team came on Friday and left on Monday morning (72 hours straight); the reason being no other team was available to cover for them. And most of the time what an intern does is merely “clerical” work, with little satisfaction. We, as final year medical students, tried to bring attention to this issue by documenting firstly how many hours the interns and residents worked; and secondly if these hours led to negative coping strategies or mechanisms, which might further contribute to the stress of these individuals, rather than helping them in relieving it. We found that long working hours were indeed leading to negative coping mechanisms such as behavioral disengagement (“I’ve been giving up trying to deal with it”), substance use (“I’ve been using alcohol or drugs to make myself feel better”), denial (“I’ve been saying to myself, ‘this isn’t real’”), and venting (“I’ve been saying things to let my unpleasant feelings escape”). The frequency of different coping strategies employed by the residents in the past two weeks was determined with the Brief COPE–28 tool [5]. We also found significant levels of mild as well as morbid stress in the trainees of the hospital, with every second individual suffering from some degree of stress as well. Action indeed is needed.