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Objectives In low/middle-income countries (LMICs), more than half of patients with first-episode psychosis initially seek treatment from traditional and religious healers as their first care. This contributes to an excessively long duration of untreated psychosis (DUP). There is a need for culturally appropriate interventions to involve traditional and spiritual healers to work collaboratively with primary care practitioners and psychiatrists through task-shifting for early detection, referral and treatment of first episode of psychosis.Methods To prevent the consequences of long DUP in adolescents in LMICs, we aim to develop and pilot test a culturally appropriate and context-bespoke intervention. Traditional HEalers working with primary care and mental Health for early interventiOn in Psychosis in young pErsons (THE HOPE) will be developed using ethnographic and qualitative methods with traditional healers and caregivers. We will conduct a randomised controlled cluster feasibility trial with a nested qualitative study to assess study recruitment and acceptability of the intervention. Ninety-three union councils in district Peshawar, Pakistan will be randomised and allocated using a 1:1 ratio to either intervention arm (THE HOPE) or enhanced treatment as usual and stratified by urban/rural setting. Data on feasibility outcomes will be collected at baseline and follow-up. Patients, carers, clinicians and policymakers will be interviewed to ascertain their views about the intervention. The decision to proceed to the phase III trial will be based on prespecified stop–go criteria.Ethics and dissemination Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH210177), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/IG/001005) and National Bioethics Committee Pakistan (ref no. 4-87/NBC-840/22/621). The results of THE HOPE feasibility trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers.Trial registration number ISRCTN75347421.

OBJECTIVE: To find out the self-motivated cadence of intestinal microbiota by zinc obtainability with help of next generation sequencing. METHODS: This cross-sectional study was conducted on infants aging 1-4 months from Peshawar, Pakistan. Out of 50 infants enrolled in study, data of 46 healthy infants [23 breast-fed (BF) and 23 formula-fed (FF)] were available for final analysis. Their blood and stool samples were collected and analyzed for zinc and fecal DNA extraction, for metagenomic shot gun sequencing using next generation. RESULTS: Mean age of infants was 78.40±35.88 days. Actinobacteria, Bacteroidetes, Firmicutes and Proteobacteria are the four dominating major phyla found in the gut microbiota of the sample population. In breast-fed infants, mean plasma zinc was 0.138 ± 0.118 mg/L whereas, in formula-fed infants it was 0.120±0. 026 mg/L. Correlation of zinc levels with gut microbes revealed that Phylum Bacteroidetes was very low in breast-fed while in formula-fed infants it was negligible to an extent that cannot be correlated with zinc. It was also observed that there is abundance of Proteobacteria (BF: r=-0.276, p=0.264) and (FF: r= -0.043, p= 0.873) in both the zinc deficient groups whereas, Firmicutes content was (BF: r= 0.392, p=0.207) and (FF: r= -0.030, p= 0.905). CONCLUSION: Both breast-fed and formula-fed infants had low gut microbial diversity due to low zinc levels emphasizing the need to address and rectify this problem. The improved zinc status of the infants will enable the researchers to establish and ascertain the association of zinc status with the diversity of microbiome.

The emergence of Novel Coronavirus (2019-nCoV) in the Wuhan City of China and its rapid shedding among countries, which reminded the history of Severe Acute Respiratory Syndrome (SARS) happened almost two decades ago. However, the genome sequence of 2019-nCoV shared within few days of outbreak shows the better response of China and the world against the virus, perhaps due to the availability of advanced technology and lesson learned from previous epidemics. The researchers trying to determine the virulence, pathogenicity and transmission of 2019-nCoV. It is believed that disease reporting and data sharing about the emerged Coronavirus with international researchers are important steps to reduce the spread of the virus to the rest of the world. This report is aimed to understand the current status of the 2019-nCoV, problems related to it and possible measures for prevention. The infection may spread through wildlife and asymptomatic patients. People in underdeveloped countries having no basic facilities are at higher risk. Ban on wildlife trade and avoiding unnecessary traveling for a certain period is required to minimize the spread of the disease. The use of face masks, keeping away from the public gathering are other possible means of precautions, capacity building of health workers and provided relevant facilities (equipment, kits, etc.) to underdeveloped countries will further help to contain the pandemic. In the current scenario, it is concluded that 2019-nCoV is spreading irrespective of the borders and become pandemic. Extensive research is a cry of the day to contain the virus and curtail human losses.

Background: Coronavirus disease 2019 (COVID-19) is a global health threat and caused a universal psychosocial impact on the general population. Therefore, the knowledge, attitude, and perceptions (KAPs) of the general population are critical for the development and effective implementation of standard operating procedures (SOP) to contain the contagion and minimize the losses. Therefore, the current study was conducted to understand and evaluate the KAPs of Pakistani populations toward the COVID-19.Methods: An online cross-sectional study was carried out among participants from 1 May to 30 July 2020 in different areas of Pakistan. The respondents of the study were the general population with age ≥ 18 years. The poll URL was posted on several channels after a call for participation. Other social media platforms such as WeChat, WhatsApp, Facebook, Twitter, Instagram, Messenger, and LinkedIn were engaged to maximize general population engagement. The questionnaire included details about sociodemographic, knowledge about COVID-19, perceptions toward universal safety precautions of COVID-19, and beliefs attitude toward the COVID-19. The obtained data were exported into a Microsoft Excel spreadsheet and SPSS software version 21 for windows. The descriptive statistics values were presented in frequencies and percentages. Binary logistic regression, Chi-square test, and one-way ANOVA were applied to analyze the participants' socio-demographic characteristics and variables related to KAPs. P-value < 0.05 was recorded as significant.Results: A total of 1,000 participants were invited of which 734 participated in this study. The response rate was 73.4% (734/1,000). The gender, marital status, education, and residence showed a significant association with the knowledge score. The majority of the study participants were thinking that COVID-19 may be more dangerous in elderly individuals 94.5% (n = 700), and individuals with chronic diseases or severe complications 96.7% (n = 710) (p = 0.00). More than half of the participants 52.5% (n = 385) showed their concern that either they or their family members might get the infection. More than 98% (n = 703), (P-value = 0.00) of the participants held that COVID-19 would be successfully controlled in Pakistan by following the standard SOPs and government guidelines.Conclusion: This study showed that the general population of Pakistan has good awareness and reasonable attitudes and perceptions toward the full features of the COVID-19. The current study suggests that mass-level effective health education programs are necessary for developing countries to improve and limit the gap between KAP toward COVID-19.

The ongoing COVID-19 pandemic is caused by SARs-CoV-2. The virus is transmitted from person to person through droplet infections i.e. when infected person is in close contact with another person. In January 2020, first report of detection of SARS-CoV-2 in faeces, has made it clear that human wastewater might contain this virus. This may illustrate the probability of environmentally facilitated transmission, mainly the sewage, however, environmental conditions that could facilitate faecal oral transmission is not yet clear. We used existing Pakistan polio environment surveillance network to investigate presence of SARs-CoV-2 using three commercially available kits and E-Gene detection published assay for surety and confirmatory of positivity. A Two-phase separation method is used for sample clarification and concentration. An additional high-speed centrifugation (14000Xg for 30 min) step was introduced, prior RNA extraction, to increase viral RNA yield resulting a decrease in Cq value. A total of 78 wastewater samples collected from 38 districts across Pakistan, 74 wastewater samples from existing polio environment surveillance sites, 3 from drains of COVID-19 infected areas and 1 from COVID 19 quarantine center drainage, were tested for presence of SARs-CoV-2. 21 wastewater samples (27%) from 13 districts turned to be positive on RT-qPCR. SARs-COV-2 RNA positive samples from areas with COVID 19 patients and quarantine center strengthen the findings and use of wastewater surveillance in future. Furthermore, sequence data of partial ORF 1a generated from COVID 19 patient quarantine center drainage sample also reinforce our findings that SARs-CoV-2 can be detected in wastewater. This study finding indicates that SARs-CoV-2 detection through wastewater surveillance has an epidemiologic potential that can be used as supplementary system to monitor viral tracking and circulation in cities with lower COVID-19 testing capacity or heavily populated areas where door-to-door tracing may not be possible. However, attention is needed on virus concentration and detection assay to increase the sensitivity. Development of highly sensitive assay will be an indicator for virus monitoring and to provide early warning signs.

A high prevalence of multidrug-resistant (MDR) pathogens has been reported in adult and pediatric populations of Pakistan. However, data describing the effect of MDR microbes on the gut microbiota is scarce. We designed a cross-sectional pediatric study to investigate the effect of MDR microbes’ infection on the gut microbiome and its resistome of children using high-throughput next-generation sequencing (NGS). A cross-sectional study was conducted at a tertiary health care hospital in Peshawar Pakistan, between 5 September 2019 to 15 February 2020. Pediatric patients with acute gastroenteritis (n = 200) were enrolled. All the enrolled pediatric patients underwent initial antimicrobial resistance (AMR) screening using the disk diffusion method. Children with MDR infections were identified and selected for gut microbiome and its resistome profiling using NGS. Out of 200 enrolled pediatric patients, 80 (40%) were found infected with MDR diarrheagenic Enterobacteriaceae consisting of 50 (62.5%) infections caused by extended-spectrum beta-lactamase (ESBL) producing E. coli while 30 (37.5%) by MDR Enterobacter specie. A total of 63 and 17 antibiotic-resistant genes (ARGs) conferring resistance to 7 and 5 classes of antibiotics were identified in the resistomes of MDR diarrheagenic Enterobacteriaceae infected and healthy children, respectively. NGS-based gut microbial profiling of MDR Enterobacter spp., ESBL producing E. coli infected pediatric patients and healthy controls revealed the predominance of Proteobacteria and Actinobacteria, respectively. An increased abundance of several pathogenic gram-negative bacteria namely E. coli, Enterobacter cloacae, and Salmonella enterica was observed in the gut microbiota of children infected with MDR bacterial infections than that of the healthy controls. This work indicates that children with MDR infections have reduced microbial diversity and enriched ARGs than healthy controls. The emergence of MDR bacterial strains and their association with gut dysbiosis needs immediate attention to regulate antibiotics usage in Pakistani children.

In this paper, we aimed to characterize the fecal microbiome and its resistomes of healthy and diseased subjects infected with multidrug-resistant Escherichia coli using next-generation sequencing (NGS). After initial screening, 26 stools samples belonging to healthy (n = 13) and diseased subjects (n = 13) were selected and subjected to NGS. A total of 23 and 42 antibiotic-resistant genes (ARGs) conferring resistance to 6 and 9 classes of antibiotics were identified in the resistomes of healthy and diseased subjects, respectively. Bacteroidetes were found to be the major phylum in both healthy and diseased subjects; however, Proteobacteria was predominantly present in the diseased subjects only. Microbial dysbiosis and predominance of various ARGs in the resistome of diseased subjects reflect the excessive usage of antibiotics in Pakistan and warrants immediate attention to regulate the use of various antimicrobials.

The study was designed to investigate the fecal microbiome and resistome of broiler chickens infected with multidrug-resistant (MDR) Escherichia coli (E. coli). Fecal samples (n = 410) from broiler chickens were collected from thirteen randomly selected sites of Khyber Pakhtunkhwa and screened for the presence of MDR E. coli. Upon initial screening, thirteen (13) MDR E. coli isolates were then subjected to shotgun metagenome next-generation sequencing (NGS). NGS based resistome analysis identified the multidrug efflux pump system-related genes at the highest prevalence (36%) followed by aminoglycoside (26.1%), tetracycline (15.9%), macrolide-lincosamide-streptogramin (9.6%), beta-lactam (6.6%), rifampin (2%), sulphonamide (1.3%), phenicol (0.91%), vancomycin (0.62%), trimethoprim (0.34%), colistin (0.30%), and quinolone (0.33%). The most abundant virulence-associated genes (VAGs) identified were iroN, iutA, iss, and iucA. NGS based taxonomic profiling at the phylum level revealed the predominance of Proteobacteria (38.9%) followed by Firmicutes (36.4%), Bacteroidetes (15.8%), and Tenericutes (8.9%). Furthermore, pathobionts such as E. coli, Salmonella enterica, Klebsiella pneumoniae, and Shigella flexneri belonging to the family Enterobacteriaceae were predominantly found. This study revealed the widespread presence of MDR genes, diverse VAGs, and a dysbiotic gut in the broiler chickens infected with MDR E. coli of Khyber Pakhtunkhwa for the first time using NGS.

Objective: To determine the effectiveness of Intrasheath steroid injection in treating de Quervain`s disease. Study Design: Case series observational study. Place and Duration of Study: Outpatient Department of Orthopedics BBS [DHQ]Teaching Hospital Abbottabad fromApril 2006 to Sept 2009 including a period of follow up of eighteen months. Materials and Methods: Eighty patients with de Quervain`s disease were diagnosed on the basis of positive Finkelstein`s test and presence of severe pain for more than four weeks. These patients were given intrasheath injections of 40 mg Methyl Prednisolone mixed with one ml of lignocaine 2% in the first dorsal compartment of wrist. Patients with trauma, infection and rheumatoid arthritis were excluded from study. Results: Seventy two patients i.e., 90% were cured and out of them 75% required only one injection .Only two cases underwent surgical release. Conclusion: Intrasheath steroid injection is a safe, very useful and cost effective method in treating de Quervain`s disease.

The fundamental presupposition of this paper is that ‘gender’ is a social category, hence a social construction, which can be negotiated and left fluid instead of something fixed and eternal. To examine the gendered social order, this study focuses on how hegemonic masculinity and feminine subordination are naturalized by positioning men as physically strong and women as weak on the ground of biological differences between the sexes. The study is informed by social constructionist understandings of gender. The main focus of the paper is to highlight how gendered discourses in Pakistan inform textbooks as objective and true knowledge. The data for the study comes from 28 educationists (11 females and 17 males). The study’s findings revealed that, despite prevailing claims to establishing gender equality and equity education, educationists are active in the production of gender/sexual identities and hierarchies in a ways that reinforces hegemonic ‘masculinity’ and a fixed notion of ‘femininity’. The paper concludes that what ends up as school knowledge arises from gendered power/knowledge relations.