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Tariq Waheed , Sajjad Ali , Muhammad Uzair ,Inayat Ur Rehman Objective: To share our experience with outcome of primary procedure for anorectal malformation (ARM) in children. METHODOLOGY: Retrospective study included 40 patients from both sexes operated between January 2018 and January 2019 for high and intermediate ARM in the department of paediatric surgery Khyber teaching hospital Peshawar. Patients with common cloaca and associated life threatening anomalies were excluded. Demographic and clinical data was tabulated and analyzed. Cost of the procedure was recorded in Pakistani Rupees and hospital stay in days. Continence was evaluated by Kelly’s score and parents’ satisfaction graded by Likert scale. RESULTS: Male to female ratio was 1.6:1. Mean hospital stay was 5.91±1.01 days and mean cost of 22950 ± 3234 PKR. Wound dehiscence was recorded in 3 (7.5%), 2 (5.0%) patients developed surgical site infection and 11 (35.48%) patients had perianal excoriation. Adhesive obstruction and mucosal prolapse were seen in 1 (2.5%) patient each while anal stenosis in 2(5.0%) Patients. After 6 months 28 (70%) patients had formed stools while 12 (30%) had loose stools. Stool frequency was 0-1 time/day in majority i.e. 20 (50 %) patients. Continence was fair in 24 (60%) patients. Parents of 20 (50%) patients were very satisfied, 17(42.5%) satisfied only. Continence for age and sex revealed insignificant P values of 0.213 and 0.07 respectively. CONCLUSION: Primary procedure for anorectal malformations may be a good alternative to traditional three stage procedure in selected patients with intermediate and high variety of ARM. KEY WORDS: Anorectal malformation (MeSH); Abdominoperineal pull through (Non-MeSH); Kelly’s score (Non-MeSH).

Background Glycine is the smallest nonessential amino acid and has previously unrecognized neurotherapeutic effects. In this study, we examined the mechanism underlying the neuroprotective effect of glycine (Gly) against neuroapoptosis, neuroinflammation, synaptic dysfunction, and memory impairment resulting from d-galactose-induced elevation of reactive oxygen species (ROS) during the onset of neurodegeneration in the brains of C57BL/6N mice. Methods After in vivo administration of d-galactose (d-gal; 100 mg/kg/day; intraperitoneally (i/p); for 60 days) alone or in combination with glycine (1 g/kg/day in saline solution; subcutaneously; for 60 days), all of the mice were sacrificed for further biochemical (ROS/lipid peroxidation (LPO) assay, Western blotting, and immunohistochemistry) after behavioral analyses. An in vitro study, in which mouse hippocampal neuronal HT22 cells were treated with or without a JNK-specific inhibitor (SP600125), and molecular docking analysis were used to confirm the underlying molecular mechanism and explore the related signaling pathway prior to molecular and histological analyses. Results Our findings indicated that glycine (an amino acid) inhibited d-gal-induced oxidative stress and significantly upregulated the expression and immunoreactivity of antioxidant proteins (Nrf2 and HO-1) that had been suppressed in the mouse brain. Both the in vitro and in vivo results indicated that d-gal induced oxidative stress-mediated neurodegeneration primarily by upregulating phospho-c-Jun N-terminal kinase (p-JNK) levels. However, d-gal + Gly cotreatment reversed the neurotoxic effects of d-gal by downregulating p-JNK levels, which had been elevated by d-gal. We also found that Gly reversed d-gal-induced neuroapoptosis by significantly reducing the protein expression levels of proapoptotic markers (Bax, cytochrome c, cleaved caspase-3, and cleaved PARP-1) and increasing the protein expression level of the antiapoptotic protein Bcl-2. Both the molecular docking approach and the in vitro study (in which the neuronal HT22 cells were treated with or without a p-JNK-specific inhibitor (SP600125)) further verified our in vivo findings that Gly bound to the p-JNK protein and inhibited its function and the JNK-mediated apoptotic pathway in the mouse brain and HT22 cells. Moreover, the addition of Gly alleviated d-gal-mediated neuroinflammation by inhibiting gliosis via attenuation of astrocytosis (GFAP) and microgliosis (Iba-1) in addition to reducing the protein expression levels of various inflammatory cytokines (IL-1βeta and TNFα). Finally, the addition of Gly reversed d-gal-induced synaptic dysfunction by upregulating the expression of memory-related presynaptic protein markers (synaptophysin (SYP), syntaxin (Syn), and a postsynaptic density protein (PSD95)) and markedly improved behavioral measures of cognitive deficits in d-gal-treated mice. Conclusion Our findings demonstrate that Gly-mediated deactivation of the JNK signaling pathway underlies the neuroprotective effect of Gly, which reverses d-gal-induced oxidative stress, apoptotic neurodegeneration, neuroinflammation, synaptic dysfunction, and memory impairment. Therefore, we suggest that Gly (an amino acid) is a safe and promising neurotherapeutic candidate that might be used for age-related neurodegenerative diseases.

OBJECTIVES:To determine the prevalence of physical and verbal harassment in nurses and doctors and to evaluate the associated factors which lead to harassment in Teachings Hospitals in Peshawar district in 2018.METHODOLOGY:Nurses and doctors of three government and one private hospital of District Peshawar were included in this study. Sample size was 384. Simple random sampling was used and those nurses and doctors having experience less than 6 months were excluded. A self-administered questionnaire was implemented having both closed and open-ended questions and a written informed consent was taken. Data was analyzed using SPSS version 22.RESULTS:Out of 384 respondents 235 (61.3%) were harassed. Common type was verbal. Prevalence was more in nurses (69.5%) than doctors (52.2%), in non-pathan (73%), Muslim (62%), rural (67.2%), non-married (61.3%), younger age and in surgical and allied (65.5%) nurses and doctors. Main source of harassment were colleagues. More harassment occurs in wards and in night shift and among those nurses and doctors whose daily working hours are more than 8 hours (62.5%) and working experience is more than 4 years (64.6%).CONCLUSION:The prevalence of harassment in our study was 61.3% and significant associated factors of harassment in our study are ethnicity, daily working hours, duration of job, nature of duty, place of duty, religion, work specialty and assailant.KEYWORDS: Physical Harassment, Verbal Harassment, Prevalence, Risk Factors, Lady Doctors, Nurses

Background During the progress and resolution of a diabetic ketoacidosis (DKA) episode, potassium levels are significantly affected by the extent of acidosis. However, none of the current guidelines take into account acidosis during resuscitation of potassium level in DKA management, which may increase the risk of cardiovascular adverse events. Objective To assess literature regarding the adjustment of potassium level using pH to calculate pH-adjusted corrected potassium level, and to observe the relationship of cardiovascular outcomes with reported potassium level and pH-adjusted corrected potassium in DKA. Methodology Seven databases were searched from inception to January 2018 for studies which had reported people with diabetes developing diabetic ketoacidosis, in relation to prevalence or incidence, fluid resuscitation or potassium supplementation treatment, treatment or cardiovascular outcomes, and experimentation with DKA management or insulin. Quality of studies was evaluated using Cochrane Risk of Bias and Newcastle Ottawa Scale. Results Forty-seven studies were included in qualitative synthesis out of a total of 10,292 retrieved studies. Forty-one studies discussed the potassium level and blood pH at the time of admission, ten studies discussed cardiovascular outcomes, and only four studies concurrently discussed potassium level, pH, and cardiovascular outcomes. Only two studies were graded as good on the Newcastle Ottawa Scale. The reported potassium level was well within normal range (5.8 mmol/L), whereas pH rendered patients to be moderately acidotic (7.13). Surprisingly, none of the included studies mentioned pH-adjusted corrected potassium level and, hence, this was calculated later. Although mean corrected potassium was within the normal range (3.56 mmol/L), 13 studies had corrected potassium below 3.5 mmol/L and five had it below 3.0 mmol/L. Nevertheless, with the exception of one study, none discussed cardiovascular outcomes in the context of potassium or pH-adjusted potassium level. Conclusion The evidence surrounding cardiovascular outcomes during DKA episodes in light of a pH-adjusted corrected potassium level is scarce. A prospective observational, or preferably, an experimental study in this regard will ensure we can modify and enhance safety of existing DKA treatment protocols.

CKD-associated pruritus is one of the common symptoms in patients undergoing dialysis, thus contributing to the diminished and compromised quality of life. This study aimed to explore the association between the CKD-associated pruritus on quality of life of patients undergoing hemodialysis in Malaysia. A cross-sectional multicenter study, carried out from February to September 2017 at tertiary care settings in Kuala Lumpur, Malaysia. Patients aged 18 years and above, undergoing hemodialysis, understanding Malay language and willing to participate were included. The CKD-associated pruritus was assessed by using Malay 5D-itch scale and Malay FANLTC questionaiare. To determine the factors associated with pruritus and quality of life, multivariate logistic regression analysis was used having P value < 0.05 as statistically significant. Among n = 334 recruited patients with a response rate of 100%, 59.6% were males and total of 61.3% were having CKD-associated pruritus. The results showed a statistically significant weak negative correlation between CKD-associated pruritus and quality of life. Multivariate linear regression revealed none of these factors were found to be associated with pruritus; however, CKD-associated prurtius was found to be associated with quality of life score. CKD-associated pruritus is have a negative impact on the patient's quality of life including physical, social, mental/emotional, and functional well-being. Despite the high prevalence and negative impact of CKD-associated pruritus on quality of life, it is disregarded by most health care professionals. It is thus pertinent to monitor the potential risk factors and consider providing timely treatment implications for CKD-associated pruritus in hemodialysis patients, in order to improve their quality of life. © 2019 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy

Bhuvan KC,1,2 Alian A Alrasheedy,3 Bey Hing Goh,4,5 Ali Blebil,1 Nida Sajid Ali Bangash,1 Mohamed Izham Mohamed Ibrahim,6 Inayat Ur Rehman7 1School of Pharmacy, Monash University Malaysia, Selangor, 47500, Malaysia; 2College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia; 3Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Qassim, Saudi Arabia; 4Biofunctional Molecule Exploratory (BMEX) Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, 47500, Malaysia; 5College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, People’s Republic of China; 6College of Pharmacy, QU Health, Qatar University, Doha, Qatar; 7Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, PakistanCorrespondence: Bhuvan KCSchool of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, MalaysiaTel +60142271852Email bhuvan.kc@monash.eduPurpose: The aims of this study are to explore the types and patterns of use of health mobile apps among pharmacy clients in Selangor, Malaysia, and to explore the users’ experiences and views regarding the benefits of and issues with the use of the health apps.Patients and Methods: A cross-sectional survey was conducted with 278 pharmacy clients who were using health apps on their smartphones. A survey was developed, piloted, and rolled out, comprised of socio-demographic characteristics, information regarding the common types and the pattern of health app use, the benefits of health apps, and issues that users faced while using these apps. Statistical analysis was performed using IBM SPSS version 21.Results: The mean (±SD) age of health app users was 29.8 (± 11.74) years old, and over half of them (51.8%) were male, while less than half were female (48.2%). There were 48 different types of mobile health apps used by the participants in this study. The two most common were multi-purpose general health apps (53.6%) and fitness apps (38.1%). In terms of pattern of use, 33.5% of the participants reported using their health apps daily, 36.7% at least once weekly, and 25.2% monthly. The main benefits reported by the users were tracking of health status (47%), motivation (41%), and knowledge about health and fitness (9%). The main issues reported by the participants included inaccuracy of the app (24%), inconvenience (20.7%), and not being user-friendly (18.5%).Conclusion: The study showed that the participants used many different types of mobile health apps for several purposes, including general health, wellness, fitness, and self-management of diseases. These apps helped the participants to track their health-related activities and motivated them to maintain their wellness and fitness. Further areas of improvement were identified to ensure evidence-based and effective utilization of apps to achieve required health outcomes.Keywords: digital health, digital patients, health apps, Malaysia, mobile health

Alzheimer’s disease (AD) is the most predominant age-related neurodegenerative disease, pathologically characterized by the accumulation of aggregates of amyloid beta Aβ1–42 and tau hyperphosphorylation in the brain. It is considered to be the primary cause of cognitive dysfunction. The aggregation of Aβ1–42 leads to neuronal inflammation and apoptosis. Since vitamins are basic dietary nutrients that organisms need for their growth, survival, and other metabolic functions, in this study, the underlying neuroprotective mechanism of nicotinamide (NAM) Vitamin B3 against Aβ1–42 -induced neurotoxicity was investigated in mouse brains. Intracerebroventricular (i.c.v.) Aβ1–42 injection elicited neuronal dysfunctions that led to memory impairment and neurodegeneration in mouse brains. After 24 h after Aβ1–42 injection, the mice were treated with NAM (250 mg/kg intraperitoneally) for 1 week. For biochemical and Western blot studies, the mice were directly sacrificed, while for confocal and “immunohistochemical staining”, mice were perfused transcardially with 4% paraformaldehyde. Our biochemical, immunofluorescence, and immunohistochemical results showed that NAM can ameliorate neuronal inflammation and apoptosis by reducing oxidative stress through lowering malondialdehyde and 2,7-dichlorofluorescein levels in an Aβ1–42-injected mouse brains, where the regulation of p-JNK further regulated inflammatory marker proteins (TNF-α, IL-1β, transcription factor NF-kB) and apoptotic marker proteins (Bax, caspase 3, PARP1). Furthermore, NAM + Aβ treatment for 1 week increased the amount of survival neurons and reduced neuronal cell death in Nissl staining. We also analyzed memory dysfunction via behavioral studies and the analysis showed that NAM could prevent Aβ1–42 -induced memory deficits. Collectively, the results of this study suggest that NAM may be a potential preventive and therapeutic candidate for Aβ1–42 -induced reactive oxygen species (ROS)-mediated neuroinflammation, neurodegeneration, and neurotoxicity in an adult mouse model.

Background Pharmacists play a significant role in the multidisciplinary care of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). However, there is less evidence to clarify the impact of pharmacist as an individual team member on HIV care. Objective This study aims to determine the effects of pharmacist intervention on improving adherence to antiretroviral therapy (ART), viral load (VL) suppression, and change in CD4-T lymphocytes in PLWHA. Methods We identified relevant records from six databases (Pubmed, EMBASE, ProQuest, Scopus, Cochrane, and EBSCOhost) from inception till June 2020. We included studies that evaluated the impact of pharmacist care activities on clinical outcomes in PLWHA. A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and mean difference (MD) for continuous data] with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence. The review protocol was published on PROSPERO (CRD42020167994). Results Twenty-five studies involving 3206 PLWHA in which pharmacist-provided intervention either in the form of education with or without pharmaceutical-care either alone or as an interdisciplinary team member were included. Eight studies were randomized controlled trials (RCTs), while 17 studies were non-RCTs. Pooled-analyses showed a significant impact of pharmacist care compared to usual care group on adherence outcome (OR: 2.70 [95%, CI 1.80, 4.05]), VL suppression (OR: 4.13 [95% CI 2.27, 7.50]), and rise of CD4-T lymphocytes count (MD: 66.83 cells/mm3 [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low. Conclusion The findings suggest that pharmacist care improves adherence, VL suppression, and CD4-T lymphocyte improvement in PLWHA; however, it should be noted that the majority of the studies have a high risk of bias. More research with more rigorous designs is required to reaffirm the impact of pharmacist interventions on clinical and economic outcomes in PLWHA.

The receptor for advanced glycation end products (RAGE), a pattern recognition receptor signaling event, has been associated with several human illnesses, including neurodegenerative diseases, particularly in Alzheimer&rsquo, s disease (AD). Vanillic acid (V.A), a flavoring agent, is a benzoic acid derivative having a broad range of biological activities, including antioxidant, anti-inflammatory, and neuroprotective effects. However, the underlying molecular mechanisms of V.A in exerting neuroprotection are not well investigated. The present study aims to explore the neuroprotective effects of V.A against lipopolysaccharides (LPS)-induced neuroinflammation, amyloidogenesis, synaptic/memory dysfunction, and neurodegeneration in mice brain. Behavioral tests and biochemical and immunofluorescence assays were applied. Our results indicated increased expression of RAGE and its downstream phospho-c-Jun n-terminal kinase (p-JNK) in the LPS-alone treated group, which was significantly reduced in the V.A + LPS co-treated group. We also found that systemic administration of LPS-injection induced glial cells (microglia and astrocytes) activation and significantly increased expression level of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-KB) and secretion of proinflammatory cytokines including tumor necrosis factor alpha (TNF-&alpha, ), interleukin-1 &beta, (IL1-&beta, ), and cyclooxygenase (COX-2). However, V.A + LPS co-treatment significantly inhibited the LPS-induced activation of glial cells and neuroinflammatory mediators. Moreover, we also noted that V.A treatment significantly attenuated LPS-induced increases in the expression of AD markers, such as &beta, site amyloid precursor protein (APP)&ndash, cleaving enzyme 1 (BACE1) and amyloid-&beta, (A&beta, ). Furthermore, V.A treatment significantly reversed LPS-induced synaptic loss via enhancing the expression level of pre- and post-synaptic markers (PSD-95 and SYP), and improved memory performance in LPS-alone treated group. Taken together, we suggest that neuroprotective effects of V.A against LPS-induced neurotoxicity might be via inhibition of LPS/RAGE mediated JNK signaling pathway, and encourage future studies that V.A would be a potential neuroprotective and neurotherapeutic candidate in various neurological disorders.

Alzheimer&rsquo, s disease (AD) is a progressive neurodegenerative disorder that represents 60&ndash, 70% of all dementia cases. AD is characterized by the formation and accumulation of amyloid-beta (A&beta, ) plaques, neurofibrillary tangles, and neuronal cell loss. Further accumulation of A&beta, in the brain induces oxidative stress, neuroinflammation, and synaptic and memory dysfunction. In this study, we investigated the antioxidant and neuroprotective effects of the natural flavonoid lupeol in the A&beta, 1&ndash, 42 mouse model of AD. An Intracerebroventricular injection (i.c.v.) of A&beta, (3 &micro, L/5 min/mouse) into the brain of a mouse increased the reactive oxygen species (ROS) levels, neuroinflammation, and memory and cognitive dysfunction. The oral administration of lupeol at a dose of 50 mg/kg for two weeks significantly decreased the oxidative stress, neuroinflammation, and memory impairments. Lupeol decreased the oxidative stress via the activation of nuclear factor erythroid 2-related factor-2 (Nrf-2) and heme oxygenase-1 (HO-1) in the brain of adult mice. Moreover, lupeol treatment prevented neuroinflammation by suppressing activated glial cells and inflammatory mediators. Additionally, lupeol treatment significantly decreased the accumulation of A&beta, and beta-secretase-1 (BACE-1) expression and enhanced the memory and cognitive function in the A&beta, mouse model of AD. To the best of our knowledge, this is the first study to investigate the anti-oxidative and neuroprotective effects of lupeol against A&beta, 42-induced neurotoxicity. Our findings suggest that lupeol could serve as a novel, promising, and accessible neuroprotective agent against progressive neurodegenerative diseases such as AD.

Helicobacter pylori (H. pylori), is the most common infectious bacterium of the Human stomach. In early childhood, colonization of H. pylori in stomach releases different pathogenic factors which interfere with functions of human cells. Combination of two main genetic pathogenic factors CagA and VacA play important role in causing severity of H. pylori infection. In H. pylori infected patients, CagA and CagPAI positive strains have positive association in development of peptic ulcer disease and gastric cancers.50-70% of H. pylori produces CagA gene that is multifunction toxin. By adapting different mechanisms CagA define its role in oncogenic signaling cascades, in tumor suppressor pathway and in inflammation. CagA gene is strongly associated with VacA cytotoxic function and the strains, ultimately responsible for epithelial destruction of stomach and leading towards cancer. Review provides, CagA has important role in the virulence of H.pylori infection. Different Peptic ulcer diseases and gastric cancers are caused by the presence of CagA gene. Key words: H. pylori, CagA gene, VacA gene, Gastric cancers, Peptic ulcer disease.

Almost 50–90% of chronic kidney disease patients undergoing haemodialysis have been reported to have Chronic kidney disease-associated pruritus (CKD-aP). The intensity of CKD-aP may vary from a mild itch to an unbearable pruritic sensation which interferes with the patient’s quality of life. CKD-aP has become one of the upmost distressing cutaneous and most common symptom of chronic kidney disease which is often overlooked by nephrologists, primary care physicians, and other health-care professionals. Typically sleep disorders, mental and social well-being have been correlated with chronic kidney disease patients. With that this article presents vital comprehensive review which includes epidemiology of chronic kidney disease in Malaysia and Pakistan, CKD-associated pruritus and other dermatological disorders associated with chronic kidney diseases, pathophysiology of CKD-associated pruritus, clinical features of chronic kidney disease-associated pruritus, diagnosis of CKD-associated uremic pruritus, differential diagnosis of CKD-associated uremic pruritus, assessment and quantification of pruritus severity.

Chronic kidney diseases-associated pruritus (CKD-aP) affects the patients’ mental and physical health, potentially resulting in fatigue, depression, and directly affecting quality of sleep. Hemodialysis patients were reported to experiencing moderate to extreme CKD-aP, thus exhibited higher possibilities of remaining awake at night while sleeping in the day. Therefore, CKD-aP is attributed toward nocturnal awakenings and difficulty falling asleep. This condition (CKD-aP) significantly impacts the quality of life (QOL), triggering sleep disturbance, mood changes, and uncontrollable scratching. CKD-aP patients have a compromised QOL that is generally linked to limited personal freedom and control due to lengthy treatment time. Overall, the loss of freedom has wider implications, such as altering marital, family, and social relationships.Thus, this writing highlights the vital effect of chronic kidney diseases-associated pruritus on patients’ sleep quality, social and mental well-being and providing comprehensive management and treatment options to improve patients’ qualityof life.

The demand for natural medicines has increased because of their limited adverse effects. The aim of study is to explore the antidiabetic potential of isolated steroidal alkaloid from Sarcococca saligna in streptozotocin induced diabetic rats. To determine the antidiabetic activity of steroidal alkaloids, diabetes was induced in rats by injecting streptozotocin intraperitoneally at a dose of 40 mg/Kg. After a week of STZ injection the treatment were started and the 8th day was considered as the 1st day of treatment and up to four weeks the rats were treated with steroidal alkaloids. Animals were divided into five groups, group 1 considered as a control group by receiving normal saline (1 ml/Kg) twice daily and group 2, 3, 4 were treated with active compound sarcovagine-D, saracodine and holaphylline at the dose of 5 mg/Kg subcutaneously twice a day while group 5 was treated with a standard drug glibenclamide at a dose of 1 mg/Kg/day. The result showed that treated group 2 and 4 reduced the glucose level in blood significantly while group 3 showed moderate glucose reduction. The fructosamine level reduced significantly in treating group 4 from the 2nd week of treatment while group 2 and 3 decreased the level significantly in week 4 in diabetic rats. The treated groups showed gradual decreases the glucose level in 1st and 2nd week of oral glucose tolerance test compared to control group. The group receiving holaphylline (4) and sarcovagine-D (2) showed good improvements in blood lipids while the effect of compound on body weight showed less significant improvement. The present study concluded that steroid alkaloids from isolated Sarcococca saligna possess hypoglycemic effect and improve others diabetes associated complications. Together these finding further research is needed using a range of doses to explore the other possible beneficial effects in diabetes mellitus and its molecular mechanism.

National immunization program of Pakistan does not include Influenza vaccines. The low rate of immunization might be attributed to the poor knowledge of influenza vaccination in Pakistan. Current study was aimed to assess the knowledge and attitude of influenza vaccination among parents. A questionnaire-based cross sectional study was conducted among randomly selected parents with at least one child aged >6 months. The responses were recorded against 27 items questionnaire assessing knowledge, perception, attitude and behaviours of parents. Data were analysed by using appropriate statistical methods. A total 532 responses were recorded with male gender preponderance (65%). Most of the parents (61.1%) reported that their children had received or planned to receive all recommended vaccines in Expanded Program on Immunization (EPI) of Pakistan. Only one third of the parents (24.4%) were aware of the availability of influenza vaccines in Pakistan, and very few (6.6%) reported vaccinating their child against influenza. Exploring the parents' attitudes regarding children vaccination, the top motivator was ‘immunization is important to keep my children healthy' (relative index = 0.93, p < 0.000). However, substantial number of parents believed that influenza is not a serious disease (18.5%) and vaccines are accompanied by several side effects (24.6%). A positive attitude was reflected among parents who were aware of influenza vaccines in Pakistan. About 35% participants believed that influenza vaccines are not required for healthy children. Current study demonstrated very low vaccination rate against influenza. Awareness and health literacy regarding influenza vaccine is poor among parents. These findings necessitate the need to appropriately structured awareness programs regarding influenza vaccination among parents.

The aim of this study was to assess the factors associated with anxiety in type 2 diabetes mellitus patients (T2DM) by using Hamilton Anxiety Rating Scale (HAM-A). A cross-sectional quantitative study was conducted after necessary ethical approval from Medicare Hospital Rawalpindi and Capital Development Authority Hospital Islamabad in accordance with Declaration of Helsinki. Three hundred thirty-eight patients with type 2 diabetes mellitus were selected by non-stratified random sampling technique from August 2016 to February 2017. Majority of the T2DM patients (n = 258, 66.5%) had mild anxiety, followed by mild to moderate anxiety (n = 82, 21.1%). A significant association (p 0.05) was observed between HAM-A score and patients’ age, family history, and life style. Linear regression analysis revealed gender (OR = − 0.308, CI-0.57-0.299) as a significant predictor (p

Background and objectives: Chronic kidney disease (CKD)-associated pruritus is a common and disturbing condition which has a negative impact on sleep quality, as well as overall health-related quality of life of patients receiving hemodialysis. To date, no systematic review has been undertaken, and there is a lack of concise evidence that statistically quantifies the impact of pruritus based on published data. Materials and Methods: A systematic search was done for original articles published in peer-reviewed English journals from database inception on 20 December, 2018, in the following databases: PubMed, MEDLINE, EMBASE, Ovid, CINHAL, ProQuest, and Scopus. Results: A total of 9217 research articles were identified. After removal of duplicates and screening for titles and abstracts, 28 articles were selected. The prevalence of disturbed sleep was 4−94%, while the pooled proportion on random effect in the study was 40% (95% CI = 0.30 to 0.49); I2 = 99.8%. However, the prevalence of disturbed sleep quality and quantity due to pruritus was 9−76%, and the pooled proportion on random effect in the study was 50% (95% CI = 0.37 to 0.64); I2 = 99.8%. Conclusions: Patients undergoing hemodialysis who are affected by CKD-associated pruritus have a higher chance of experiencing sleep disturbances. The prevalence of disturbed sleep due to CKD-associated pruritus was found to be 9−76% in the included studies for patients receiving hemodialysis therapy.

Supplemental Digital Content is available in the text, Chronic kidney disease (CKD)-associated pruritus is one of the most common symptoms found in patients who undergo dialysis for CKD, leading to a compromised quality of life. This study aimed to investigate the association between CKD-associated pruritus and the quality of life in patients undergoing hemodialysis in Pakistan. A cross-sectional multicenter study was carried out from July 2016 to April 2017 in 2 tertiary care hospitals in Pakistan. Patients aged 18 years and above of both genders, undergoing hemodialysis, understood the Urdu language, and were willing to participate; were included. Of 354 recruited patients with a response rate of 100%, majority (66.1%) of the patients were males. The median (intra-quartile range [IQR]) age of patients was 42.0 [34.0–50.0] years. The prevalence of pruritus was 74%. The median [IQR] score for pruritus was 10.0 (out of possible 25) [8.0–12.0]. Multivariate linear regression revealed a statistically significant association between CKD-associated pruritus with age of patients (β = 0.031; 95% confidence interval [CI] = 0.002–0.061; P = .038), duration of CKD (β = −0.013; 95% CI = −0.023 –−0.003; P = .014) and quality of life (β= −0.949; 95% CI = −1.450; −0.449). The median [IQR] score for health-related quality of life was 52.00 [43.00–58.00]. Prevalence of CKD-associated pruritus was reported to be 74% and it negatively affected the patient's quality of life. Patients with moderate to severe CKD-associated pruritus have poor quality of life. With an increase in intensity of pruritus, the QOL score decreased among the patients undergoing hemodialysis.

Background Chronic kidney disease-associated pruritus (CKD-aP) is a well-recognized, frequent and compromising complication among patients on hemodialysis. Despite advancement in basic medical sciences, CKD-aP is still a major complication and a challenge for both physicians and patients to manage. The aim of this study was to estimate the prevalence of CKD-aP among hemodialysis patients in Malaysia, to determine the impact of CKD-aP on sleep quality and any factors associated with CKD-aP. Method A multi-centered, cross-sectional study design was conducted from February 2017 to September 2017 at a tertiary hospital and its affiliated dialysis centers, in Kuala Lumpur, Malaysia. Included were patients > 18 years of age who were undergoing hemodialysis and could understand Malay. Participants were asked to fill the Malay 5D-itch scale and the Malay Pittsburgh sleep quality index (PSQI) upon recruitment. Results A total of 334/334 patients were recruited (response rate = 100%). The majority were male (59.6%) and Chinese (61.7%). A total of 61.3% had pruritus, of which most patients (63.4%) reported that their pruritus was mild. More than half (54.1%) reported that they slept > 6 h, and 93.2% experienced no sleep disturbances during the night. However; the overall PSQI median score [IQR] was 6.0 [5.0–9.0]. No significant association was found between demographic and clinical characteristics of patients with the severity of pruritus. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus. Conclusion In Malaysia, the prevalence of CKD-aP was 61.3%, of which the majority reported that their pruritus was mild. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus.

BACKGROUND Chronic kidney disease (CKD)-associated pruritus (CKD-aP) contributes to poor quality of life, including reduced sleep quality and poor sleep quality is a source of patient stress and is linked to lower health-related quality of life. This study aimed to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-aP. METHOD A multicenter, prospective, randomized, parallel-design, open label interventional study to estimate the effectiveness of zolpidem (10 mg) oral tablets versus acupressure on sleep quality and quality of life in patients with CKD-aP on hemodialysis. A total of 58 hemodialysis patients having sleep disturbance due to CKD-aP completed the entire 8-week follow-up. The patients were divided into a control (acupressure) group of 28 patients and an intervention (zolpidem) group of 30 patients. RESULTS A total of 58 patients having CKD-aP and sleep disturbance were recruited. In the control group there was a reduction in the PSQI score with a mean ± SD from 12.28 ± 3.59 to 9.25 ± 3.99, while in the intervention group the reduction in PSQI score with a mean ± SD was from 14.73 ± 4.14 to 10.03 ± 4.04 from baseline to endpoint. However, the EQ5D index score and EQ-visual analogue scale (VAS) at baseline for the control group with a mean ± SD was 0.49 ± 0.30 and 50.17 ± 8.65, respectively, while for the intervention group the values were 0.62 ± 0.26 and 47.17 ± 5.82, respectively. The mean EQ5D index score in the control group improved from 0.49 ± 0.30 to 0.53 ± 0.30, but in the intervention group there was no statistical improvement in mean EQ5D index score from 0.62 ± 0.26 to 0.62 ± 0.27 from baseline to week 8. The EQ 5D improved in both groups and the EQ-VAS score was 2.67 points higher at week 8 as compared to baseline in the control group, while in the intervention group the score was 3.33 points higher at week 8 as compared to baseline. Comparing with baseline, the PSQI scores were significantly reduced after week 4 and week 8 (P =

World Health Organization (WHO) measles surveillance data report a reduction in cases of measles globally from 67,524 cases in 2015 to 16,846 in 2016, and a reduction in deaths from 546,800 to 114,900 during period of 2000-14. Pakistan is among the five nations where almost a million children did not receive their first dose of measles vaccination, and outbreaks of the disease resulted in 4386 cases in 2011, 14,687 cases in 2012 with 310 deaths. In 2013, about 25,401 cases of measles were reported and 321 affected children died. The measles vaccination coverage is very low in Pakistan for both 1st dose and booster dose. To prevent outbreaks of measles in Pakistan a national vaccination program should be launched side by side with a polio eradication program in each district and township and a campaign should be launched to educate parents on measles vaccination for childrens to reduce the measles case fatality rate.

Background: The irrational use, &ldquo, over the counter supply&rdquo, and unregulated supply chains of antimicrobials are contributing toward antimicrobial resistance. Antimicrobial stewardship programs regulate antimicrobials usage to prevent resistance and reduce health care burden. Objective: To assess the knowledge and practice of pharmacists&rsquo, working in various healthcare settings toward antimicrobial stewardship in Pakistan. Method: A cross-sectional study was conducted among pharmacists working in different sectors between March to June 2017. Results: A total of 181 pharmacists participated, of whom (n = 145, 80.1%) were males. The majority of participants were in the 20&ndash, 30 age group (n = 147, 81.2%) and hold Doctor of Pharmacy degrees. More than 80% of pharmacists agreed that &ldquo, antimicrobial stewardship is essential to improve patient care&rdquo, while (n = 159, 87.8%) pharmacists agreed that &ldquo, pharmacist should be trained on the use of antimicrobial&rdquo, Close to 90% of pharmacists agreed that &ldquo, adequate training should be provided to pharmacists on antimicrobial use&rdquo, Regarding the practice of antimicrobial stewardship, (n = 72, 39.8%) pharmacists often/always &ldquo, make efforts to prevent or reduce the transmission of infections within the community&rdquo, (n = 58, 32%) pharmacists never &ldquo, dispense antimicrobials without a prescription&rdquo, and (n = 60, 32%) pharmacist often/always &ldquo, communicate with prescribers if unsure about the appropriateness of an antibiotic prescription&rdquo, Conclusions: Increased antimicrobial stewardship efforts can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. Pharmacists in Pakistan have good knowledge and adopt positive practices toward antimicrobial stewardship. Pharmacist and other health care professionals should collaborate within multi-disciplinary teams to reduce the problem of antimicrobial resistance and improve the quality of life of patients.

BackgroundThe prevalence of chronic kidney disease-associated pruritus (CKD-aP) varies from 22% to 84% among patients receiving hemodialysis. It occurs more frequently at night, and often affects patient's sleep quality. CKD-aP is often unreported by patients, and many do not receive effective treatment. There is, however, a paucity of available data on the prevalence and impact of CKD-aP on patients receiving hemodialysis in Pakistan.MethodsA multicenter cross-sectional study was undertaken from July 2016 to April 2017 at a tertiary care hospitals in Pakistan.Results354 patients undergoing hemodialysis were studied. 35.6% had CKD for 1-2 years, and 42.4% were receiving hemodialysis for 1-2 years. The prevalence of pruritus was 74%. The median [interquartile range] score for pruritus was 10.0 (out of possible 25) [8.0-12.0]; while the median [interquartile range] Pittsburgh Sleep Quality Index (PSQI) score was 8.0 (out of possible 21) [7.0-10.0]'. Pruritus was significantly correlated with the sleep score (r = 0.423, pConclusionsChronic kidney disease-associated pruritus is very common in patients receiving hemodialysis in Pakistan. Pruritus is significantly associated with poor sleep quality.

Background Chronic kidney disease (CKD) has become a major public health issue worldwide in the past few years. Pruritus is a common, well-recognized complication often seen in patients with chronic renal failure. For assessment of pruritus, different tools are used but these tools are unable to identify the changes and variations in the severity of pruritus. The aim of our study was to validate the Urdu-version of the Urdu-version of the 5D itch scale among patients suffering from chronic kidney disease in Pakistan. Method The 5D itch scale was translated from English into Urdu following translation guidelines for translation. Face and content validity was determined by a panel of experts and piloted. For retest, the Urdu version of the 5D itch scale was administered at baseline and two weeks. Results A total of 50 participants with end stage renal disease were recruited, and of these, 64% were males. Exploratory factor analysis revealed that the 5D–IS had 2-factor loadings: “Pattern and activity” and “Distribution” with Kaiser–Mayer–Olkin (KMO) = 0.802, Bartlett’s test of sphericity was significant (df = 28, p

Background Vaccinating healthcare professionals against influenza is considered an effective infection control measure. However, there is a low uptake of influenza vaccine among healthcare professionals around the globe. Currently, it is unknown whether healthcare professionals in Sierra Leone are aware of, and have been vaccinated against influenza. Also, there is a paucity of research evidence on their level of knowledge and attitude toward influenza vaccination. This study assessed healthcare professionals’ current influenza vaccine uptake rate, reasons for not getting vaccinated as well as their awareness, knowledge of, and attitude towards influenza vaccination in Freetown Sierra Leone. Method A cross-sectional study was conducted between February and April 2016 among healthcare providers working in four public and two private health facilities in Freetown Sierra Leone. Linear regression analysis, one-way ANOVA and independent t-test were employed for data analysis. Results Among 706 respondents that participated in the study more than half were females 378 (53.6%), nurses 425 (60.4%), and the majority were between the age group of 20-39 years 600 (85.3%). Only 46 (6.5%) were vaccinated against influenza. Key reasons for not vaccinated against influenza were less awareness about influenza vaccination among HCPs 580 (82.73%) with (β = 0.154; CI 0.058–0.163), the high cost of influenza vaccines and therefore not normally purchased 392 (55.92%) having (β = 0.150; CI 0.063–0.186). More than half believed that HCPs are less susceptible to influenza infections than other people. Also, majority 585 (84.3%) of HCPs thought that influenza disease could be transmitted after symptoms appear. In addition, 579 (83.2%) of HCPs felt that symptoms usually appear 8–10 days after exposure. Close to half 321 (46.0%) of HCPs were not aware of the influenza immunisation guidelines published by the Advisory Committee on Immunization Practices and Centre for Disease Control. Conclusion Influenza vaccine coverage among healthcare professionals in Freetown Sierra Leone was low. High cost, inadequate knowledge about influenza and its vaccine as well as the lack of awareness of vaccine availability were key barriers. Increasing access to influenza vaccine and the use of appropriate educational interventions to increase knowledge and awareness are required to improve influenza vaccination coverage among HCPs. Electronic supplementary material The online version of this article (10.1186/s12889-017-4700-2) contains supplementary material, which is available to authorized users.

Introduction Several tools have been developed to assess the severity of pruritus. In Malaysia, no tool has been validated to assess pruritus in patients with chronic kidney disease (CKD). Therefore, the aim of our study was to validate the Malay 5D itching scale (M5D-IS) among patients with CKD in Malaysia. Method The English version of the 5D-IS was translated into Malay according to International Guidelines. Face and content validity was determined by an expert panel and pilot tested in patients with end-stage renal disease (ESRD). The M5D-IS was then validated in a tertiary hospital in Malaysia from May to June 2016. We recruited patients with (i.e., patients with ESRD) and without pruritus (i.e., patients with stage 1–3 CKD) (to determine if the M5D-IS could discriminate between the two groups), and administered the M5D-IS at baseline and 2 weeks later. Exploratory factor analysis was used to examine the construct validity. Internal consistency was assessed using Cronbach’s alpha and intraclass correlation coefficient was calculated to assess the reliability of the instrument. Results A total of 70 participants were recruited (response rate = 100%). The majority were males (51.4%) and Malay (67.1%). Exploratory factor analysis revealed that the 5D-IS had 2-factor loadings: “daily routine activity” and “pattern of itching,” which explained 77.7% of the variance. The overall score of the M5D-IS, as well as for each domain, was significantly worse in participants with pruritus (9.83 ± 0.35), compared to those without pruritus (5.51 ± 0.93, p

Supply of adequate moisture is one of the most important factors limiting agricultural extension and productivity. Ca 2+ and K + are both essential plant nutrients required in a number of developmental and metabolic processes. Both of these nutrients play an important role in ameliorating drought stress in crop plants. This experiment was designed to study whether exogenous application of Ca 2+ and K + before the drought could enhance the potential of plants to survive under limiting water conditions. Brassica napus L. cv Bulbul-98 seedlings were exposed to drought stress for 10 days after exogenous application of different concentrations of Ca 2+ , K + and N through irrigation water. Exogenous Ca 2+ and K + application was associated with increased relative water content, membrane stability and chlorophyll content in seedlings exposed to water deficit. Though the quantity of Pro and activities of APX (EC: 1.11.1.11) and CAT (EC: 1.11.1.6) were increased after K + application, they were strongly induced in seedlings supplemented with Ca 2+ in a dose dependent manner. Increasing quantity of N application, however, had a negative effect on these parameters. Key words : Drought, Ca 2+ , K + , AOS enzymes, proline, chlorophyll.