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This study investigated the concentrations of potentially harmful elements (PHE) in edible tissues of trout fish (Salmo trutta) in the Phander Valley, Northern Pakistan. For this purpose, fish were sampled from the Phander Valley (Gilgit River and Phander Lake). PHE concentrations in edible fish tissues (muscle, fins, and skin) were determined using atomic absorption spectrometry (AAS, AAnalyst 700, Perkin Elmer, USA). Among PHE, zinc (Zn) showed the highest concentration of 1097 μg/kg in the skin, followed by manganese (Mn) of 241 μg/kg in the muscle, and the lowest of 3.78 μg/kg for cadmium (Cd) in fins. The concentration of PHE in fish tissues of the study area was observed within the threshold limits set by the food and agriculture organization (FAO). PHE concentration of fish tissues was used for the calculation of chronic risk assessment using the chronic daily intake (CDI) and hazard quotient (HQ) indices. The highest CDI values were observed for Zn through fish tissue consumption in juveniles, followed by Mn, and the lowest for Cd in adults. The HQ values were observed less than 1 for adults through PHE consumption in fish tissue; however, that of juvenile surpassed the threshold limit through Cd consumption in all studied tissues and that of Pb in the muscle and skins only. Higher HQ values than the threshold limit could pose a potential chronic risk to the exposed community. Spearman's non-parametric correlation showed a varying degree of correlation among PHE in fish tissues and canonical discriminant analyses were used to differentiate the tissues based on PHE accumulation tendencies.

Epilepsy is one of the most common but manageable neurological disorder. The relation between epilepsy, sleep, and health-related quality of life (HRQoL) in culturally distinct environment of Pakistan remains unclear. The purpose of this study was to determine prevalence and predictors of excessive daytime sleepiness (EDS), poor sleep quality (SQ), and to analyze their association with HRQoL in people with epilepsy (PWE).A study was conducted among PWE attending two tertiary care hospitals of Islamabad and Rawalpindi, Pakistan. The EDS, SQ, and HRQoL were evaluated by Urdu versions of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31).The study included 200 PWE and 51 healthy controls with mean (SD) ages of 33.1 ± 13.9, 32.9 ± 10.9, and a disease duration of 5.01 ± 6.17, respectively. The majority of the respondents (n = 130, 65%) had poor seizure control, and most of these (n = 88, 68%) were on combination antiepileptic drug (AED) therapy. In comparison to controls, a higher number of PWE had EDS by ESS (score ≥ 11, 10% vs. 40%, p-value 0.00), and poor SQ by PSQI (score 5, 9% vs. 71%, p-value 0.00). A multiple logistic regression analysis reveals that the factors significantly associated with EDS were: female gender; increasing age; seizure control; duration of epilepsy; and combination AED therapy. A second multiple binary logistic regression analysis suggests that factors significantly associated with poor SQ were: increasing age; female gender; poor seizure control; and combination therapy. The Hierarchical multivariate analysis suggests that poor seizure control, EDS, and poor SQ were significant predictors of low HRQoL.The findings suggest high prevalence of EDS and poor SQ in PWE in Pakistan. A significant negative association exists between sleep complaints and HRQoL. During routine clinical consultations, awareness about sleep hygiene practices must be provided to enhance HRQoL.

This study focuses on enrichment, spatial distribution, potential ecological risk index (PERI) and human health risk of various toxic metals taken via soil and surface water in the vicinity of Sewakht mines, Pakistan. The samples of soils (n = 54) of different fields and surface water (n = 38) were analyzed for toxic metals including cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), lead (Pb), nickel (Ni), zinc (Zn) and molybdenum (Mo). Soil pollution level was evaluated using pollution indices including geo-accumulation index (Igeo), contamination factor (CF), degree of contamination (CD), enrichment factor (EF) and PERI. CF showed moderate contamination of soil with Cd, Co, Fe and Mo, while Igeo values indicated moderate accumulation of Cu. For Cd, EF> 1.5 was found in agricultural soils of the study area. PERI findings presented a very high ecological risk (PERI > 380) at two sites (4%), considerable ecological risk at four sites (7.4%). Non-carcinogenic risk from exposure to Fe in soil was higher than limit (HI > 1) for both children and adults. Moreover, carcinogenic risk postured by soil contaminants i.e. Cd, Cr, Co and Ni in children was higher than their limits (except Pb), while in adults only Co posed higher risk of cancer than the limit (10−4) through soil exposure. Non-carcinogenic risks in children due to Cd, Co, Mo via surface water intake were higher than their safe limits (HQ > 1), while in adults the risk order was Cr > Cd > Cu > Pb > Co > Mo. Moreover, carcinogenic risk exposure due to Co > Cd > Cr > Ni from surface water (except Pb) was higher than the tolerable limit (1 × 10−4) both for children and adults. However, Pb concentrations in both soil and surface water exposure were not likely to cause cancer risk in the local population.

Seasonal influenza is a highly contagious viral respiratory disorder. Prior knowledge of flu among general community is of paramount importance in order to mitigate its growing burden. In a pandemic, young adults are more likely to be infected increasing the potential for universities to be explosive disease outbreak centers. In this context, current study aims to assess the knowledge and perception of flu among university students from health sciences (HS) and non-HS background. Questionnaire-based cross sectional (August-December 2015) study was conducted among students of 65 universities across Pakistan. The students willing to participate were requested to fill out the self-administered questionnaire and responses were recorded and descriptively analyzed by SPSS. A total of 1694 students (age: 21.12 ± 2.13 years), 95% which belonged to age group 18-25 years, participated in the current study. Most of the participants (91.7%) had suffered from influenza during their life but only 55.7% correctly answered virus as causative agent of flu, while majority of participants, primarily from non-HS disciplines were not aware of flu cause. Very few participants (8.1%) believed that flu can cause death. About 20% students, mainly from non-HS disciplines reported that antibiotic can kill viruses. Similarly, 47.1% respondents agreed on the effectiveness of antibiotic in flu. A large proportion of study population preferred self-medication for influenza. Only 20.1% students were aware of influenza vaccine while majority of students (79.9%) from both disciplines reported that there is no such vaccine. Awareness and health literacy regarding seasonal influenza is poor among university students, especially from non-HS disciplines. These findings necessitate dire need to appropriately structured awareness programs in educational institutes to curb the growing burden of influenza.

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.

This study investigated the concentrations of potentially toxic elements (PTE) including copper (Cu), chromium (Cr), cobalt (Co), cadmium (Cd), nickel (Ni), iron (Fe), zinc (Zn), lead (Pb), molybdenum (Mo) and manganese (Mn) in water and soil of the Chitral city, Pakistan. For this purpose, water (n = 66) and soil (n = 48) samples were collected from various locations of the Chitral city and analyzed for the PTE concentrations. Determined PTE concentrations were evaluated for the human and ecological potential risk. Results revealed that hazard quotient through water consumption was less than the threshold limit (1). However, for soil, the Fe mean hazard index (HI > 1) value for children only surpassed the threshold limits. The mean cancer risk index values via soil exposure were higher (RI > 1 × 10–4) through consumption of Co, Ni and Cd for children and only Co for adults. Contamination factor (CF) values for Mo, Cd and Fe were found very high, considerable and moderate for 79%, 8% and 77% of sampling sites, respectively. Geoaccumulation index (Igeo) showed that soils were moderately–heavily polluted due to Mo. Potential ecological risk index (PERI) values exhibited considerable risk with an average risk index value in the range 190

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: A great deal of research has been carried out on the assessment of the eudaimonic perspective of psychological well-being and the hedonic perspective of subjective well-being. The Flourishing Scale (FS) has been extensively used in research and practice, as it assesses the fundamental aspects of social psychological functioning. Nevertheless, the psychometric properties of Urdu versions of eudaimonic measures, such as the FS, have not yet been ascertained. The translation and validation of the FS in the Urdu language was not available, and hence this study was planned with the aim to validate the Urdu version of the FS.Methods: We assessed the psychometric properties of the FS in a sample of adults aged 18 years and above in Pakistan (N = 130) using exploratory factor analysis based on principal component analysis with varimax rotation and confirmatory factor analysis.Results: The exploratory factor analysis confirmed the unidimensional nature of the 8-item FS. We assessed that the Urdu version of the FS showed a high internal consistency reliability (α = 0.914) with a significant intraclass correlation coefficient (ICC), p < 0.001). In our study, the Kaiser–Mayer–Olkin value was 0.915 with a chi-square test value (χ2) of 637.687, and Bartlett's test of sphericity was significant (df = 28, p < 0.001). The intraclass correlation coefficients (ICCs) at test–retest for all domains were statistically significant (p < 0.001) and showed excellent agreement for all the items. The revised confirmatory factor analysis revealed a good-fit model, but with item 8—“People respect me”—removed due to its lower factor loading.Conclusions: The findings suggest that the FS is a psychometrically sound instrument for assessing social psychological functioning among adults in Pakistan. Therefore, the validated Urdu version of the FS may be used in future studies of well-being in clinical psychology and positive psychology.

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.

Homicide is one ofthe oldest crimes in human civilization. For every person who dies as a result of homicide, many more are injured. A study of the patterns of homicide in a society is one of the first steps in developing strategies to prevent it. This study was conducted at the department of Forensic Medicine Khyber Medical College, Peshawar, to know the patterns of homicide, taking it as the first step in the prevention of this crime.This study includes 520 cases of homicide out of the total of 662 medico-legal autopsies conducted at Khyber Medical College, Peshawar, during the year 2002. The cases have been labeled as homicide on the basis of autopsy and police inquest.The homicide rate for Peshawar during the period under study was 22.9/100,000. Males constituted 86.15% ofthe victims. 32% of the victims were in their third decade of life. Firearms were the causative agent in 86% of the cases. Chest was the primarily targeted area of the body. The highest number of homicides occurred in the month of November.The homicide rate is alarmingly high in Peshawar as is the use of firearms. This is something that should be seriously looked at by the policy makers.

To examine the impact of cannabis abuse on the short term outcome in terms of relapses, use of services, compliance and functioning in patients with schizophrenia.A case control study was conducted in the Department of Psychiatry PGMI Lady Reading Hospital, Peshawar from January 2004 to October 2004. Fifty schizophrenic patients with co-morbid misuse of cannabis were selected. Fifty schizophrenic patients who were not using cannabis were selected as control group for the study. Data regarding socio-demographic detail, relapse, compliance to drugs and service utilization was collected with the help of a Performa. Problem cannabis use in the past year and social assessment of functioning were assessed with the help of Schedule for Clinical assessment in Neuropsychiatry (SCAN) and Global Assessment of Functioning (GAF) scale respectively.Schizophrenic patients with cannabis use were younger on admission and had younger age at onset of illness. They had more number of relapses and more contacts with psychiatric services including the police. Patients with comorbid cannabis use had poor drug compliance and their relapses were preceded by poor drug compliance Cases and control did not differ significantly on score of Global assessment of functioning.Comorbidity of cannabis seems to have adverse effects on almost all domains of the illness including course, service use and drug compliance.

This study was conducted with an objective to observe various presentations of Meckel's Diverticulum in our setting and compare it with other national and international studies.It was a retrospective analysis of hospital record carried out at the department of paediatric surgery Khyber Teaching Hospital, Peshawar. A total of 63 patients meeting the inclusion criteria were included in the study who had presented to our unit with signs and symptoms of Meckel's Diverticulum and who were diagnosed either by investigations or at surgery. All the patients were explored and resection and anastomosis performed. We did not do H. Pylori culture. Patients with bleeding per rectum were investigated by Meckel's scan. Analysis of the results was done by SPSS version 10.Majority of our patients presented with obstruction (82.5%) in contrast to the Western studies (around 40%) while only 4.7% presented with bleeding per rectum again in contrast to the Western countries (38.56%).There appears to be a geographical and/or racial difference in the presentation of Meckel's diverticulum.

The aim of the study was to know the extent of violent deaths among females in Peshawar, the most vulnerable age group, weapons of infliction and the mode of death.Non interventional (descriptive) type study.This study was conducted from 1st January, 2001 to 31st December, 2001 in the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar.Out of 679 deaths, presented for autopsy at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar 89 were females. These were grouped according to age, mode of death and weapons of infliction.Females formed 13% of all the autopsies done in Peshawar. The age group most commonly involved was 21-40 years (50.56%). Firearms were the predominant weapons of infliction (70.78%) and the intent was mostly homicidal (77.52%).Fatal violence against women is uncommon in Peshawar. Suicide is rare. Young women are mostly killed by firearms.

This cross-sectional study comprises a questionnaire-based survey regarding knowledge about human papillomavirus and its vaccine among students in different educational fields at public and private universities in the city of Lahore in Pakistan. A 26-item questionnaire was used to attain the objective of this study. The reliability of this tool was assessed using Cronbach's alpha (0.79) and the Kaiser-Meyer-Olkin value was 0.827. The response rate to the survey was 78.0%, of whom the majority (74.9%) were females and 308 (79%) were single (median age=23 years). While assessing the respondents' knowledge about HPV, 223(57%) students reported that they had already heard of HPV (human papillomavirus) and nearly 215 (55%) reported that HPV causes cervical cancer and can infect both men and women. Gender and field of study were two main factors found influencing the respondents' knowledge about HPV. Moreover, students' understanding about the mode of transmission of HPV was cursory: 40.51% said they did not know how HPV is transmitted, 133 (34.10%) stated that HPV spreads through the exchange of bodily fluids, and 22 (5.64%) selected cough/sneezing. In terms of prevention, 175 (44.87%) students stated that HPV can be prevented by vaccination, 30.0% reported sexual abstinence, 21.54% using condoms, and nearly 5.38% disclosed use of antibiotics. Addressing the knowledge of students regarding HPV vaccine, nearly 53% stated there is no vaccine against HPV and almost 64% rejected the statement that HPV vaccine prevents cervical cancer. In addition, students reported that they will be more than willing to get vaccinated for HPV if their physician recommend them (RII=0.74) followed by parents (RII=0.69). The results of this study revealed a poor understanding among respondents about the health problems associated with HPV, its prevention, modes of transmission and arability of HPV vaccine in Pakistan., Highlights • University students in Lahore, Pakistan have poor understanding of health problems associated with HPV. • Students lack of awareness about the availability of the HPV vaccine and modes of transmission of HPV indicate an immediate need for a national HPV awareness campaign. • Moreover, regardless of the field of education and gender, students understanding about preventing HPV and chances of reoccurrence after vaccination was poor. • Recommendations from a friends, parents or physician were found to be influence the students decision to get vaccinated for HPV.