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Depression is common in caregivers of children with asthma and is associated with poor outcomes in their child. No prior studies have longitudinally examined caregiver depression remission as a predictor of improvement in child asthma control.This 2-site study examined whether the proportion of time a caregiver was in depression remission predicted subsequent child asthma control at exit.Caregivers (n = 205) with current major depressive disorder and their children, ages 7 to 17, with persistent asthma were observed every 4 weeks for 52 weeks. Caregiver depressive symptoms were measured using the 17-item Hamilton Rating Scale for Depression (HRSD). Child asthma was assessed with the (Childhood) Asthma Control Test (cACT/ACT) and spirometry, and depression with the Children's Depression Inventory (CDI). Linear regression analyses were conducted with change in cACT/ACT, CDI, and forced expiratory volume in 1 second (FEVChildren were, on average, 54.1% female and 11 years old. Caregiver proportion of time in HRSD-assessed remission of depression was a significant predictor of improvement in cACT/ACT, CDI, and FEVImprovement in caregiver depression positively influences child asthma outcomes partially through improvement in child depressive symptom severity. Caregiver depression screening and treatment might lead to improvement in child asthma outcomes.

Objective To evaluate key corneal tomography parameters for screening mixed astigmatism and hyperopic males and females for refractive surgery and to compare the data to a previously studied myopic group in Pakistani population. Study design Cross-sectional, observational study. Place and duration of study Armed Forces Institute of Ophthalmology AFIO, National University of Medical Sciences, Rawalpindi, Pakistan, from August 2013 to August 2018. Methodology WaveLight Allegro Oculyzer II diagnostic device was used to examine eyes of 106 adult hyperopic patients in order to determine normal values of 20 parameters, which are considered most clinically applicable for refractive surgery screening. Kolmogorov-Smirnov test was used to evaluate normality of data. Results for outliers were displayed as 2.5%, 5%, 95% and 97.5% percentiles. Results Two hundred and nine eyes were examined; 110 men and 99 women with overall mean age of 31+11.7 years. Normal mean anterior segment values included: flat simulated keratometry (K1) 42.1±1.84 diopters (D), steep K2 43.8 ± 1.93 D, K maximum 44.4 ± 1.93 D, K mean 42.9 ± 1.75 D, astigmatism -1.3 ± 1.75 D, pachymetry at thinnest point 546.9 ± 33.3 um, front elevation at thinnest point 5.2 ± 3.47 um, and at the back was 14.1 ± 6.60 um, Ambrosio relational thickness maximum 472.0 ± 88.73, progression index (PI) maximum 1.2 ± 0.18, and anterior chamber depth (ACD) 2.7 ± 0.35 mm. Conclusion Hyperopic patients had greater front and back elevation and pachymetry but lesser keratometry, anterior chamber depth and chamber volume as compared to myopic patients in Pakistani population. Front and back elevation data in this hyperopic study population was slightly higher than previously published studies. Key Words: Refractive surgery, Corneal tomography, Screening, Hyperope.

To determine the refractive outcomes of wavefront optimized photo refractive keratectomy (PRK) in patients having myopia and myopic astigmatism in terms of efficacy, safety, accuracy, stability and predictability of the procedure.Quasi-experimental study.Refractive Surgical Unit, Armed Forces Institute of Ophthalmology, National University of Medical Sciences, Rawalpindi, Pakistan, from October 2013 to August 2018.Patients having myopia and myopic astigmatism, consented to be a part of the study, underwent meticulous screening consisting of detailed medical history, ocular examination and investigations. Each case was compiled and evaluated. Those who satisfied the criteria for refractive surgery were subjected to PRK procedure. Postoperative follow-up was carried out and parameters were recorded at designated intervals of 1 week, 1, 3, 6 and 12 months.This study included 208 eyes of 106 patients with mean age of 25.33 + 5.196 years. At the end of one year, 97% (202 out of 208) eyes had uncorrected distance visual acuity (UDVA) better than 20/25 with efficacy index of 1.009 ± 0.132 and safety index of 1.019 ± 0.126. None of the eyes lost two or more lines. In this study, 207 out of 208 eyes remained within + 0.50 diopter (D) of intended spherical equivalent (SEQ). Results showed 100% accuracy of procedure since all the study patients achieved SEQ within + 1D.PRK is an effective, predictable, and safe treatment procedure for correcting myopia and myopic astigmatism. Key Words: Photorefractive keratectomy, Myopia, Refractive surgery, Myopic astigmatism, Uncorrected distance visual acuity.

To evaluate key corneal tomography parameters for screening mixed astigmatism and hyperopic males and females for refractive surgery and to compare the data to a previously studied myopic group in Pakistani population.Cross-sectional, observational study.Armed Forces Institute of Ophthalmology AFIO, National University of Medical Sciences, Rawalpindi, Pakistan, from August 2013 to August 2018.WaveLight Allegro Oculyzer II diagnostic device was used to examine eyes of 106 adult hyperopic patients in order to determine normal values of 20 parameters, which are considered most clinically applicable for refractive surgery screening. Kolmogorov-Smirnov test was used to evaluate normality of data. Results for outliers were displayed as 2.5%, 5%, 95% and 97.5% percentiles.Two hundred and nine eyes were examined; 110 men and 99 women with overall mean age of 31+11.7 years. Normal mean anterior segment values included: flat simulated keratometry (K1) 42.1±1.84 diopters (D), steep K2 43.8 ± 1.93 D, K maximum 44.4 ± 1.93 D, K mean 42.9 ± 1.75 D, astigmatism -1.3 ± 1.75 D, pachymetry at thinnest point 546.9 ± 33.3 um, front elevation at thinnest point 5.2 ± 3.47 um, and at the back was 14.1 ± 6.60 um, Ambrosio relational thickness maximum 472.0 ± 88.73, progression index (PI) maximum 1.2 ± 0.18, and anterior chamber depth (ACD) 2.7 ± 0.35 mm.Hyperopic patients had greater front and back elevation and pachymetry but lesser keratometry, anterior chamber depth and chamber volume as compared to myopic patients in Pakistani population. Front and back elevation data in this hyperopic study population was slightly higher than previously published studies. Key Words: Refractive surgery, Corneal tomography, Screening, Hyperope.

BACKGROUND: Pediatric asthma is associated with increased health services utilization, missed school days and diminished quality of life. Children with asthma also report more frequent depressive and anxiety symptoms than non-asthmatic children, which may further worsen asthma outcomes. OBJECTIVE: The current study investigated the relationship between depressive and anxiety symptoms and four asthma outcomes (asthma control, asthma severity, lung function, and asthma-related quality of life) in children (N = 205) with moderate-to-severe persistent asthma. METHODS: The data were analyzed using a canonical correlation analysis (CCA), a multivariate framework that allows examination of all variables of interest in the same model. RESULTS: We found a statistically significant relationship between symptoms of depression and anxiety and asthma outcomes (1 − Λ = .372, p < .001). A large effect size suggests that 37.2% of variance is shared between depression and anxiety symptoms and four asthma outcomes (particularly asthma control and asthma-related quality of life) in the overall sample. Among girls (vs. boys), asthma control (measured by ACT) emerged as a stronger contributor to asthma outcomes compared to boys. CONCLUSIONS: These results suggest that psychiatric symptoms, especially anxiety, are associated with poor asthma-related quality of life, and more negative perception of asthma control in girls compared to boys (with no observed sex difference in physiological lung function). Clinicians should consider incorporating questions about psychiatric symptoms as part of routine asthma management, and focus patient education on unique differences in which boys and girls perceive their asthma symptoms.

Background Overweight/obesity (OV/OB) and depression have each been separately associated with worsened childhood asthma severity and control. Pathways by which these factors may jointly affect childhood asthma have not been elucidated. Objective To examine the interrelationship of OV/OB and depressive symptoms with childhood asthma and explore associated psychobiologic pathways. The present study investigated whether comorbid OV/OB and depressive symptoms are associated with impaired baseline lung function and increased airway resistance during emotional stress, and to assess whether such effects may be mediated by autonomic nervous system (ANS) dysregulation, specifically through predominance of vagal over sympathetic reactivity (vagal bias). Methods A total of 250 children with asthma, aged 7 to 17, were assessed for OV/OB using body mass index, depressive symptoms using the Children's Depression Inventory (CDI), and asthma severity using National Asthma Education and Prevention Program Expert Panel Report 3 criteria. Baseline pulmonary function (forced expiratory volume in 1 second [FEV1]) was assessed. The film “E.T. the Extra-Terrestrial” was used in a laboratory paradigm to evoke emotional stress/arousal. Airway resistance (Rint) was measured before and after the film to determine changes in airway function. ANS reactivity was assessed by measuring parasympathetic/vagal and sympathetic reactivity throughout the film. Results In OV/OB children with asthma, depressive symptoms predicted lower baseline FEV1 (β = −0.67, standard error [SE] = 0.24, P = .008), CDI predicted vagal bias under emotion stress/arousal (β = 0.27, SE = 0.09, P = .009), and vagal bias predicted increased Rint (β = 3.55, SE = 1.54, P = .023). Conclusion This study is the first to link OV/OB and depressive symptoms in their relationship to childhood asthma. In OV/OB children with asthma, depression may potentiate airway compromise, mediated by vagal bias. Use of antidepressant and anticholinergic therapies should be studied in this subgroup of patients.

Objective. To compare patient’s satisfaction level in performing routine activities during daylight and night vision after implantation with rigid, foldable, or rollable posterior chamber intraocular lens implants in uneventful cataract surgery. Design. Retrospective, cross-sectional. Place and Duration of Study. PNS SHIFA Hospital, Karachi, from Nov. 2009 to Nov. 2010. Methodology. 91 cataract surgery patients who had uneventful phacoemulsification, within the bag placement of intraocular lens and achieved best corrected visual acuity 6/9 or better were included in the study. Patients who developed postoperative complications were excluded. A specially designed questionnaire was used to assess patient’s satisfaction level of vision for those who underwent cataract surgery at least 3 months ago. Finally, they were categorized into five groups ranging from “very good” to “very poor.” SPSS version 16 was used to analyze the results. Results. There was a difference in satisfaction level between three groups. Vision was good in the day and the night with foldable posterior chamber intraocular lens implants. Conclusion. It was concluded that visual satisfaction level of patients who had foldable posterior chamber intraocular lens implantation was better during the day and night as compared to patients who had rigid or rollable posterior chamber intraocular lenses implantation.

Long-term, sustainable programs to address high incidence and death rates from neonatal infections are required for improving child survival. There is an urgent need to define the role of community-based management for neonates with serious bacterial infections--both at home and at first-level facilities.We reviewed available evidence for community-based antibiotic management strategies for serious neonatal infections.Nine distinct studies contributing data for community-based management of neonatal pneumonia and sepsis were identified. In a pooled analysis of 5 controlled trials of community-based management of neonatal pneumonia (4 using cotrimoxazole, 1 ampicillin, or penicillin), all-cause neonatal mortality showed 27% [95% confidence interval (CI): 18%-35%] reduction and pneumonia-specific mortality, 42% (95% CI: 22%-57%). Substantial reductions in neonatal mortality have been demonstrated in a nonrandomized controlled study in rural India (62% reduction, P0.001) and in a cluster randomized trial in rural Bangladesh (34% reduction, 95% CI: 7%-53%). Reduced case fatalities (0%-3%) with community-based management of neonatal sepsis were observed in 2 small uncontrolled studies from India and Guatemala and a recent randomized trial from Pakistan.Although methodological limitations preclude estimating the precise contribution of antibiotics toward neonatal mortality reduction in community settings in low income countries, available data suggest substantial benefit of case management approaches using antibiotics for neonatal sepsis in such settings.

BACKGROUND: Helminthiasis is an infestation of the human body with parasitic worms. It is estimated to affect 44 million pregnancies, globally, each year. Intestinal helminthiasis (hookworm infestation) is associated with blood loss and decreased supply of nutrients for erythropoiesis, resulting in iron‐deficiency anaemia. Over 50% of the pregnant women in low‐ and middle‐income countries (LMIC) suffer from iron‐deficiency anaemia. Though iron‐deficiency anaemia is multifactorial, hookworm infestation is a major contributory cause in women of reproductive age in endemic areas. Antihelminthics are highly efficacious, but evidence of their beneficial effect and safety when given during pregnancy has not been established. This is an update of a Cochrane Review last published in 2015. OBJECTIVES: To determine the effects of mass deworming with antihelminthics for soil‐transmitted helminths (STH) during the second or third trimester of pregnancy on maternal and pregnancy outcomes. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) (8 March 2021) and reference lists of retrieved studies. SELECTION CRITERIA: We included all prospective randomised controlled trials evaluating the effect of administration of antihelminthics versus placebo or no treatment during the second or third trimester of pregnancy; both individual‐randomised and cluster‐randomised trials were eligible. We excluded quasi‐randomised trials and studies that were only available as abstracts with insufficient information. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data, checked accuracy and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included a total of six trials (24 reports) that randomised 7873 pregnant women. All of the included trials were conducted in antenatal clinics within hospitals in LMICs (Uganda, Nigeria, Peru, India, Sierra Leone and Tanzania). Among primary outcomes, five trials reported maternal anaemia, one trial reported preterm birth and three trials reported perinatal mortality. Among secondary outcomes, included trials reported maternal worm prevalence, low birthweight (LBW) and birthweight. None of the included studies reported maternal anthropometric measures or infant survival at six months. Overall, we judged the included trials to be generally at low risk of bias for most domains, while the certainty of evidence ranged from low to moderate. Analysis suggests that administration of a single dose of antihelminthics in the second trimester of pregnancy may reduce maternal anaemia by 15% (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.72 to 1.00; I²= 86%; 5 trials, 5745 participants; low‐certainty evidence). We are uncertain of the effect of antihelminthics during pregnancy on preterm birth (RR 0.84, 95% CI 0.38 to 1.86; 1 trial, 1042 participants; low‐certainty evidence) or perinatal mortality (RR 1.01, 95% CI 0.67 to 1.52; 3 trials, 3356 participants; low‐certainty evidence). We are uncertain of the effect of antihelminthics during pregnancy on hookworm (average RR 0.31, 95% CI 0.05 to 1.93; Tau² = 1.76, I² = 99%; 2 trials, 2488 participants; low‐certainty evidence). Among other secondary outcomes, findings suggest that administration of antihelminthics during pregnancy may reduce the prevalence of trichuris (average RR 0.68, 95% CI 0.48 to 0.98; I²=75%; 2 trials, 2488 participants; low‐certainty evidence) and ascaris (RR 0.24, 95% CI 0.19 to 0.29; I²= 0%; 2 trials, 2488 participants; moderate‐certainty evidence). Antihelminthics during pregnancy probably make little or no difference to LBW (RR 0.89, 95% CI 0.69 to 1.16; 3 trials, 2960 participants; moderate‐certainty evidence) and birthweight (mean difference 0.00 kg, 95% CI ‐0.03 kg to 0.04 kg; 3 trials, 2960 participants; moderate‐certainty evidence). AUTHORS' CONCLUSIONS: The evidence suggests that administration of a single dose of antihelminthics in the second trimester of pregnancy may reduce maternal anaemia and worm prevalence when used in settings with high prevalence of maternal helminthiasis. Further data is needed to establish the benefit of antihelminthic treatment on other maternal and pregnancy outcomes. Future research should focus on evaluating the effect of these antihelminthics among various subgroups in order to assess whether the effect varies. Future studies could also assess the effectiveness of co‐interventions and health education along with antihelminthics for maternal and pregnancy outcomes.

Background Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan. Methods Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D. Results The mean time (minutes) spent in sun over 4 days (±SD) was 69.5 (±32) for low, 83.5 (±29.7) for moderate and 329 (±115) for high exposure group. The correlation between average time (minutes) spent in sun over 4 days and mean change in absorbance of UV dosimeters for 4 days was 0.60 (p Conclusions The sunlight exposure measurement questionnaires were valid tools for use in large epidemiological studies to quantify sunlight exposure.