Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome

Objective: Postinfectious irritable bowel syndrome (IBS) is a known entity. We evaluated the incidence of post-COVID-19 IBS in patients discharged from the hospital and analyzed its correlation with the clinical and laboratory parameters, and treatment during the hospital stay. Methods: Three hundred three COVID-19 hospitalized patients without prior history of IBS were prospectively followed after their discharge and were evaluated as per Rome-IV criteria for IBS. Results: One hundred seventy-eight patients were males (58.7%). The age range was 17-95 years (mean +or- SD, 55.9 +or- 15.8). A total of 194 (64%) had mild COVID-19, 74 (24.4%) had moderate COVID-19, whereas 35 (11.6%) had severe COVID-19 infection. Sixteen (5.3%) patients had concomitant GI symptoms during COVID-19 infection. IBS symptoms were found to be present in 32 (10.6%) patients, out of which 17 (53.13%) had diarrhea-predominant, 10 (31.25%) had constipation-predominant, and five (15.62%) had mixed-type IBS. Post-COVID-19 IBS was more common in the female sex (P < 0.001), concomitant GI symptoms with COVID-19 (P < 0.001), oxygen requirement (P = 0.015), deranged liver function tests at the time of admission (P = 0.002), high procalcitonin (P = 0.013), high C-reactive protein levels (P = 0.035);whereas negative correlation was found with remdesivir treatment (P = 0.047). After performing regression analysis, female sex (P < 0.001), oxygen requirement during hospital stay (P = 0.016), GI symptoms during COVID-19 infection (P < 0.001), and high procalcitonin levels (P = 0.017) were independently associated with post-COVID-19 IBS. Conclusion: GI symptoms during active COVID-19 infection increase the chances of developing post-COVID-19 IBS. The risk of developing post-COVID-19 IBS increases in female patients, those requiring oxygen and having high procalcitonin levels during COVID-19 infection.

Local Perceptions of COVID-19 in Pakistan's Sindh Province: "Political Game", Supernatural Test, or Western Conspiracy?

OBJECTIVE: The coronavirus disease 2019 (COVID-19) has received various distinct perspectives and responses at the local as well as global levels. The current study pays attention to local perspectives, which have appeared in the Sindh Province of Pakistan. METHODS: Given the constraints of the pandemic, and using convenience sampling, we conducted 10 online group discussions, 7 one-on-one interviews, and 30 cellphone discussions from a small town of Sindh Province. We made every effort to make our sampling inclusive in terms of decisive sociocultural factors: gender, religion, level of formal education, and occupation/job. We obtained data from women, men, Muslims and non-Muslims, the formally educated and noneducated, government employees, and daily wage laborers. Moreover, to perform content analysis, we used social media such as WhatsApp and Facebook. RESULTS AND DISCUSSIONS: We have found that some people consider COVID-19 a "political" game, "supernatural test" or "Western plot". The given perceptions then guide further actions: either ignore or adopt the preventive measures or take supernatural preventive measures. Considering it as a test of God, Muslims perform prayers, while the Bagrri community who practice Hinduism are taking cow urine to deal with the virus. This study brings these perspectives to the center stage; yet, the results cannot be generalized across the country, or within the province. Moreover, the study situates these perspectives within the global and socio-cultural, economic, and political contexts and invites more in-depth studies to inquire why such perspectives emerge. CONCLUSIONS: We discuss different narratives concerning COVID-19 in a small town of Sindh Province. We maintain that documenting these various perspectives and analyzing their impacts on the preparedness programs is essential, yet understanding the causes behind the stated standpoints is equally essential, if not more so.

Knowledge, Risk Perceptions and Preventive Behaviors Regarding to COVID-19 Pandemic in General Population of Sindh, Pakistan

Aim: The purpose of this research was to evaluate how Pakistanis feel about and understand COVID-19 Methods: To conduct the cross-sectional survey, we used Google forms to digitize a questionnaire with 17 items, which we then sent to a sample of the general population. Result(s): There was a total of 615 questionnaires collected from residents of Sindh Province. Most people 75.1% believe that the disease is spread through direct contact with an infected person or through inhaling air droplets expelled by a sick person while they sneeze or cough. When asked how they had avoided contracting COVID-19 over the preceding 14 days, the vast majority, 39.4%, reported consistently washing and sanitizing their hands. Other steps include not shaking hands with people 33.0% and staying at least one meter away from them (24.9%), not letting people share utensils at meals 38.1%, and masking their faces even when they don't feel sick 28.8%. Additionally, 56.1% of the respondents admitted that they had not taken any special precautions to protect themselves. It is duty of every citizen to obey the government's steps to avoid from COVID-19. Conclusion(s): In general, the people who took part knew a lot about the disease and felt good about taking precautions. The government and the public are taking effective steps to stop the spread of disease, but there is still a need for more awareness campaigns and knowledge of safe ways to stop the spread of disease.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Violence against health care workers in rural areas of Sindh, Pakistan.

OBJECTIVE: To determine the magnitude of violence against healthcare workers in a rural setting, and the consequences of this violence on their personal and professional lives. METHODS: The descriptive, quantitative, cross-sectional study was conducted in 4 rural districts of the Sindh province of Pakistan from February to December 2019, and comprised healthcare workers, including doctors, nurses, support staff and field workers. Data was collected using a structured questionnaire. Data was analysed using SPSS 22. RESULTS: Of the 1622 subjects, 929(57.3%) were males and 693(42.7%) were females. The overall mean age was 35.55+/-10.05 years. The largest cluster was that of doctors 396(24.4%), followed by technicians 202(12.5%). Overall, 522(32.2%) subjects had a professional experience of 1-5 years. Violence at workplace in any form was experienced by 693(42.7%) subjects. Verbal violence had been experienced by 396(24.4%) subjects, while 228(14.1%) had witnessed it. The corresponding numbers for physical violence were 122(7.5%) and 22(1.4%). Verbal violence was more prevalent compared to physical violence (p<0.01). The major effect was that the healthcare workers remained alert 537(33.1%), felt frustrated 524(32.3%) and disturbed 503(31%). Also, 272(16.8%) subjects were planning to migrate or quit the profession. CONCLUSIONS: Violence was found to be a significant issue in rural Sindh.

An Assessment of Common Problems of Post Graduate Students Pursuing Post-Graduation In Orthodontics and Dentofacial Orthopedics, due to COVID 19 Lockdown

Objective: To assess the common concerns of FCPS and MDS trainees in Orthodontics due to COVID-19 lockdown. Methods: This cross-sectional study was conducted in different institutes of Sindh which offered FCPS/MDS training in Orthodontics. The study was carried out after approval from the ethical committee. A questionnaire was designed comprising of 15 questions. Each question aiming to assess the difficulties faced by trainees due to the imposition of lockdown. The questionnaire was distributed amongst 80 participants/trainees in the training year 2 to 4. Results: The average age of study participants was 29 years with range of 27 to 38 years. In this study a large number of subjects said that they were unsure regarding completion of cases due to lockdown i.e;n=63,(77.8%). Approximately half of the study subjects thought that there will be massive patient burden after resuming to the normal practice i.e 40(49.4%). Nearly quarter of them were puzzled that due to lockdown it was difficult to focus on thesis and research work i.e 18(22.2%). Few of them also responded that after resuming to the normal practice there would be pressure from superior authorities for academic works i.e;n=9,(11.1%). Conclusion: This study analyzed those major concerns were non-availability of basic materials for procedures, fear of completion of cases due to lockdown and massive patient burden in clinics after uplifting of lockdown. Therefore, Covid-19 lockdown has in many ways affected the academic and clinical activities of the post-graduate students. The uncertainty to tackle this surprise situation is still an unanswered question. [ FROM AUTHOR] Copyright of Annals of Abbasi Shaheed Hospital & Karachi Medical & Dental College is the property of Knowledge Bylanes and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Pandemic situation in Pakistan: recoveries and mortalities rate of COVID-19 during first and second waves of pandemic in Pakistan - data from Feb to Dec 2020

The novel coronavirus disease COVID-19 outbreak has caused significant global issues and challenged healthcare systems across the globe and in Pakistan as well. This infectious disease is found to be a pandemic and has massively impacted countries across the world. The disease is still rapidly spreading and has caused many deaths in Pakistan, according to the world health organization;early in the year of 2020, Pakistan was ranked among the top 10 countries in the world reporting the highest number of new cases of COVID-19 per day during the first wave of the outbreak. The second wave of COVID-19 was relatively high on the first wave of disease in the current scenario of the pandemic. In the all over Pakistan, the real-time PCR is being applied for the qualitative detection of COVID-19 in the human nasopharyngeal swab specimen. From Feb to Dec. 2020, in Pakistan there were a total of 416,499 cases registered across the country there have been (2%) deaths, with (85.2%) total recoveries. Sindh and Punjab were the most affected provinces, however, Balochistan, KPK, and other regions of Pakistan were less affected comparatively. This short communication is carried out to shed light on the coronavirus outbreak in the country;it will help to highlight the recoveries and mortalities rate of first and second waves of the disease.

Effect of Metarhizium anisopliae on the nutritional physiology of the fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae)

Background: The fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae), was recorded for the first time in Pakistan in 2019, and now it has spread in several regions, i.e., Punjab and Sindh, affecting maize production. Farmers are using widely synthetic pesticides to control the pest. Further, the resistance development in insects and the non-target effect of chemicals on the environment and humans pose serious threats of using insecticides. The use of entomopathogenic fungi (EPF) is being considered an important tool in integrated pest management program. The main objective of this study was to check the impact of different conidial concentrations of Metarhizium anisopliae fungus on the nutritional physiology of S. frugiperda. Results: The dose-dependent effect of tested EPF was observed, and the highest concentration (1 × 109 conidia/ml) considerably affected nutritional parameters. Reduced relative consumption rate (21.7%), relative growth rate (19.5%), the efficiency of conversion of ingested food (24.2%), and approximate digestibility (16.3%) were observed in treated larvae compared to the untreated by using a higher concentration of EPF. Pupal weight was also found lower (77.9 mg and 84.2 mg, respectively), when larvae were treated by 1 × 109 and 1 × 108 conidia/ml concentrations of EPF. Further, 46.7% of larvae were found dead with this conidial concentration. Conclusions: This study suggests that the application of a higher concentration of M. anisopliae could be an effective option to control S. frugiperda. The EPF can enhance the integrated pest management programs and could be useful in reducing the environmental impact of synthetic insecticides. [ FROM AUTHOR] Copyright of Egyptian Journal of Biological Pest Control is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Cardiac complications in COVID-19 infected patients admitted in a tertiary care hospital in Karachi

The objective of the current cross-sectional study was to determine the frequency, types, associations, and outcome of cardiac complications in hospitalized COVID-19 infected patients. This study was conducted at Dr. Ziauddin University Hospital, Clifton campus, Karachi, from 1st April 2020 to 31st March 2021. A total number of 1,050 patients were included in the study through consecutive sampling with the diagnosis of COVID-19 infection. Patients were labeled as having complications secondary to COVID pneumonia only after comparing their hospital's clinical course with their baseline status. The independent variables were age, gender, cardiovascular risk factors (smoking status, diabetes mellitus, and hypertension), while the dependent variables were cardiac complications including acute coronary syndrome, myocarditis, pericarditis, and arrhythmias. The Association of complications with independent variables was analyzed by applying the Chi-Square test and statistical significance was set at a P-value of 0.05. There were 599 (57.0%) males and 451 (43.0%) females with the mean age of the participants being 55.1 years (+or- 13.08) years. Diabetes and hypertension were present in 451 (43.0%) and 490 (46.6%) patients respectively. Out of 1050 patients, the primary endpoint occurred in 55.6% of patients, including 23.1% acute coronary syndrome, 19.3% arrhythmias, 10.8% myocarditis, and 2.2% pericarditis. Analysis of secondary endpoint showed that 31.1% of patients had severe disease out of which the mortality was 39.4%. Acute coronary syndrome and atrial fibrillation are frequent complications, especially in those with severe disease and multi-organ dysfunction. Furthermore, the incidence of these complications is higher in patients with multiple co-morbidities. Considering the devastating impact this pandemic has had globally, it is important to know the cardiac involvement this condition can have along with the debilitating outcome so that healthcare facilities can be upgraded to provide better care to save lives.

An evaluation of public understanding regarding COVID-19 in Sindh, Pakistan: a focus on knowledge, attitudes and practices. (COVID-19 dedicated issue.)

Coronavirus disease-2019 (COVID-19) has emerged as a global crisis. Inadequate knowledge, inapt attitude, and malpractice may enhance the risk of disease. Therefore, we aimed to explore the knowledge and behaviors of the people towards COVID-19 in Sindh, Pakistan, that can further help the government to enforce the SOPs for better containment strategy. A cross sectional study was conducted in Sindh, Pakistan during the month of December, 2020 using convenience sampling method. A pre-designed and pre-validated online survey consisting of 30 questions on knowledge, attitude and practice (KAP) regarding COVID-19 was used for data collection. Among 1004 respondents, accuracy of knowledge response ranged from 20.7% to 95.2% and average rate was 62.2%. For attitude, the percentage of positive responses ranged from 16.9% to 49.5% and average value was 34.88%. The range for good practice was 15.0% to 91.4% and the average was 67.4%. The statistical analysis results showed the significant differences between the responses of each participant for knowledge, attitude, and practices towards COVID-19 (P = 0.001). Our study concluded that majority of people of Sindh, Pakistan have good knowledge, average attitude, and proactive practices regarding COVID-19 but still there is a need for implementing strategies for enhancing knowledge and practices.

Doctors Dealing With COVID-19 in Pakistan: Experiences, Perceptions, Fear, and Responsibility.

This study aimed to describe the dealings of 20 biomedical doctors with coronavirus disease-19 (COVID-19) in the Sindh province of Pakistan. Focusing on physicians from three different hospitals, we describe their challenges, emotions, and views concerning the pandemic. Many regarded the virus from a biomedical standpoint. Yet some also perceived it as a "tool of a proxy war" and a "plot," without giving agency to anyone for that "plot." Furthermore, these care providers faced a great fear of infection and an even greater fear of transmitting the virus to their families and friends. A few also feared stigmatization as viral carriers. Whether they experienced fear or not, all of our physician interlocutors emphasized their sense of responsibility to "serve humanity," yet some also expressed a strong belief in the inevitability of the will of Allah. Some were satisfied with the role of the government in containing the virus, while others expressed concerns and felt that the government should be doing much more. All expressed confidence in the use of personal protective equipment (PPE), viewing it as an effective buffer against viral contagion. We conclude with a call for further research especially ethnographic studies on dealings of physicians with COVID-19 across Pakistan as frontline care providers.

The Psychological Impact of COVID-19 on Sindh and Baluchistan's Bachelors of Dental Surgery (BDS) Students and Their Stress Management Strategies During the Current Pandemic

Objective: The objective of this study was to evaluate the anxiety among the bachelors of dental surgery (BDS) students of Sindh and Baluchistan during COVID-19 pandemic. The secondary objective of this study was to evaluate the stress management strategies. Methods: In this web-based cross-sectional study, data of eight hundred and nine bachelors of dental surgery (BDS) students of Sindh and Baluchistan were analyzed using SPSS version 21. A validated e-questionnaire created using Google form was distributed among the dental college students pursuing bachelors of dental surgery (BDS) through social media. A P-value of less than 0.05 was considered significant. Results: The majority of the respondents were females (n=596, 73.7%) and studied in private dental colleges (n = 543, 67.15). Most of the students were dissatisfied with online education, and no significant difference was found among private and public sector dental college (p>0.05). Moderate to severe level of anxiety among both genders was prevalent. Praying and reciting the Holy Book is the most common coping strategy, followed by sleeping and talking to friends and family. Conclusion: We conclude that the BDS students of Sindh and Baluchistan are suffering from anxiety. The majority of the students are not happy with the quality of online education.

Birthing Between the "Traditional" and the "Modern": DaI Practices and Childbearing Women's Choices During COVID-19 in Pakistan.

Pregnancy and birth are biological phenomena that carry heavy cultural overlays, and pregnant and birthing women need care and attention during both ordinary and extraordinary times. Most Pakistani pregnant women now go to doctors and hospitals for their perinatal care. Yet traditional community midwives, called DaI in the singular and Dayun in the plural, still attend 24% of all Pakistani births, primarily in rural areas. In this article, via data collected from 16 interviews-5 with Dayun and 11 with mothers, we explore a maternity care system in tension between the past and the present, the DaI and the doctor. We ask, what does the maternity care provided by the Dayun look like during times of normalcy, and how does it differ during COVID-19? We look at the roles the DaI has traditionally performed and how these roles have been changing, both in ordinary and in Covidian circumstances. Presenting the words of the Dayun we interviewed, all from Pakistan's Sindh Province, we demonstrate their practices and show that these have not changed during this present pandemic, as these Dayun, like many others in Sindh Province, do not believe that COVID-19 is real-or are at least suspect that it is not. To contextualize the Dayun, we also briefly present local mother's perceptions of the Dayun in their regions, which vary between extremely positive and extremely negative. Employing the theoretical frameworks of "authoritative knowledge" and of critical medical anthropology, we highlight the dominance of "modern" biomedicine over "traditional" healthcare systems and its effects on the Dayun and their roles within their communities. Positioning this article within Pakistan's national profile, we propose formally training and institutionalizing the Dayun in order to alleviate the overwhelming burdens that pandemics-present and future-place on this country's fragile maternity care system, to give mothers more-and more viable-options at all times, and to counterbalance the rising tide of biomedical hegemony over pregnancy and birth.

From Normal to Viral Body: Death Rituals During Ordinary and Extraordinary Covidian Times in Pakistan.

Death is far from being simply a physiologic event; it is a complex phenomenon with sociocultural and politicoeconomic aspects. During extraordinary times such as the 2020 coronavirus pandemic, death becomes a contested site. I argue that the Pakistani government's dealings with the bodies of people who die from COVID-19 have shifted the meaning of a normal dead body to a viral body that poses particular challenges to cultures and people, including the government. This article is both autoethnographic and ethnographic. It concurrently draws on my observations and participation in death rituals in a Pakistani village in Sindh province as a member of that society, and on a recent experience that I faced after the death of a gentle lady of my acquaintance due to COVID-19. I also build on my previous long-term ethnographic research in Pakistan and my ongoing research on COVID-19 in that country. I discuss the death rituals and ceremonies performed during "ordinary" situations as background information; and the changes in these rituals that have resulted from the coronavirus pandemic. My data demonstrate significant differences between usual and customary death rituals and those performed during Covidian times by government mandate, which have severely and negatively affected people's mental health. I show the government's "symbolic ownership" of the viral body, in that the government can control how people deal with their viral dead.