The state of health in Pakistan and its provinces and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding health trends and estimating the burden of disease at the national and subnational levels helps policy makers track progress and identify disparities in overall health performance. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides comprehensive estimates for Pakistan. Comparison of health indicators since 1990 provides valuable insights about Pakistan's ability to strengthen its health-care system, reduce inequalities, improve female and child health outcomes, achieve universal health coverage, and meet the UN Sustainable Development Goals. We present estimates of the burden of disease, injuries, and risk factors for Pakistan provinces and territories from 1990 to 2019 based on GBD 2019 to improve health and health outcomes in the country. Methods We used methods and data inputs from GBD 2019 to estimate socio-demographic index, total fertility rate, cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years, healthy life expectancy, and risk factors for 286 causes of death and 369 causes of non-fatal health loss in Pakistan and its four provinces and three territories from 1990 to 2019. To generate estimates for Pakistan at the national and subnational levels, we used 68 location-years of data to estimate Pakistan-specific demographic indicators, 316 location-years of data for Pakistan-specific causes of death, 579 location-years of data for Pakistan-specific non-fatal outcomes, 296 location-years of data for Pakistan-specific risk factors, and 3089 location-years of data for Pakistan-specific covariates. Findings Life expectancy for both sexes in Pakistan increased nationally from 61 center dot 1 (95% uncertainty interval [UI] 60 center dot 0-62 center dot 1) years in 1990 to 65 center dot 9 (63 center dot 8-67 center dot 8) years in 2019;however, these gains were not uniform across the provinces and federal territories. Pakistan saw a narrowing of the difference in healthy life expectancy between the sexes from 1990 to 2019, as health gains for women occurred at faster rates than for men. For women, life expectancy increased by 8 center dot 2% (95% UI 6middot3-13middot8) between 1990 and 2019, whereas the male life expectancy increased by 7 center dot 6% (3 center dot 5-11 center dot 8). Neonatal disorders, followed by ischaemic heart disease, stroke, diarrhoeal diseases, and lower respiratory infections were the leading causes of all-age premature mortality in 2019. Child and maternal malnutrition, air pollution, high systolic blood pressure, dietary risks, and tobacco consumption were the leading all-age risk factors for death and disability-adjusted life-years at the national level in 2019. Five non-communicable diseases-ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease-were among the ten leading causes of years of life lost in Pakistan. Burden varied by socio-demographic index. Notably, Balochistan and Khyber Pakhtunkhwa had the lowest observed gains in life expectancy. Dietary iron deficiency was the leading cause of years lived with disability for both men and women in 1990 and 2019. Low birthweight and short gestation and particulate matter pollution were the leading contributors to overall disease burden in both 1990 and 2019 despite moderate improvements, with a 23 center dot 5% (95% UI 3 center dot 8-39 center dot 2) and 27 center dot 6% (14 center dot 3-38 center dot 6) reduction in age-standardised attributable DALY rates during the study period. Interpretation Our study shows that progress has been made on reducing Pakistan's disease burden since 1990, but geographical, age, and sex disparities persist. Equitable investment in the health system, as well as the prioritisation of high-impact policy interventions and programmes, are needed to save lives and improve health outcomes. Pakistan is facing several domestic and foreign challenges-the Taliban's return to power in Afghanistan, political turmoil, catastrophic flooding, the COVID-19 pandemic-that will shape the trajectory of the country's health and development. Pakistan must address the burden of infectious disease and curb rising rates of non-communicable diseases. Prioritising these three areas will enhance Pakistan's ability to achieve universal health coverage, meet its Sustainable Development Goals, and improve the overall health outcomes.

Drug repurposing against COVID-19 by GWAS

This note is prepared by the authors of a recent publication on shared genetic architecture of drug response based on summary statistics from genome-wide association studies (GWAS) to propose a drug repurposing approach for the treatment of coronavirus COVID-19. The authors proposed that in silico studies may be preceded by analyzing shared genetic architecture of drug response based on existing GWAS.Copyright © 2020, Health Biotechnology and Biopharma.

NephroS: Phenotypical Analysis of a Large National Nephrotic Syndrome Cohort: A Multicentre Longitudinal Study From Great Britain

Background: Nephrotic Syndrome (NS) is a rare kidney disease diagnosed by the presence of proteinuria, oedema and hypoalbuminemia. The estimated global incidence of NS is 2-7 people per 100,000. The pathological processes that cause NS remain elusive. This novel multicentre longitudinal study aimed to identify the clinical and socio-demographic characteristics of a large NS cohort across Great Britain. Phenotypical analysis of such a large cohort will help understand the natural history and patterns of disease during a patient's lifetime. Method(s): A large multicentre longitudinal study was set up in January 2010 in 51 adult and paediatric sites across England, Scotland and Wales. Detailed prospective and retrospective clinical data was captured onto the Rare Renal Diseases Registry (RaDaR) over a period of 12 years from date of diagnosis until the cut-off point in January 2022. Patients were categorised by both their response to steroids and histological diagnoses to identify specific NS subgroups. Result(s): Over 12 years, a total of 1974 adult and paediatric NS patients were recruited. The results show that NS is a male predominant condition (56%) and more prevalent in South Asian (13%) and African ethnicities (4%). A large proportion of patients were steroid-sensitive (48%), and the main histological diagnosis was Minimal Change Disease (MCD) (50%). Those who reached end stage renal disease (16%) were mainly aged 0 - 17 years old. A high proportion of deaths were noted in 2020/1, and caused by cancer or COVID-19. Conclusion(s): It can be concluded that NS is dominant in males, and in South Asian and African ethnicities. A large proportion of patients were steroid-sensitive, and the main histological diagnosis was MCD. The data gathered in this study will help transform our understanding of NS. To better understand the implications of these results, future research including international collaboration will facilitate the development of translational research and evidence-based recommendations.

Behavioural Determinants for Hand Hygiene Practices among Primary School Children during COVID-19 Pandemic

Background: Children acquire SARS CoV-2 infection from their family members but they experience mild symptoms. Hand washing promotion programs are being executed in many countries to enhance child healthcare development. Objective: This study was designed to identify behavioural determinants to increase hand washing practices among primary school children during COVID-19 pandemic. Methods: This was a cross-sectional study conducted by the Department: of Pediatrics, King Edward Medical University/ Mayo Hospital, Lahore from June to November 2020. Total of 195 mothers of primary school children were enrolled by non -probability consecutive sampling. A 23-item, 5 points likert scale questionnaire assessed 5 domains related to hand hygiene. Data was entered in SPSS 24. Domains were presented as frequency tables. Independent sample t -test was applied to mean score of sub-category of each domain, and to cumulative mean score of each domain. A cut off mean scores of >= 3 was taken as satisfactory. Results: We found satisfactory mean scores amongst mothers for knowledge regarding the importance of hand washing (3.59 +/- 0.62), and commitment regarding maintenance of hand -hygiene (3.44 +/- 0.773). Better mean score for liking hand washing with alcohol rub/sanitizer than with soap and water (3.14 +/- 1.063 versus 1.10 +/- 1.229) was seen. Children reported not feeling dirty if they did not practice hand-hygiene (2.99 +/- 1,195). Elders in the households promoted hand-washing, but lacked practicing it themselves (3.48 +/- 0.881 versus 2.85 +/- 1.242). There was below satisfactory mean score for hand-hygiene amongst children after sneezing, coughing, blowing their nose, or playing (2.50 +/- 1.253, 2.23 +/- 1.265, 2.27 +/- 1.301, 2.83 +/- 1.280 respectively). Norm and self-efficacy factors had adequate overall scores (3.17 +/- 0.84, 3.17 +/- 0.65). The total score for this study was 2.8759 +/- 0.419. Conclusion: We found satisfactory mean scores for risk, attitudes, norms, ability;and self-reglation factorsof hand hygiene among primary school children.

Drug repurposing against COVID-19 by GWAS

This note is prepared by the authors of a recent publication on shared genetic architecture of drug response based on summary statistics from genome-wide association studies (GWAS) to propose a drug repurposing approach for the treatment of coronavirus COVID-19. The authors proposed that in silico studies may be preceded by analyzing shared genetic architecture of drug response based on existing GWAS. © 2020, Health Biotechnology and Biopharma.

Knowledge, attitude, practices (KAP) and psychological impact of COVID-19 among Pakistani population: A quick cross-sectional online study

Background: Coronavirus causes extremely contagious infection and currently is a major threat for the public health globally. The aim of this study was to evaluate the current level of awareness towards Corona Virus Disease 2019 (COVID-19) among Pakistani residents, their attitude, practices and psychological impact towards COVID-19 those contribute in an important way to control this pandemic. Methods: A cross sectional online study was conducted. A self-developed online questionnaire was made by Google forms and sent to the author's network with local residents in Pakistan. The questionnaire contained 35 questions among which 6 questions were related with the demographic features, 14 questions assess knowledge of participants, 4 questions evaluate the attitude, 7 questions assess the practices of the participants towards COVID-19 and 4 questions assess the psychological impact towards COVID-19. Results: Among the participants (n=528) 66.7% were female and 33.3% were male. Among them 49.8% of the participants were from the age group of 18-24 and the percentage of students was higher i.e. 39.8%. The overall range for correct answers for the knowledge questionnaire was 97.5%-46.8%, for attitude 75.2%-91.9% and for practices 39%-95%. 79% of the participants were confident that Pakistan will overcome the disaster situation of COVID-19. Conclusion: The findings of the current study indicated that Knowledge among the Pakistani residents about COVID-19 was found satisfactory. A significant number of the participants still lacking confidence when compared with the other countries. However, to effectively control the infection spread and improving COVID- 19 knowledge the well-structured awareness programs must be launched by the government those could be helpful for Pakistani residents to hold optimistic attitudes and maintain appropriate practices. © 2021 Centre of Excellence in Molecular Biology. All right reserved.

Impact of COVID-19 on project performance in the UAE construction industry

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has affected the global economy and, thus, the global construction industry. This paper aims to study the impact of COVID-19 on construction project performance in the United Arab Emirates (UAE). Design/methodology/approach: This study adopted a qualitative and exploratory approach to investigate the impact of COVID-19 and its policies on project performance in the UAE construction industry in critical areas of the project management body of knowledge (e.g. schedule, cost, resources and contracts). Semi-structured interview questions were asked from ten construction professional to obtain valuable insights into the pandemic’s effects on the UAE construction industry and the effectiveness of policies implemented to rectify the damage and identify the industry’s new normal. Findings: The findings indicate that the construction industry faced several challenges such as schedule delays, disrupted cashflows, delayed permits, approvals and inspections, travel restrictions, serious health and safety concerns, material and equipment shortages, among others which hindered the timely delivery of construction projects. It also indicates that efforts made by the government institutions and the construction industry of the UAE such as economic support programs, digitization of processes, fee and fine waivers, health facilities, among other statutory relaxations proved effective in supporting the construction industry against the adverse effects of the pandemic. Research limitations/implications: The research findings are limited to the literature review and ten semi-structured interviews seeking an expert’s opinion from industry professionals working in the UAE construction industry. The research team did not get access to project documents, contracts and project progress reports which may be required to validate the interview findings, and to perform an in-depth analysis quantifying the impact of COVID 19 on construction projects performance, which is a limitation of this research. Practical implications: The implication is that, owing to the imposed lockdowns and strict precautionary measures to curb the rapid spread of the pandemic, smooth execution of the construction project across the country was affected. The government institutions and stakeholders of the construction projects introduced and implemented various techniques and solutions which effectively handled the implications of the COVID-19 pandemic on the construction industry of the UAE. Originality/value: This study has identified the challenges faced by the construction industry of the UAE in the context of the management of project schedule, project cost, construction contracts, health and safety of construction employees and other related aspects of the construction projects. This study also identified the techniques and solutions adopted by various public and private institutions of the country and their implications on construction projects. Therefore, this study provides guidelines for policymakers and future research studies alike. © 2021, Emerald Publishing Limited.

Implementation of machine learning algorithms for predictive analysis about mortality for covid-19 data sets

Covid-19, a viral global pandemic, gave number of question marks for various machine learningbased industries.Collecting data and related solutions for infected crowd worldwide is a biggest challenge today. This article represents contribution of machine learning to fight against COVID-19. Itreflects various factors and other related work that could determine the help of machine learning in this current scenario. In this article decision tree and linear regression, supervised learning algorithms of machine learning are used to calculate various predictions with the help of attributes of collected data. Python 3.8.0 is used for the implementation and model functions are used for data validation, prediction and accuracy. © 2021, Universitatea de Vest Vasile Goldis din Arad. All rights reserved.

COVID-19 in children - what is known so far. (COVID-19 Supplement.)

During past couple of decades, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) - the two human coronaviruses (HCoVs), emerged as highly pathogenic microbes causing widespread concerns. World Health Organization has declared the current pandemic caused by the highly contagious SARS-CoV-2 a global public health emergency. There is evolving understanding and knowledge regarding COVID-19 in children. Based on the current available literature, this review article summarizes the etiology, epidemiology, clinical features, diagnosis, management and prevention of COVID-19 in children, along with implications of the pandemic on child health. This will help the Pediatricians and general practitioners to understand and effectively deal with this pandemic in children.

Covid-19 in children – what is known so far

During past couple of decades, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) – the two human coronaviruses (HCoVs), emerged as highly pathogenic microbes causing widespread concerns. World Health Organization has declared the current pandemic caused by the highly contagious SARS-CoV-2 a global public health emergency. There is evolving understanding and knowledge regarding COVID-19 in children. Based on the current available literature, this review article summarizes the etiology, epidemiology, clinical features, diagnosis, management and prevention of COVID-19 in children, along with implications of the pandemic on child health. This will help the Pediatricians and general practitioners to understand and effectively deal with this pandemic in children. © 2020, Pakistan Pediatric Journal. All rights reserved.