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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.
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Mucormycosis is a fungal disease involving predominantly the paranasal sinuses and further spreading to the orbit and cerebral regions. It does rarely affect the pulmonary region and gastrointestinal regions. This disease is seen more in a very serious state, where the tissues undergo necrosis and cause huge morbidity and, in some cases, end up being fatal. The disease was common in individuals with an immune-compromised state, thus more commonly presenting in individuals with uncontrolled diabetes. The disease is usually acquired through coming into contact with spores of the fungus Mucormycetes through the nose, and the fungi invade the paranasal regions, colonize, and spread locally with angio-invasion and relying on host ferritin for survival, thereby causing tissue necrosis. The incidence of mucormycosis had increased considerably post-COVID-19 due to host immune factors. This fungus commonly spreads from paranasal regions to the cranial direction through orbit. The spread is rapid, thus needing early medical and surgical intervention. The spread of infection from the paranasal regions to the caudally placed mandible is very rarely seen. In this paper, we present three cases of mucormycosis spreading caudally and involving the mandibular regions.
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Objective: To assess the sleep quality among medical students, comparing their sleep cycles during physical and online studies along with other factors associated with sleep patterns. Study Design: Cross-sectional Questionnaire based survey Place and Duration of Study: Department of Community Medicine, HITEC Institute of Medical Sciences Taxila from 1st January 2020 to 31st March 2020 Methodology: One hundred and forty seven students were surveyed in a time period of 1 month. The questionnaire included PSQI Pittsburgh Sleep Quality Index and other clinically validated questions. Students with known sleeping disorders were excluded from this survey. Result(s): There were 81 (55.1%) females and 65 (44.2%) males with mean age 20+/-1.4 years. Out of these 94(63.9%) were classified as "Poor Sleepers" and only 53 (36.1%) were "Good Sleepers". Poor sleep quality was associated with female gender (p<0.05), day-scholar residence status (p<0.054), excessive time required to sleep (p<0.00), excessive screen time usage (p<0.007), increased hours of study (p<0.089), experiencing trouble while driving, eating and socializing (p<0.002), lack of enthusiasm (p<0.000), unsatisfactory daily activities (p<0.000) and poor daytime alertness levels (p<0.360). 104 (70.7%) were aware of the effects of melatonin on sleep, only 51 (34.7%) admitted to have used coffee to stay awake at night. 98 (66.7%) subjects were pre-exam workers, 95 (64.6%) admitted not being able to wake up easily in the morning. Conclusion(s): The students and hostelites that used less screen time slept better. Excessive daytime tiredness was also a result of poor sleeping habits. Students who studied for longer periods of time and had difficulty waking up in the morning slept poorly. Poor sleepers also find it difficult to interact and are often unambitious about performing their daily menial tasks, as well as displeased with their daily activities. As a matter of fact, we deduce that sleep quality has unanticipated consequences for medical students' social and mental health.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Purpose Covid-19 is a serious threat to the dietary quality of vulnerable communities in developing countries with limited economic resources. This study explored the implications of COVID-19 on daily dietary behavior and food consumption patterns of perishable and nonperishable food commodities based on the gender of household headship in Pakistan. Design/methodology/approach The data was collected through an online survey using the snowball sampling technique. A mixed design ANOVA, an independent t-test and a multivariate probit model were used to look at the data from 417 female-headed households and 1,131 male-headed households that were surveyed in the study. Findings Female-headed households experienced a greater decrease in their daily intake of perishable and nonperishable food commodities compared to male-headed households during COVID-19. The decrease in consumption of perishable food commodities was greater than the decrease in nonperishable food commodities for both female-headed and male-headed households. Female-headed households witnessed the largest decrease in daily intake of animal-derived foods, while male-headed households observed the highest diminution in consumption of fruits. Female-headed households and male-headed households reduced their consumption of perishable food commodities by more than one-third and one-fifth, respectively. Households with lower socioeconomic status reported higher reductions in their daily intakes of food commodities compared to households with higher socioeconomic status. Research limitations/implications The cross-sectional nature of the collected data does not allow the development of a causal relationship between COVID-19 implications and food consumption changes in daily dietary patterns. Originality/value Dietary and consumption patterns of populations are changing worldwide due to COVID-19. There is no study to assist policymakers in determining how COVID-19 is affecting the daily food consumption patterns of perishable and non-perishable food commodities of households based on gender in the developing world.
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Proteases and RNA-Dependent RNA polymerase, major enzymes which are essential targets involved in the life and replication of SARS-CoV-2. This study aims at in silico examination of the potential ability of coumarins and their derivatives to inhibit the replication of SARS-Cov-2 through multiple targets, including the main protease, papain-like protease and RNA-Dependent RNA polymerase. Several coumarins as biologically active compounds were studied, including coumarin antibiotics and some naturally reported antiviral coumarins. Aminocoumarin antibiotics, especially coumermycin, showed a high potential to bind to the enzymes' active site, causing possible inhibition and termination of viral life. They demonstrate the ability to bind to residues essential for triggering the crucial cascades within the viral cell. Molecular dynamics simulations for 50 ns supported these data pointing out the formation of rigid, stable Coumermycin/enzyme complexes. These findings strongly suggest the possible use of Coumermycin, Clorobiocin or Novobiocin in the fight against COVID-19, but biological evidence is still required to support such suggestions.
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BACKGROUND: COVID-19 the ongoing pandemic. Mortality due to other reasons, other than COVID-19 across age groups reduced which was anecdotally reported from Pakistan. This survey was undertaken to assess the number of deaths recorded in Islamabad from 1st March 2019 to 30th May 2019 and from 1st March 2020 to 30th May 2020 and compare the two estimates by age and gender while documenting the cause of deaths. METHODS: The cross-sectional study was conducted in the Islamabad from 11th to 16th June 2020, comprising of secondary data received on age, gender, cause of death and months of death from the both, large private-public hospitals records and graveyards registers. Data was entered in both SPSS and Microsoft Excel and analysed using SPSS 22. RESULTS: The total number of hospitals and graveyards approached in ICT were 14 and 4 respectively. The total number of deaths reported from these during March to June in 2019 and 2020 were 2,389;out of which 1,225 (51.3%) deaths were recorded in 2019 and 1,162 (48.6%) deaths in 2020. In both years, predominant variables with more mortality were both age and gender between 61-70 years of age 511 (21.4%) 1,395 (58.4%) males respectively. CONCLUSIONS: More deaths were reported in males with old age. Cardio vascular diseases and neurological disorders were the leading causes of mortality. Not much of a larger difference in number of deaths between the both years was seen. Scarcity of data and unavailability of evidence make the anecdotal reports mere just a rumour.
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Aim: To find out association of herpes zoster and changes in disease course like incidence of post-herpetic neuralgia with Covid-19 vaccination. Study design: Cross-sectional, observational study. Place and duration of study: Outpatient Department of Dermatology, CMH and PEMH Rawalpindi from 1st January 2021 to 30th September 2021. Methodology: Seventy three patients presenting with herpes zoster selected by convenience sampling after their verbal and written consent. Demographics, Covid-19 vaccination history, type of vaccination, dermatome effected, co-morbids and presence of post herpetic neuralgia were recorded in them. Results: Mean age of participants was 48.09±15.73 years with 50 (68.5%) were males and 23 (31.5%) were females. 33 (45.2%) were vaccinated and 36 (49.3%) were non-vaccinated against covid-19. Maximum patients were vaccinated with Sinopharm i.e. 19(57.6%).8 (24.2%) patients developed the lesions after first dose and 25(75.8%) after 2nd dose of vaccination. Conclusion: Herpes zoster risk is increased with covid-19 vaccination.
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INTRODUCTION: As the COVID-19 pandemic threatens to strain health care systems worldwide, the presence of gaps in the global critical care capacity has become glaringly obvious, particularly in less developed countries like Pakistan. To identify existing gaps, an assessment of the critical care units across Pakistan was carried out. METHODS: A novel checklist for assessing critical care units was developed based on the Partners in Health 4S Framework. Our checklist evaluated the following key components: Space/Infrastructure, Staffing, Stuff/Equipment, and Systems/Protocols. A series of surveys was conducted using telephonic and on-site interviews at hospitals identified by the Ministry of Health in Pakistan. RESULTS: Critical care facilities at 53 hospitals were surveyed. The majority were from the public sector (62%) and located in metropolitan cities (62%). In terms of infrastructure, the majority of units were adequate, with gaps primarily being identified for negative-pressure rooms (21%), donning-doffing areas (58%) and isolation rooms (64%). In terms of staffing, the majority of hospitals had trainee doctors (94%) and nursing staff (100%) available, with gaps being identified in terms of presence of qualified intensivists (47%) and ancillary staff (ethicists - 17%, dietitians - 45%). Furthermore, an adequate nurse-to-patient ratio of 1:2 or 1:3 was only present in 53% of the hospitals. Equipment was present in the majority of facilities including ventilators (96%, n=9.7±1.1) and BIPAP machines (85%, n=4.5±0.6), with a relative lack of high-flow nasal cannulas (64%, n=3.2±0.9). More than 80% of hospitals had protocols in place for COVID-19 management and staffing, but fewer had them for patient surge (60%), clinician credentialing (58%) and risk mitigation (49%). On chi-square analysis, statistically significant differences (p<0.05) were noted between public and private sectors as well as metropolitan and rural hospitals in terms of availability of negative pressure rooms, ancillary staff like dietitians, and optimal nurse-to-patient ratio. CONCLUSIONS: The results from this study will be pivotal to guide policy makers in devising strategies for improving the quality of critical care units across Pakistan during the COVID-19 pandemic and beyond.