Human Papillomavirus Vaccine Awareness and Acceptability for Primary Prevention of Cervical Cancer in Pakistan: A Cross-Sectional Study.

BACKGROUND: Human papillomavirus (HPV) vaccine is the most effective option for primary prevention HPV, a well-known cause of cervical cancer.  The objective of the study was to assess awareness of HPV, the acceptability of its vaccine and factors associated with the acceptability among the adult population in Pakistan. MATERIALS & METHODS: A cross-sectional survey was conducted among adult population of Pakistan from January 2022 and March 2022. Due to the ongoing COVID-19 pandemic, instead of face-to-face interviews, a self-administered questionnaire was developed and distributed through Google Forms. The questionnaire was available in both English and Urdu languages to cater to a diverse population. RESULTS: Overall, 313 (65.2 %) study participants had heard about HPV infection, while 297 (61.9%) knew HPV as the cause of genital warts and 256 (53.3 %) knew that HPV can cause any type of cancer, with a higher percentage of awareness among those who were in any health care setting compared to those who were in a non-healthcare setting. Regarding the acceptability to get HPV vaccine, 320 (66.7%) of the study participants were willing to get vaccinated, while only 15(3.1%) of the study population had previously received HPV vaccine. The most important factors associated with HPV vaccine acceptability were younger age of 18-25 years (Prevalence Ratio (PR) =1.60, 95% Confidence Interval (CI) =1.11, 2.32), and 26-35 years (PR= 1.65, 95% CI=1.09, 2.50). HPV vaccine acceptability was also associated with working in a healthcare setting due to better awareness of HPV vaccine (PR= 1.29, 95% CI=1.03, 1.62). CONCLUSION: It is important to address the knowledge gaps existing in the community about HPV vaccine acceptability and barriers against it for the successful rollout of the HPV vaccination program in Pakistan. Mass awareness campaigns about HPV, HPV vaccine, and cervical cancer are needed to increase the acceptability of HPV vaccine among public at the time of reintroducing HPV vaccine.

Non-cystic fibrosis bronchiectasis: a retrospective review of clinical, radiological, microbiological and lung function profile at a tertiary care center of low-middle income country.

Non-cystic fibrosis (non-CF) bronchiectasis has emerged as a significant respiratory disease in developing countries. Given the variation in causes and clinical characteristics across different regions, it is necessary to conduct studies in regions with limited data such as low-middle income countries (LMIC). The aim of the study was to investigate the underlying causes, clinical presentation, etiology, lung function and imaging in patients with bronchiectasis who sought treatment at a tertiary care hospital in a LMIC. We conducted retrospective observational study at the Aga Khan University, Pakistan. Adult patients diagnosed with non-CF bronchiectasis on high-resolution computed tomography scan between 2000 and 2020 were included. We evaluated the etiology, clinical characteristics, microbiology, radiology and spirometric pattern of these patients. A total of 340 patients were included with 56.5% being female and 44.7% aged over 60 years. Among them, 157 (46.2%) had experienced symptoms for 1-5 years. The most common spirometric pattern observed was obstructive impairment (58.1%). Previous tuberculosis (TB) (52.94%) was the most common etiology followed by allergic bronchopulmonary aspergillosis (7.64%). Bilateral lung involvement on HRCT scan was found in 63.2% of patients. Pseudomonas aeruginosa was the most frequently identified organism (38.75%) among 240 patients with available specimens. Patients with P. aeruginosa infections had a significantly higher number of exacerbations (p=0.016). There was a significant difference (p<0.001) in P. aeruginosa growth among different etiologies. In conclusion, post-TB bronchiectasis was the most common cause of non-CF bronchiectasis in our study population. P. aeruginosa was the predominant organism, and 63.2% of the patients exhibited bilateral lung involvement. Since P. aeruginosa growth and extensive lung involvement have been associated with poor prognosis and increased mortality risk, we recommend close follow ups of these patients to improve quality of life and survival in developing countries like Pakistan.

YAG capsulotomy rates between two types of trifocal intraocular lenses.

Objectives: To evaluate YAG capsulotomy rates following implantation of two types of trifocal intraocular lenses (IOLs). METHODS: In this retrospective cohort study consecutive patients who underwent cataract surgery with a trifocal IOL from 1st May 2017 to 30th October 2019 at Aga Khan University Hospital, Karachi were included. Eyes which either had an AT Lisa Tri or Alcon PanOptix IOL implant were included. The primary outcome measure was Nd: YAG laser. Univariate analysis of all predictor variables was performed followed by a multivariate regression analysis of those which were significant. A p-value of < 0.05 was taken as significant. RESULTS: A total of 328 eligible eyes were identified. Nine eyes were excluded. Out of the 319 eyes of 177 patients included in this study, 180 received AT Lisa Tri while 139 of them received Alcon PanOptix Trifocal IOLs. The mean (SD) age of the patients was 52.29 years (±11.04). Gender was equally distributed with 91(51.4%). male patients. Median (IQR) time to laser capsulotomy was 8 months (3-16). Clinically posterior capsular opacification (PCO) was present in 75(23.5%) eyes. A total of 39(12.2%) eyes underwent Nd: YAG laser capsulotomy. Among the AT Lisa Tri group 29 (16.1%) eyes underwent laser capsulotomy compared to 10 (7.2%) (n=10) in Alcon PanOptix group (p=0.016). In both univariate and multivariate analyses, gender and IOL type were statistically significant. CONCLUSIONS: Eyes implanted with AT Lisa Tri showed a significantly increased rate of YAG capsulotomy. A prospective randomized control trial is recommended to confirm these findings.