Understanding community resistance to sexuality education and exploring prospective implementation strategies in Pakistan: A content and network analysis of qualitative data.

Providing comprehensive sexuality education (CSE) in schools is a work in progress in many countries throughout the world. In some countries, the journey is just beginning; in others, investments in this field have been made for many years. It is and has been difficult in Pakistan to implement and promote reproductive health, women's empowerment, and CSE. In Pakistan, previous implementation efforts revealed the critical role of community influencers in propagating misleading information about the initiatives, inciting organized community resistance, and provoking backlash. This paper looked at several aspects of community resistance, as well as approaches for overcoming the resistance for increasing community engagement in the implementation of CSE in Islamabad, Pakistan. To analyze community perceptions of CSE implementation in Islamabad, the community readiness assessment (CRA) questionnaire was adapted. Questions and prompts for discussion included leadership, current initiatives, community knowledge, resource availability, community support, and implementation strategies. A total of 35 in-depth interviews were conducted. Data was analyzed and interpreted using qualitative content analysis to explore community perspectives that contribute to resistance around CSE, as well as implementation options. Using inter-code relationship data, network analysis was conducted to provide a graphical representation of the analyzed qualitative data. The study reveals community resistance to CSE being implemented in schools. Misconceptions, a lack of awareness, a lack of priority, and the lack of dedicated resources are just a few of the primary implementation challenges to consider when implementing CSE in practice. Network analysis identified, based on modularity class, five distinct clusters of highly connected nodes/codes: non-governmental organizations (NGOs), misconceptions, resources and policy, strategies and community support, and personal social and health education (PSHE) and current efforts. In conservative environments and when confronted with resistance, innovative marketing and rebranding are critical for priority setting and community engagement, especially when developing curriculum and implementing CSE. Some of the suggested strategies for implementation include community sensitization through strategic awareness campaigns, involving already established infrastructure and NGOs, endorsement by all major stakeholders, particularly decision-makers, and the use of creative digital platforms for better dissemination.

Evaluating data-driven methods for short-term forecasts of cumulative SARS-CoV2 cases.

BACKGROUND: The WHO announced the epidemic of SARS-CoV2 as a public health emergency of international concern on 30th January 2020. To date, it has spread to more than 200 countries and has been declared a global pandemic. For appropriate preparedness, containment, and mitigation response, the stakeholders and policymakers require prior guidance on the propagation of SARS-CoV2. METHODOLOGY: This study aims to provide such guidance by forecasting the cumulative COVID-19 cases up to 4 weeks ahead for 187 countries, using four data-driven methodologies; autoregressive integrated moving average (ARIMA), exponential smoothing model (ETS), and random walk forecasts (RWF) with and without drift. For these forecasts, we evaluate the accuracy and systematic errors using the Mean Absolute Percentage Error (MAPE) and Mean Absolute Error (MAE), respectively. FINDINGS: The results show that the ARIMA and ETS methods outperform the other two forecasting methods. Additionally, using these forecasts, we generate heat maps to provide a pictorial representation of the countries at risk of having an increase in the cases in the coming 4 weeks of February 2021. CONCLUSION: Due to limited data availability during the ongoing pandemic, less data-hungry short-term forecasting models, like ARIMA and ETS, can help in anticipating the future outbreaks of SARS-CoV2.

A Cross-Sectional Community Readiness Assessment for Implementing School-Based Comprehensive Sexuality Education in Islamabad, Pakistan.

Evidence indicates that school-based sexuality education empowers children and adolescents with the skills, values, and attitudes that will enable them to appreciate their health and well-being, nourish respectful social and sexual relationships, understand their rights, and to make informed choices. Owing to organized community resistance and prevalent misconceptions, promoting sexual and reproductive health has been challenging, especially in conservative settings like Pakistan. This study aimed at systematically exploring communities' perceptions regarding implementing school-based comprehensive sexuality education by conducting a cross-sectional community readiness assessment in Islamabad, Pakistan. A total of 35 semi-structured interviews were conducted with community key informants. Following the guidelines of the community readiness handbook, the interviews were transcribed and scored by two independent raters. The results indicate that, overall, the Islamabad community is at stage two of community readiness, the denial/resistance stage. Individual dimension scores indicate that knowledge of efforts, resources for efforts, knowledge about the issue, and leadership dimensions are at the denial/resistance stage. Only community climate was rated at stage three of community readiness, the vague awareness stage. This indicates that, for promoting sexuality education in the Pakistani context, it is essential to tackle resistance by sensitizing the community and the stakeholders through awareness campaigns.

A Cross-Sectional Survey to Assess Biorisk Management System in Research and Diagnostic Laboratories in Khyber Pakhtunkhwa, Pakistan.

Financial, cultural, and managerial hurdles have made biosafety and biosecurity measures difficult in resource-constrained countries like Pakistan. Because of increasing awareness of biorisk management, diagnostic and research laboratories have made major advances in biosafety and biosecurity in the recent decade. As a result, identifying and addressing gaps in biorisk management has never been more critical. The purpose of this study was to assess the current situation of personal protective equipment (PPE), biosafety behavior, waste management, biosafety and biosecurity measures, training and safety, and health services in diagnostic and research laboratories across Pakistan's Khyber Pakhtunkhwa (KP) province. We adapted the WHO Laboratory Assessment tool (2012) and CWA 15793 (Biorisk management guidelines) for conducting a cross-sectional survey, which was distributed among various laboratories in KP. The survey included 30 laboratories, including 11 diagnostic and 19 research laboratories. In comparison to diagnostic laboratories, biorisk management practices in research laboratories were better in terms of PPE, biosafety behavior, waste management, biosafety measures, biosecurity measures, trainings, and safety and health services. KP laboratories' biorisk management practices have improved over time, according to our findings. However, we were able to identify inadequacies that would require considerable improvements to the current setups based on the WHO and CWA 15793 recommendations. Organizations can tailor their biosafety measures and training to address identified gaps using the presented KP snapshot.

Corrigendum: Leishmania-Specific Promiscuous Membrane Protein Tubulin Folding Cofactor D Divulges Th1/Th2 Polarization in the Host via ERK-1/2 and p38 MAPK Signaling Cascade.

[This corrects the article DOI: 10.3389/fimmu.2020.00817.].

Key indicators for appraising adolescent sexual and reproductive health in South Asia: international expert consensus exercise using the Delphi technique.

BACKGROUND: There is a need for an accurate assessment of the patterns and determinants of sexual and reproductive health in South Asia owing to high fertility rates and high incidence of unplanned pregnancy among adolescents. Health indicator sets, with a wide range of health dimensions, also support in formulating evidence-based policies. For attaining this, indicators should be developed and prioritized based on consensus and relevance. OBJECTIVE: This study aimed to develop a comprehensive list of adolescent sexual and reproductive health (ASRH) key indicators for South Asia through systematic participatory expert consultation exercise using the Delphi technique. METHODS: Experts were invited to two rounds of an indicator rating exercise and a third round to discuss the results in a broader regional perspective. A list of nine indicator categories, including 41 adolescent health indicators, was rated by the expert panel. Prioritization was based on mean Likert scores while consensus was established using Kendall's W. RESULTS: 24, 16 and six experts participated in the first, second and third round, respectively. Out of the nine indicator categories, demographics, reproductive health, violence, and nutrition were ranked high in relevance by the expert panel. Experts had a strong consensus on the relevance of parental control and connection, and behavioral indicators while there was moderate consensus on the relevance of nutrition, infectious disease, and mortality indicators. CONCLUSION: As far as we know, this is the first study that employs the Delphi technique for prioritizing ASRH indicators for South Asia. Engaging a diverse group of experts, using an online platform, we developed a comprehensive list of key indicators for appraising ASRH relevant to South Asia based on expert panel consensus and recommendations. Our results also highlight that there is a need for developing a region-specific prioritized list of indicators which might assist in identifying regional health needs.

Systemic risk: The impact of COVID-19.

Banking sectors across the globe are under immense stress due to the evolving COVID-19 situation and policy responses thereto. This study investigates how COVID-19 impacted the systemic risk in the banking sectors of eight of the most COVID-19 affected countries. We find a significant increase in systemic risk among the sample countries initially, while stagnancy (at an elevated level) is observed during April 2020 except for China, which is showing some recovery. By using spillover measures, we also identify systemically important institutions. The findings of this study testify to the benefits of policy responses in containing systemic risk.

Leishmania-Specific Promiscuous Membrane Protein Tubulin Folding Cofactor D Divulges Th1/Th2 Polarization in the Host via ERK-1/2 and p38 MAPK Signaling Cascade.

Visceral leishmaniasis (VL)-related mortality and morbidity imposes a great deal of health concern across the globe. The existing anti-leishmanial drug regimen generally fails to eliminate newly emerging resistant isolates of this dreadful parasite. In such circumstances, the development of a prophylactic strategy to impart protection against the disease is likely to take center stage. In order to develop a promising prophylactic vaccine, it is desirable to identify an adequately potential vaccine candidate. In silico analysis of Leishmania tubulin folding cofactor D protein predicted its potential to activate both B- and T-cell repertoires. Furthermore, the ELISA employing anti-peptide27 (a segment of tubulin folding cofactor D) antibody revealed its proficiency in VL diagnosis and treatment monitoring. The peptide27 and its cocktail with another Leishmania peptide (peptide23) prompted the up-regulation of pro-inflammatory cytokines, such as IFN-γ, TNF-α, IL-2, IL-17, etc., and the down-regulation of immune-regulatory cytokines, such as IL-10, in the immunized BALB/c mice. Coherent to the consequence of peptide-specific humoral immune response, peptide cocktail-based immunization ensued in the predominant amplification of pathogen-specific IgG2a over the IgG1 isotype, up-regulated proliferation of T lymphocytes, and enhanced production of nitric oxide, reactive oxygen species, etc. We also established that the peptide cocktail modulated host MAPK signaling to favor the amplification of Th1-dominated immune response in the host. The peptide cocktail mediated the activation of the host immune armory, which was eventually translated into a significant decline in parasitic load in the visceral organs of experimental animals challenged with Leishmania donovani.

Hajrul yahood (Lapis judaicus): An important mineral drug of Unani system of medicine for the management of urolithiasis.

ETHNOPHARMACOLOGICAL RELEVANCE: Hajrul yahood (Lapis judaicus) is a mineral drug used in different dosage forms in Unani system of medicine and claimed to be effective in the management of urolithiasis. AIM OF THE STUDY: To explore the role of Hajrul yahood in the management of urolithiasis along with determination of its morphological, ethnomedicinal, physicochemical and pharmacological attributes. MATERIALS AND METHODS: A review of literature on Hajrul yahood was undertaken using the bibliographic database viz. Pub Med, Google Scholar, Science Direct and Scopus. The search was conducted using the terms 'Hajrul yahood', 'Lapis judaicus', 'Majoon Hajrul yahood' and 'Kushta Hajrul yahood'. Further books, monographs and reports on Lapis judaicus published in Urdu and English were used to compile the information. RESULTS: Hajrul yahood as such and as an ingredient in multidrug formulations has been used for the treatment of kidney and bladder stones since ancient times mainly by the practitioners of traditional medicines. Literature of Unani medicine clearly indicated that Hajrul yahood and its different formulations are safe and have antilithiatic effect. Sufficient information in respect of morphological, physicochemical and ethnomedicinal properties of Hajrul yahood are available but very few pharmacological and clinical studies have been conducted. The available reports on Hajrul yahood and its products mainly Cystone® though has shown varying results but on the whole indicated possible antilithiatic effect. The studies conducted so far have been limited by small patient numbers, weak methodology, and poor study design therefore a conclusive result cannot be arrived at. CONCLUSION: Hajrul yahood and its formulations have been claimed by Unani medicine to be useful in the management of urolithiasis. Some of the scientific reports also suggest the possibility of such an effect however further elaborate and comprehensive studies are required to validate such a claim.

Nephroprotective effect of Kabab chini (Piper cubeba) in gentamycin-induced nephrotoxicity.

Kabab chini (KC) (Piper cubeba) is an important drug in Unani Medicine, widely described to be effective in renal diseases, and physicians are using it as a protective and curative agent in various renal disorders from ancient times. The present study was designed to evaluate the nephroprotective effect of KC against gentamycin-induced nephrotoxicity in Wistar rats. This was studied in two different sets of tests, in which both the protective as well as the curative effects were evaluated in groups of albino rats. The powder of the test drug was administered orally in a dose of 810 mg/kg and 1220 mg/kg, in suspension form, in the pre- and post-treated models. The nephroprotective effect was assessed on the basis of biochemical estimation of serum urea and creatinine levels and histopathological examination of the treated kidney. The effect observed in the pre-treated and post-treated groups was compared with plain as well as negative control groups using one-way ANOVA with Dunnett's multiple pair comparison test. The findings of the two tests demonstrated that KC produced a significant nephroprotective effect in both pre-treated and post-treated groups. The results of our study indicate that KC possesses significant benefit against gentamycin-induced nephrotoxicity.

Tectone, a new antihyperglycemic anthraquinone from Tectona grandis leaves.

A new anthraquinone (3,8-dihydroxy-2-methyl anthraquinone), named tectone (1), along with fourteen known compounds (2-15) comprised of five terpenoids (2-5, 15), four flavonoids (6-9), three flavone glycosides (10-12), and two phenolic glycosides (13-14) were isolated from the chloroform and n-butanol fractions of the ethanol extract of Tectona grandis leaves. Attempts were made to synthesize compound 1. This resulted in the synthesis of three additional anthraquinones (16-18), out of which compound 16 is new. The structures of all compounds were established by spectral analysis. The isolated and synthesized compounds were evaluated for their antihyperglycemic activity. Compounds 1, 2, 4 and 14 showed significant antihyperglycemic activity in streptozotocin-induced diabetic rats at a dose of 100 mg/kg body weight, which is comparable to the standard drug metformin.

Synthesis of novel benzofuran isoxazolines as protein tyrosine phosphatase 1B inhibitors.

PTPases are considered to be involved in the etiology of diabetes mellitus and neural diseases, such as Alzheimer's disease and Parkinson's disease. Therefore, PTPase inhibitors should be useful tools to study the role of PTPases in these diseases and other biological phenomena, and which can be developed into chemotherapeutic agents. In the present study, we have synthesized novel benzofuran isoxazolines 13-21 via 1,3-dipolar cycloaddition reaction using karanjin (1) and kanjone (2), isolated from Pongamia pinnata fruits. All the synthesized compounds were evaluated against PTPase enzyme. Compounds 19 and 20 displayed significant inhibitory activity with IC50 values 76 and 81 microM, respectively.

Glycolipids and other constituents from Desmodium gangeticum with antileishmanial and immunomodulatory activities.

Nineteen compounds of various classes, such as flavonoid glycosides, pterocarpanoids, lipids, glycolipids, and alkaloids, were isolated and identified from the Desmodium gangeticum whole plant. Aminoglucosyl glycerolipid (8) is reported here for the first time. Its structure has been elucidated by spectroscopic and degradation studies. This novel compound exhibited in vitro antileishmanial and immunomodulatory activities, as it enhanced nitric oxide (NO) production and provided resistance against infection established in peritoneal macrophages by the protozoan parasite Leishmania donovani. Another known compound, glycosphingolipid (cerebroside) (7) was found to possess significant in vitro antileishmanial and immunomodulatory activities against the same parasite. Other compounds were found to be inactive.

Protective effect of Arque-Ajeeb on acute experimental diarrhoea in rats.

BACKGROUND: Diarrhoea is a major health problem for children worldwide, accounting for 5-8 million deaths each year. Arque-Ajeeb (AA) is a compound formulation of Unani medicine. It is reputed for its beneficial effects in the treatment of diarrhoea and cholera, but the claim of its efficacy is yet to be tested. Therefore the present study has been planned to investigate the real efficacy of this drug in rats. METHODS: The effect of Arque-Ajeeb was investigated for antidiarrhoeal activity against charcoal-induced gut transit, serotonin-induced diarrhoea and PGE2-induced small intestine enteropooling in rats. The control, standard and test groups of experimental animals were administered with normal saline (p.o.), diphenoxylate hydrochloride (5 mg/kg, p.o.) and Arque-Ajeeb (0.07 ml and 0.14 ml/kg, p.o.) respectively except the control group of PGE2-induced small intestine enteropooling which received only 5% ethanol in normal saline (i.p.). Charcoal (10 ml/kg, p.o.) and serotonin (600 micrograms/kg, i.p.) were administered after 30 min, while PGE2 (100 micrograms/kg, p.o.) was administered immediately afterwards. The distance traveled by charcoal in small intestine was measured after 15 and 30 min of charcoal administration, diarrhoea was observed every 30-min for six hour after serotonin administration and the volume of intestinal fluid was measured after 30 min of PGE2 administration. RESULTS: Arque-Ajeeb (0.07 ml and 0.14 ml/kg) significantly inhibited the frequency of defaecation and decreased the propulsion of charcoal meal through the gastrointestinal tract, reduced the wetness of faecal droppings in serotonin-induced diarrhoea and also reduced the PGE2-induced small intestine enteropooling. CONCLUSION: Arque-Ajeeb may have potential to reduce the diarrhoea in rats. Thus the drug may prove to be an alternate remedy in diarrhoea.

Furanoflavonoid glycosides from Pongamia pinnata fruits.

Pongamia pinnata fruits afforded three new furanoflavonoid glucosides, pongamosides A-C (1-3), and a new flavonol glucoside, pongamoside D (4). The structures of these compounds were established on the basis of spectroscopic studies. This is the first time that furanoflavone glucosides have been found as naturally occurring compounds.

Furanoflavonoids from Pongamia pinnata fruits.

Fruits of Pongamia pinnata afforded four new furanoflavonoids, pongapinnol A-D (1-4), and a new coumestan, pongacoumestan (5) along with thirteen known compounds 6-18. Compounds 16 and 17 are isolated for the first time from this plant. The structures of isolated compounds were elucidated on the basis of spectroscopic data interpretation.