The Scope of Practice for Primary Cardiovascular Disease Prevention Expanded to Advanced Practice Providers: What Does the Data Show?

PURPOSE OF REVIEW: The review aims to explore the available literature on the role of advance practice providers (APPs) in the primary prevention of cardiovascular diseases (CVD). RECENT FINDINGS: CVD are the major cause of death and disease with the growing burden of direct and indirect costs. Globally, one out of every three deaths is due to CVD. A total of 90% of CVD cases are due to modifiable risk factors which are preventable; however, challenges are faced by the already overburdened healthcare systems where the shortage of workforce is a common constraint. Different CVD preventive programs are working but, in a silo, and with different approaches except in few of the high-income countries where specialized workforce such as advance practice providers (APPs) is trained and employed in practice. Such initiatives are already proven more effective in terms of health and economic outcomes. Through an extensive literature search of APPs' role in the primary prevention of CVD, we identified very few high-income countries where APPs' role has already been integrated into the primary healthcare system. However, in low- and middle-income countries (LMICs), no such roles are defined. In these countries, either the overburdened physicians or any other health professionals (not trained in primary prevention of CVD) sometimes provide brief advice on CVD risk factors. Hence, prompt attention is appealed by the current scenario of CVD prevention specifically in LMICs.

Nurse-led culturally relevant smoking reduction intervention among cardiovascular and respiratory patients in Pakistan.

INTRODUCTION: Socioeconomically deprived populations are at greater risk for smoking-induced diseases and death, such as cancers, and cardiovascular and respiratory illnesses. The initiation of a nurse-led smoking cessation program in clinical practice is an effective method to enhance smoking cessation among cardiovascular and respiratory patients in Pakistan. This study aimed to evaluate the effectiveness of nurse-led smoking reduction intervention performed at out-patient clinics in Karachi, Pakistan. METHODS: A single group pre-and post-test study was conducted on eligible patients (n = 83) with a typical profile of cardiovascular and respiratory diseases in a tertiary care hospital from December 2020 to July 2021. INTERVENTION: The multi-modal nurse-led intervention consisted of two face-to-face motivational counseling (30-min) and free nicotine replacement therapy with telephonic counseling and follow-ups offered to all eligible patients for 2 months. RESULTS: The nurse-led intervention resulted in a significant decrease in daily cigarette consumption in most of the patients (75.9%) by 50% and 16.9% of the patients reported smoking abstinence (quitter) at 1-week follow-up (p < .001), verified by a CO breath test. CONCLUSION: A nurse-managed smoking reduction intervention for even a short duration (2 months) in clinics is an effective approach in enhancing smoking abstinence and reduction among cardiovascular and respiratory patients.

Rapid Response Team Activation Triggers in Adults and Children: An Integrative Review.

PURPOSE: This integrative review aims to identify the triggers for rapid response team (RRT) activation and their outcomes in pediatric patients and to compare them with those of adult patients. In addition, this integrative review synthesizes the outcomes of cardiopulmonary resuscitation (CPR), intensive care unit (ICU) admission, length of hospital stay, and mortality following RRT activation. METHOD: An integrative review using the Whittemore and Knafl methodology was undertaken with a search of three large databases (PubMed, Ovid MEDLINE, and CINAHL) and found 25 relevant studies published in the years 2017 through 2022. RESULTS: Tachypnea, decreased oxygen saturation, tachycardia, changes in blood pressure, and level of consciousness were the most common triggers in both populations. However, specific activation triggers differed between children and adults. CONCLUSIONS: The most common triggers for RRT are detectable through vital signs monitoring; therefore, vigilant tracking of patients' vital signs is critical and can provide early clues to clinical deterioration.

Sexual Violence: A Review and Case Study Utilizing Watson's Caring Science.

The care provided to persons who experience sexual violence is complex and needs to be individualized and account for the person's expressed needs. Nurses have the potential to facilitate the recovery from such traumatic events. Utilizing Watson's theory of human caring science, nursing care practices provide an influence through their utilization of artistry with caring-healing processes and attending to the healing environment for people. The authors in this article present a case study enlightening the applicability, implementation, and outcomes of caring for patients with this experience sensitively and holistically.

Malaria epidemiology and comparative reliability of diagnostic tools in Bannu; an endemic malaria focus in south of Khyber Pakhtunkhwa, Pakistan.

The present study was aimed at elucidation of malaria epidemiology and comparing performance of several diagnostic procedures in Bannu, a highly endemic district of Khyber Pakhtunkhwa, Pakistan. Dried blood spots were collected from patients suspected of malaria visiting a hospital and two private laboratories in district Bannu and processed for species-specific PCR (rRNA). Patients were also screened for malaria through microscopy and RDT. A well-structured questionnaire was used to collect patient information to assess risk factors for malaria. Of 2033 individuals recruited, 21.1% (N = 429) were positive for malaria by at least one method. Overall, positivity detected by PCR was 30.5% (95/311) followed by 17.7% by microscopy (359/2033) and 16.4% by RDT (266/1618). Plasmodium vivax (16.9%, N = 343) was detected as the dominant species followed by Plasmodium falciparum (2.3%, N = 47) and mixed infections (1.2%, N = 39). Microscopy and RDT (Cohen's kappa k = 0.968, p = <0.0001, McNemar test p = 0.069) displayed significant agreement with each other. Satisfactory health, sleeping indoors, presence of health-care facility in vicinity (at an accessible range from home), living in upper middle class and in concrete houses significantly reduced malaria risk; whereas, low literacy level, presence of domestic animals indoors and malaria diagnosis recommended by clinician increased the disease risk. Overall, findings from the study provide reasonable basis for use of RDT as a cost-effective screening tool in field and for clinicians who can proceed with timely treatment of malaria patients. Appropriate management of identified risk factors could contribute to reduction of malaria prevalence in Bannu and its peripheries.

Geospatial and Climatic Patterns Associated With the Distribution of Sand Fly (Diptera: Psychodidae) Vectors of Leishmaniasis in Pakistan.

We provide a comprehensive and updated review on the effects of elevation and climatic factors on distribution of sand fly (Diptera: Psychodidae) vectors of cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) across Pakistan. Our study was undertaken in view of the increasing risk of leishmaniasis, particularly resulting from climatic deviations and political instability in the region. Literature (published and unpublished) on suspected vectors of CL (Phlebotomus sergenti Parrot and Phlebotomus papatasi Scopoli) and VL (Phlebotomus major Yakimoff and Schokhor and Phlebotomus hindustanicus Theodor) was collected, sorted, and utilized in geospatial analysis. P. papatasi and P. sergenti co-occurred in majority of the referenced localities and were generally distributed toward the western and southern parts across a wide range of elevation, whereas P. major and P. hindustanicus were limited to high elevation in cool and humid northern areas of Pakistan. Conversely P. papatasi and P. sergenti exploited diverse ecological settings across the country, being particularly abundant in warm/hot and arid regions.

Potential Resting and Breeding Sites of Sand Flies (Diptera: Psychodidae) and Their Habitat Characteristics in Leishmaniasis Foci of Dir Districts, Khyber Pakhtunkhwa, Pakistan.

Despite their medical importance, natural breeding sites of sand flies have been poorly explored. Detecting such sites is imperative in vector control strategies. This study aimed to identify potential breeding and resting microhabitats of sand flies and household risk factors associated with cutaneous leishmaniasis transmission in Dir districts, Khyber Pakhtunkhwa, Pakistan. Survey of indoor and outdoor habitats in four tehsils (subdistricts) of upper and lower Dir districts was carried out using sticky traps, flit method, and aspirator. To assess risk factors associated with cutaneous leishmaniasis (CL), questionnaires were administered to household heads. Mud houses and plants belonging to Cucurbitaceae family sheltered highest number of sand flies. Excessive number of flies were collected from indoor sites (common rooms used for both people and animals) compared to outdoor habitats (cattle dungs). Phlebotomus salangensis Artemiev, 1978 and Phlebotomus sergenti were the most widely distributed species, while Sergentomyia bailyi peaked in caves with high organic content in soil. Roof material and ownership of fans were associated with significant risk of CL. Findings of this study present a list of potential breeding sites for sand flies and CL risk factors that can be targeted and implemented in control programs for CL. Further studies are required to elucidate the breeding behavior and preferences of these medically important vectors.

Urinogenital Myiasis From Blow Fly in a Pakistani Child.

Herein is reported the first case of urogenital myiasis from Peshawar, Pakistan. Third instar blow fly larvae were recovered from the urinogenital tract of a 5-year old female child. The larvae were identified as Chrysomya bezziana(Villeneuve), using Light and Scanning Electron microscopic techniques. The study brings into focus the subject of human myiasis, about which little is known in Pakistan.

Species composition and activity patterns of sand flies (Psycodidae: Phlebotomine) in four tehsils of Dir Districts, Khyber Pakhtunkhwa, Pakistan.

The present study reports sand flies species composition, fauna diversity and seasonal variations from four tehsils of Dir Districts, Khyber Pakhtunkhwa, Pakistan. Collection was made using sticky traps, flit method and aspiration where highest number of sand flies was captured through sticky traps. Digitalized sand flies distribution maps were produced using geographic information system ArcGIS. A total of 7292 specimens were captured between January to December 2014, comprised of 11 Sergentomyia and 9 Phlebotomus. Phlebotomus salengensis was the most abundant species followed by Phlebotomus sergenti. Overall, male to female ratio observed was 3:1 and species diversity varied among the studied tehsils. Highest abundance was recorded in July and August, whereas the flies disappeared in the colder months (November-April) of the year. Information about insect vector behaviour in natural setting is required to understand the status of disease caused by them. This study is a thorough account of biodiversity of sand flies in the region and provides a useful insight in to identifying potential breeding preferences of sand flies and recognition of active and potential vector species in the Dir districts. Further large scale studies are needed to determine the behaviour, infection rate, and the natural reservoir hosts of sand fly vectors in the region.

Comet assay based DNA evaluation of fuel filling stations and automobile workshops workers from Khyber Pakhtunkhwa province, Pakistan.

BACKGROUND: Fuel filling stations workers and automobile workshops mechanics are consistently exposed to gasoline hydrocarbons during their occupation, this may cause DNA damage. Objective of this study was to evaluate the level of DNA damage in subjects occupationally exposed to these hydrocarbons. METHODS: Comet assay was performed on blood lymphocytes of exposed subjects to assess the probable DNA damage. 100 cells per individual were scored and graded by comet tail length. Exposed group consisted of 98 subjects (age 25.4 ± 7.2 years), of which 68 were CNG/Petrol filling men and 30 were automobile workshop workers, selected randomly from different service stations and automobile workshops of populated and adjacent cities of Peshawar, Mardan and Nowshera of Khyber Pakhtunkhwa province, while control group included 92 subjects (age 26.7 ± 11.8 years) were also from the same areas. RESULTS: Significantly high level of DNA damage was found in the subjects exposed to gasoline hydrocarbons as compared to control subjects (173.2 ± 50.1 and 61.0 ± 25.0, P = 0.001, respectively). Period of exposure and use of tobacco also showed considerable effects (P < 0.05) on DNA damage, while effect of age and daily working hours on total comet score (TCS) were non-significant (P > 0.05). CONCLUSIONS: The results of our study concluded that petroleum hydrocarbons have the potential to cause DNA damage in the exposed subjects. The study also suggested that protective strategies should be implemented by the concerned authorities to minimize exposure to fuel hydrocarbons.

Evaluation of DNA damage in lymphocytes of radiology personnel by comet assay.

OBJECTIVES: The importance of X-rays as a diagnostic medical tool cannot be denied. However, continuous exposure to X-rays can cause DNA damage. This study aimed to use the comet assay technique to investigate the level of DNA damage in lymphocytes due to X-rays in occupationally exposed personnel. METHODS: Blood samples were collected from 74 exposed and 70 control subjects for analysis. A total of 100 randomly captured cells from each slide were examined using an epifluorescent microscope. The comets were analyzed by a visual scoring method according to comet tail length. RESULTS: The results indicated a significant increase (p<0.05) in DNA damage in X-rays technicians (129.8 ± 17.2) as compared with the control group (53.0 ± 25.0). A significant increase (p<0.02) in DNA damage was also observed with an increase in exposure duration of technicians because of their service length. CONCLUSIONS: The present study suggests that the exposed radiology personnel should carefully comply with radiation protection procedures such as wearing of lead apron during diagnostic procedures and minimize radiation exposure where possible to avoid potential genotoxic effects due to X-rays.

Population dynamics of mosquitoes and malaria vector incrimination in district Charsadda, Khyber Pakhtunkhwa (KP) Pakistan.

This study aimed to obtain updated information on mosquito diversity and malaria vector incrimination in Charsadda Khyber Pakhtunkhwa to help in devising effective control and preventive measures in the area. Monthly survey of indoor mosquitoes for one year was carried out in three villages, Dhaki Totaqi and Mathra. Female Anopheline were used to detect Circumsporozoites protein (CSP) using Enzyme Linked Immunosorbent Assay. Among 17 mosquito species, Culex quinquefasciatus, Anopheles splendidus, Anopheles stephensi, Anopheles fluviatilus, Anopheles culicifacies and Culex tritaeniorhynchus were predominant. Dhaki village had the highest mosquito species diversity (1.015) and similar species richness (0.7) and evenness (0.5) with village Mathra. Slide positivity rate (SPR) shows that the rate of malaria transmission increases with mosquito population. Four anopheline species i.e. A. stephensi, A. fluviatilis, A. splendidus, and A. culicifacies were CSP positive. The CSP rate was 0.8%, where two specimens of A. splendidus and one of A. fluviatilus were positive for Plasmodium falciparum, Plasmodium vivax was represented by two variants 210 and 247. Among the 20 CSP positive specimens, variant 210 was found in 12 (one belonging to A. culicifacies, two each of A. stephensi and A. fluviatilus, seven specimens of A. splendidus) and 247 in 8 specimens (two of A. stephensi, three each of A. fluviatilus and A. splendidus). The number of infected mosquitoes collected from animal sheds was higher (15) though non-significant (P>0.05) than that from bedrooms (8).