Factors associated with maternal health services utilization in Pakistan: Evidence from Pakistan maternal mortality survey, 2019.

BACKGROUND: This study investigates the factors associated with maternal health services utilization in Pakistan using two outcome indicators, ideal antenatal care (IANC), defined as the pregnant woman receiving all the essential services included in standard antenatal care, and skilled birth attendance (SBA). METHODS: This study used the Pakistan Maternal Mortality Survey 2019 data. The study utilized binary logistic regression models to investigate the adjusted association between the outcome variables, separately for IANC and SBA, and the independent variables, education, wealth, parity, and residence. RESULTS: Wealth showed a positive association with utilization of IANC (adjusted odds ratio [AOR] = 11.48, 95% CI = 7.76, 16.99) and SBA (AOR = 4.37, 95% CI = 3.30,5. 80). Maternal age was associated only with IANC for women aged 35 or more years (AOR = 1.31, 95% CI = 1.06, 1.62). Increased likelihood of utilization of IANC and SBA services was also observed for women with formal education. Women who had 3-5 previous live births had higher odds of using IANC and SBA than women who had 1-2 or more than five previous live births. Urban residency was not correlated with either IANC or SBA. CONCLUSION: When compared to the wealthy and educated quintile, women in the lower wealth quintile and those without any formal education were less likely to utilize ANC and SBA services. A comprehensive and multipronged approach from the health and education sectors is needed to improve maternal health in Pakistan.

Food waste: causes and economic losses estimation at household level in Pakistan.

Food waste is one of the major sustainability issues that need to be addressed due to its negative impacts on the economy, environment, and food security. To develop food waste reduction policies on regional and global level, it is mandatory to have a clear understanding of the various factors prompting food waste at household level and the extent of the economic losses incurred by food waste. Reducing food waste can decrease household expenditure on food, freeing resources for health, education, and well-being. The current study was aimed to (1) examine the food waste behavior of the respondents and to (2) determine the level of monetary losses from food waste. To address these objectives, a questionnaire survey and sample of food waste generated during 24 h were collected from 51 households in Tehsil Kahror Pakka, District Lodhran, Punjab, Pakistan. The survey focus was on levels of food waste and respondents' knowledge and behaviors about food waste. Economic estimation of food waste was also done. In the survey, respondents from both high- and low-income households revealed that their fruit and vegetables (31%; 32%) and peel and scrap (53%; 48%) losses were higher while egg losses (4%; 4%) were lower among various food waste categories. Wanting to eat fresh food and having no time to save food were the reasons for food waste. Monetary losses from food waste (US$ 12.8/Rs. 3677.01 per capita per annum) were higher in high-income households compared to low-income households.

Use of agricultural bio-wastes to remove arsenic from contaminated water.

Arsenic (As) is a highly toxic metalloid. High As levels have been recorded in groundwater aquifers at a global scale. This study investigated As level in groundwater of District Vehari and assessed the potential of different agricultural by-products (sugarcane bagasse, cottonseed hulls, soybean hulls, corncobs and rice husk) to remove As from water. The study was carried out in two steps. In the first step, a total of 38 groundwater samples were obtained from Vehari. Groundwater samples were analyzed for total As contents and physicochemical parameters. Results indicated that As content ranged from below detection limit to 49 µg/L in the groundwater samples. The values of hazard quotient and cancer risk were up to 1.5 and 0.0004, respectively, which delineated severe risk of As poisoning. During the second step, six As-contaminated groundwater samples (total As contents: 49, 40, 29, 24, 18, 16 µg/L) were selected to remove As using agricultural by-products. Furthermore, four As solutions (200, 100, 50 and 25 µg/L) were prepared in the laboratory. Results revealed that corncobs and soybean hulls removed, respectively, 98% and 71% As from aqueous mediums after 120 min. Moreover, agricultural by-products were less effective in removing As from groundwater samples than synthetic solutions. The adsorption/removal capacity of by-products was lower at low initial As concentration compared to high initial levels, which needs further studies to explore the underlying mechanisms. Overall, the As removal efficiency of agriculture by-products differed significantly with respect to initial As level, contamination category, type of agricultural by-products and interaction duration. Therefore, these aspects need to be optimized before the possible use of an agricultural by-product as a potential biosorbent.

Face mask detection and social distance monitoring system for COVID-19 pandemic.

Coronavirus triggers several respirational infections such as sneezing, coughing, and pneumonia, which transmit humans to humans through airborne droplets. According to the guidelines of the World Health Organization, the spread of COVID-19 can be mitigated by avoiding public interactions in proximity and following standard operating procedures (SOPs) including wearing a face mask and maintaining social distancing in schools, shopping malls, and crowded areas. However, enforcing the adaptation of these SOPs on a larger scale is still a challenging task. With the emergence of deep learning-based visual object detection networks, numerous methods have been proposed to perform face mask detection on public spots. However, these methods require a huge amount of data to ensure robustness in real-time applications. Also, to the best of our knowledge, there is no standard outdoor surveillance-based dataset available to ensure the efficacy of face mask detection and social distancing methods in public spots. To this end, we present a large-scale dataset comprising of 10,000 outdoor images categorized into a binary class labeling i.e., face mask, and non-face masked people to accelerate the development of automated face mask detection and social distance measurement on public spots. Alongside, we also present an end-to-end pipeline to perform real-time face mask detection and social distance measurement in an outdoor environment. Initially, existing state-of-the-art single and multi-stage object detection networks are fine-tuned on the proposed dataset to evaluate their performance in terms of accuracy and inference time. Based on better performance, YOLO-v3 architecture is further optimized by tuning its feature extraction and region proposal generation layers to improve the performance in real-time applications. Our results indicate that the presented pipeline performed better than the baseline version, showing an improvement of 5.3% in terms of accuracy.

Relationship Between Mass Loss and Fruit Quality of Sweet Orange at Two Different Storage Conditions.

Mass loss from fresh produce is linked to a reduction of its aesthetic value. However, a relationship between mass loss and biochemical quality parameters at different storage conditions has not been widely explored. Therefore, the current study is designed with the objectives to determine the behavior of fruit quality parameters and a relationship between fruit mass loss and fruit quality at two different storage conditions. Sweet orange fruit stored in a zero energy cool chamber (ZECC) had greater shelf-life of more than 15 days, fruit size (62.40 mm) and peel (35.15%) and lower mass loss (4.94%), juice (32.19%) and electrical conductivity (EC) (2.06 S/m) as compared to ambient conditions in laboratory during 25 days of storage. In ZECC, only EC was positively correlated (r = 0.57) with mass loss, whereas at room temperature EC (r = 0.76), total soluble solids (TSS) (r = 0.60) and fruit internal temperature (r = 0.64) were positively and peel (%) (r = -0.52) and fruit diameter (r = -0.49) were negatively correlated with mass loss. Correlation of combined storage conditions revealed that EC (r = 0.47) and TSS (r = 0.50) were positively and peel (%) (r = -0.77) and fruit diameter (r = -0.55) were negatively correlated with mass loss (%). The principal component analysis (PCA) revealed that the scores of room temperature were strongly associated with TSS, pH, EC, mass loss (%), juice (%) and internal temperature (°C), whereas scores of ZECC were strongly associated with pulp (%), ascorbic acid (mg 100 mL-1), acidity (%), and fruit diameter (mm).

Patients' perception of the pharmacovigilance system: A pre-diagnostic and post-interventional cross-sectional survey.

Background and objective: The risk of adverse reactions necessitated the pharmacovigilance system for patient safety. A literature search documented better health literacy of patients through intervention. This investigation aims to assess the perception and the effect of an intervention on patients regarding adverse reactions caused by drugs. Methods: A pre-diagnostic and post-interventional cross-sectional investigation was designed with a sample size of 423 patients in hospitals of Islamabad. The proportion of patients was selected based on a stratified probability technique. A prevalidated tool was used to collect the response twice through a health promotion brochure with counseling, which was applied as an intervention. Results: The outcome of the investigation revealed that the prerequisite of the pharmacovigilance center in the hospital among respondents was improved significantly by 41.2% after intervention. Knowledge, communication, and practice were significantly different with respect to gender. There was a moderate Pearson correlation between diagnostic and interventional responses of patient's knowledge of adverse reactions by drugs (r = 0.66, p < 0.01) and patient's communication in pharmacovigilance (r = 0.62, p < 0.01) and a strong correlation between diagnostic and interventional responses of patient's practice in the pharmacovigilance system (r = 0.72, p < 0.01). Conclusion: The finding of the investigation provided evidence that patient awareness was significantly improved by the health promotion model. Patient participation in the reporting of adverse reactions of drugs will complement the hospital staff reporting. These reports will construct an authentic, cross-checked database for rational drug safety practices in Pakistan.

Protective effect of jasmonic acid and potassium against cadmium stress in peas (Pisum sativum L.).

A combination of mineral nutrients and plant growth regulators should be assessed to improve crop performance under various abiotic stresses. There is a need to include plant growth regulators in fertilization regime of various crops along with essential mineral nutrients, especially when they are irrigated with polluted water with higher levels of heavy metals. The performance of pea was evaluated under cadmium (Cd) stress coupled with potassium (K) and jasmonic acid (JA) supplementation. The Cd stress (50 µM) was applied to soil (sandy loam) grown pea plants as basal dose after a month of sowing. The control and stressed plants were then supplemented with K (5 M), JA (0.5 mM) and their collective application along with control as distilled water. Cd stress showed a marked reduction in growth pattern, however, the collective supplementation sufficiently improved the growth pattern of stressed peas plants as evidenced by improvement in shoot length (cm), root length (cm), number of leaves per plant, leaf area (cm2), plant fresh and dry weight (gm). Potassium application under Cd stress significantly enhanced internodal distance (cm) while the number of seeds per pod and relative water contents remained nonsignificant. The applied treatment (JA + K) under Cd stress prominently improved enzymatic activities, which were measured as nitrate reductase activity (NRA), nitrite reductase activity (NiRA), superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT). Cd stress impacted the biochemical profile by enhancing antioxidant capacity (AC), antioxidant activity (AA), total phenols (TP), while reducing total soluble protein (TSP), chlorophyll 'a', chlorophyll 'b' and carotenoids. The combined application of JA and K under Cd stress enhanced AC, AA, TP, Chl a and b, TSP and carotenoids. The results indicate that foliar application of JA and K efficiently negated the harmful effects of Cd stress on peas.

Arsenic-induced oxidative stress in Brassica oleracea: Multivariate and literature data analyses of physiological parameters, applied levels and plant organ type.

Plant redox homeostasis governs the uptake, toxicity and tolerance mechanism of toxic trace elements and thereby elucidates the remediation potential of a plant. Moreover, plant toxicity/tolerance mechanisms control the trace element compartmentation in edible and non-edible plant organs as well as the associated health hazards. Therefore, it is imperative to unravel the cellular mechanism involved in trace element toxicity and tolerance. The present study investigated the toxicity and tolerance/detoxification mechanisms of four levels of arsenic (As(III): 0, 5, 25 and 125 µM) in Brassica oleracea under hydroponic cultivation. Increasing As levels significantly decreased the pigment contents (up to 68%) of B. oleracea. Plants under As stress showed an increase in H2O2 contents (up to 32%) in roots while a decrease (up to 72%) in leaves because As is mostly retained in plant roots, while less is translocated toward the shoot, as evident from the literature. Arsenic treatments caused lipid peroxidation both in the root and leaf cells. Against As-induced oxidative stress, B. oleracea plants mediated an increase in the activities of peroxidase and catalase. Contradictory, the ascorbate peroxidase and superoxide dismutase activities slightly decreased in the As-stressed plants. In conclusion and as evident from the literature data analysis, As exposure (especially high level, 125 µM) caused pigment toxicity and oxidative burst in B. oleracea. The ability of B. oleracea to tolerate As-induced toxicity greatly varied with applied treatment levels (As-125 being more toxic than lower levels), plant organ type (more toxicity in leaves than roots) and physiological response parameter (pigment contents more sensitive than other response variables). Moreover, the multivariate statistical analysis appeared to be a useful method to estimate plant response under stress and trace significant trends in the data set.

Application of Organic Fertilizers Affect the Citrus Leafminer, Phyllocnistis citrella (Lepidoptera: Gracillariidae) Infestation and Citrus Canker Disease in Nursery Plantations.

Citrus leafminer (CLM), Phyllocnistis citrella Stainton (Lepidoptera: Gracillariidae), is one of the most important insect pests of Pakistan's citrus nursery stock and caused extensive damage to young flushes. The organic compost is a widespread technique used to manage insect pests and plant diseases. Different composts (biofert, tara root and vermicompost) at 0.5 and 0.25 kg/plant concentration in comparison to NPK fertilizer at 0.4 and 0.2 g/plant were evaluated for CLM infestation and the associated citrus canker disease in nursery plantations of Citrus reticulata Blanco. Application of biofert at 0.5 kg/plant reduced the CLM infestation up to 54.5% during Fall-2016 and 39.1% during Summer-2017 in comparison to control treatment. The CLM larval density was also found lower by the application of biofert followed by vermicompost during both seasons. Both concentrations of biofert followed by vermicompost at 0.5 kg/plant resulted in remarkable protection against citrus canker disease in both flushes. The incidence of canker associated with CLM infested leaves was also studied and found lower by the application of biofert and vermicompost compared with control treatment. Conclusively, the soil amendment using biofert and vermicompost affects the CLM population and canker infection in nursery plantations. These organic fertilizers can be used in future citrus IPM programs as a tool to suppress the CLM population and citrus canker disease.

Heavy metal exposure through artificial diet reduces growth and survival of Spodoptera litura (Lepidoptera: Noctuidae).

Insect physiology is affected by the presence of toxins in the surrounding environment of insects as well as their food sources. The objective of this study was to determine the effect of heavy metal exposure to two low concentrations (50 µg/g and 150 µg/g) of lead (Pb) and zinc (Zn) through artificial diet to the larvae on biological parameters of Asian armyworm (Spodoptera litura Fabricius) (Lepidoptera: Noctuidae). Both Pb and Zn, even at low concentrations, had relatively high toxic effects on S. litura larvae (P < 0.01). S. litura larval weight and length suffered the maximum reduction when the larvae were fed on diet mixed with the high Pb concentration (150 µg/g) tested compared to the other treatments. At the same Pb concentration (150 µg/g), values of larva growth index, pupa growth index, immature growth index, standardized growth index, and fitness index were 4.66, 7.33, 7.82, 5.35, and 10.00 times lower, respectively, than those of control. At the same Zn concentration (150 µg/g), values of larval growth index, pupal growth index, immature growth index, standardized growth index, and fitness index were 5.61, 3.00, 3.04, 3.23, and 9.24 times lower, respectively, than those of control. The survival rate of S. litura larvae was also lower (12.5%) when the larvae were fed on diet mixed with Pb at 150 µg/g after 10 days of observation. Overall, the presence of those heavy metals in the environment, even at low concentrations, would exert an adverse impact on larvae development of this insect. From this point of view, findings could provide a basis for long-term evaluation of heavy metal risk and its impact on populations of important agricultural pests.

Health risk assessment of drinking arsenic-containing groundwater in Hasilpur, Pakistan: effect of sampling area, depth, and source.

Currently, several news channels and research publications have highlighted the dilemma of arsenic (As)-contaminated groundwater in Pakistan. However, there is lack of data regarding groundwater As content of various areas in Pakistan. The present study evaluated As contamination and associated health risks in previously unexplored groundwater of Hasilpur-Pakistan. Total of 61 groundwater samples were collected from different areas (rural and urban), sources (electric pump, hand pump, and tubewell) and depths (35-430 ft or 11-131 m). The water samples were analyzed for As level and other parameters such as pH, electrical conductivity, total dissolved solids, cations, and anions. It was found that 41% (25 out of 61) water samples contained As (≥ 5 µg/L). Out of 25 As-contaminated water samples, 13 water samples exceeded the permissible level of WHO (10 µg/L). High As contents have been found in tubewell samples and at high sampling depths (> 300 ft). The major As-contaminated groundwater in Hasilpur is found in urban areas. Furthermore, health risk and cancer risk due to As contamination were also assessed with respect to average daily dose (ADD), hazard quotient (HQ), and carcinogenic risk (CR). The values of HQ and CR of As in Hasilpur were up to 58 and 0.00231, respectively. Multivariate analysis revealed a positive correlation between groundwater As contents, pH, and depth in Hasilpur. The current study proposed the proper monitoring and management of well water in Hasilpur to minimize the As-associated health hazards.

Automated Segmentation and Quantification of Drusen in Fundus and Optical Coherence Tomography Images for Detection of ARMD.

Age-related macular degeneration (ARMD) is one of the most common retinal syndromes that occurs in elderly people. Different eye testing techniques such as fundus photography and optical coherence tomography (OCT) are used to clinically examine the ARMD-affected patients. Many researchers have worked on detecting ARMD from fundus images, few of them also worked on detecting ARMD from OCT images. However, there are only few systems that establish the correspondence between fundus and OCT images to give an accurate prediction of ARMD pathology. In this paper, we present fully automated decision support system that can automatically detect ARMD by establishing correspondence between OCT and fundus imagery. The proposed system also distinguishes between early, suspect and confirmed ARMD by correlating OCT B-scans with respective region of the fundus image. In first phase, proposed system uses different B-scan based features along with support vector machine (SVM) to detect the presence of drusens and classify it as ARMD or normal case. In case input OCT scan is classified as ARMD, region of interest from corresponding fundus image is considered for further evaluation. The analysis of fundus image is performed using contrast enhancement and adaptive thresholding to detect possible drusens from fundus image and proposed system finally classified it as early stage ARMD or advance stage ARMD. The proposed system is tested on local data set of 100 patients with100 fundus images and 6800 OCT B-scans. Proposed system detects ARMD with the accuracy, sensitivity, and specificity ratings of 98.0, 100, and 97.14%, respectively.

Fully Automated Robust System to Detect Retinal Edema, Central Serous Chorioretinopathy, and Age Related Macular Degeneration from Optical Coherence Tomography Images.

Maculopathy is the excessive damage to macula that leads to blindness. It mostly occurs due to retinal edema (RE), central serous chorioretinopathy (CSCR), or age related macular degeneration (ARMD). Optical coherence tomography (OCT) imaging is the latest eye testing technique that can detect these syndromes in early stages. Many researchers have used OCT images to detect retinal abnormalities. However, to the best of our knowledge, no research that presents a fully automated system to detect all of these macular syndromes is reported. This paper presents the world's first ever decision support system to automatically detect RE, CSCR, and ARMD retinal pathologies and healthy retina from OCT images. The automated disease diagnosis in our proposed system is based on multilayered support vector machines (SVM) classifier trained on 40 labeled OCT scans (10 healthy, 10 RE, 10 CSCR, and 10 ARMD). After training, SVM forms an accurate decision about the type of retinal pathology using 9 extracted features. We have tested our proposed system on 2819 OCT scans (1437 healthy, 640 RE, and 742 CSCR) of 502 patients from two different datasets and our proposed system correctly diagnosed 2817/2819 subjects with the accuracy, sensitivity, and specificity ratings of 99.92%, 100%, and 99.86%, respectively.

Tree age, fruit size and storage conditions affect levels of ascorbic acid, total phenolic concentrations and total antioxidant activity of 'Kinnow' mandarin juice.

BACKGROUND: Bioactive compounds (ascorbic acid, total phenolics and total antioxidants) are important constituents of citrus fruit juice; however, information with regard to their concentrations and changes in relation to tree age and storage conditions is limited. 'Kinnow' (Citrus nobilis Lour × Citrus deliciosa Tenora) mandarin juice from fruit of three tree ages (6, 18 and 35 years old) and fruit sizes (large, medium and small) were examined for their bioactive compounds during 7 days under ambient storage conditions (20 ± 2 °C and 60-65% relative humidity (RH)) and during 60 days under cold storage (4 ± 1 °C and 75-80% RH) conditions. RESULTS: Under ambient conditions, a reduction in total phenolic concentrations (TPC) and in total antioxidant activity (TAA) was found for the juice from all tree ages and fruit sizes. Overall, fruit from 18-year-old trees had higher mean TPC (95.86 µg mL(-1) ) and TAA (93.68 mg L(-1) ), as compared to 6 and 35-year-old trees. Likewise, in cold storage, TAA decreased in all fruit size groups from 18 and 35-year-old trees. In all tree age and fruit size groups, TPC decreased initially during 15 days of cold storage and then increased gradually with increase in storage duration. Ascorbic acid concentrations showed an increasing trend in all fruit size groups from 35-year-old trees. Overall, during cold storage, fruit from 18-year-old trees maintained higher mean ascorbic acid (33.05 mg 100 mL(-1) ) concentrations, whereas fruit from 6-year-old trees had higher TAA (153.1 mg L(-1) ) and TPC (115.1 µg mL(-1) ). Large-sized fruit had higher ascorbic acid (32.08 mg 100 mL(-1) ) concentrations and TAA (157.5 mg L(-1) ). CONCLUSION: Fruit from 18-year-old trees maintained higher TPC and TAA under ambient storage conditions, whereas fruit from 6-year-old trees maintained higher TPC and TAA during cold storage. Small-sized fruit had higher TPC after ambient temperature storage, whereas large fruit size showed higher ascorbic acid concentrations and TAA after cold storage.