Determinants of Adherence to Antihypertension Medications Among Patients at a Tertiary Care Hospital in Islamabad, Pakistan, 2019.

INTRODUCTION: Medication nonadherence leads to poor health outcomes, frequent complications, and high economic impact. Our objective was to assess the determinants of adherence to medication regimens among patients with hypertension. METHODS: We conducted a cross-sectional study of patients with hypertension attending the cardiology clinic of a tertiary care hospital in Islamabad, Pakistan. Data were collected by using semistructured questionnaires. A score of 7 or 8 on the 8-item Morisky Medication Adherence Scale was classified as good adherence, 6 as moderate, and less than 6 as nonadherence. Logistic regression was performed to determine covariates associated with medication adherence. RESULTS: We enrolled 450 patients with hypertension (mean age, 54.5 y; SD, 10.6). Medication adherence was good among 115 (25.6%) patients and moderate among 165 (36.7%); 170 (37.8%) patients were nonadherent. Most patients (72.7%) had uncontrolled hypertension. Nearly half (49.6%) were unable to afford monthly medication. In bivariate analysis, nonadherence was associated with female sex (odds ratio [OR], 1.44; P = .003) and long waiting times in the health care facility (OR, 2.93; P = .005); the presence of comorbidities (OR, 0.62; P = .01) was associated with good adherence. In multivariate analysis, nonadherence was associated with unaffordability of treatment (OR, 2.25; P = .002) and uncontrolled hypertension (OR, 3.16; P < .001). Good adherence determinants included adequate counseling (OR, 0.29; P < .001) and education (OR, 0.61; P = .02). CONCLUSION: Addressing identified barriers, including medication affordability and patient counseling, should be included in Pakistan's national policy on noncommunicable disease.

Impact of background colorations on growth, movement behavior, and some body physiological factors of Nile tilapia, Oreochromis niloticus.

This study tested the reverence of background color with growth, movement behavior, and some body physiological factors in Nile tilapia. Fish were first acclimatized for two weeks in 80 L glass aquaria. In the experimental design, three groups were maintained separately. In 1st group, glass aquaria were covered with black, 2nd with green charts, and 3rd remained uncovered and maintained as a control group. All groups were in three replicates and fed on a 30% protein diet. All fishes were closely observed for movement behavior and growth-related parameters. On the 28th day, fish were anesthetized and blood was drawn from the caudal fin to determine some hematological parameters, cortisol, and glucose level. The highest weight gain and the greatest number of movements throughout the aquarium were observed in the control group. Furthermore, aquarium color determined the body pigmentation color. Black aquarium had the lowest weight gain, glucose level, FCR, DFI, FCE, and CF, while green aquarium had the highest cortisol level. Histological changes observed in black aquaria fish included reduced lamellar size, deformed blood vessels, and cardiac muscle fascicle in the gills, liver, and heart, respectively, while green aquaria fish showed fused lamellae, necrosis, fibrosis, endomiocardiac hyperplasia, and cardiac muscle fascicle. It was concluded that background coloration has a significant effect on the growth performance, behavior, hematology, body color, histology, cortisol, and glucose levels of Oreochromis niloticus, with green background inducing significant stress while black background causes black pigmentation with less growth.

A comprehensive review on green perspectives of electrocoagulation integrated with advanced processes for effective pollutants removal from water environment.

The rapidly expanding global energy demand is forcing a release of regulated pollutants into water that is threatening human health. Among various wastewater remediating processes, electrocoagulation (EC) has scored a monumental success over conventional processes because it combines coagulation, sedimentation, floatation and electrochemical oxidation processes that can effectively decimate numerous stubborn pollutants. The EC processes have gained some attention through various academic and industrial publications, however critical evaluation of EC processes, choices of EC processes for various pollutants, process parameters, mechanisms, commercial EC technologies and performance enhancement via other degradation processes (DPs) integration have not been comprehensively covered to date. Therefore, the major objective of this paper is to provide a comprehensive review of 20 years of literature covering EC fundamentals, key process factors for a reactor design, process implementation, current challenges and performance enhancement by coupling EC with pivotal pollutant DPs including, electro/photo-Fenton (E/P-F), photocatalysis, sono-chemical treatment, ozonation, indirect electrochemical/advanced oxidation (AO), and biosorption that have substantially reduced metals, pathogens, toxic compound BOD, COD, colors in wastewater. The results suggest that the optimum treatment time, current density, pulse frequency, shaking speed and spaced electrode improve the pollutants removal efficiency. An elegant process design can prevent electrode passivation which is a critical limitation of EC technology. EC coupling (up or downstream) with other DPs has resulted in the removal of organic pollutants and heavy metals with a 20% improved efficiency by EC-EF, removal of 85.5% suspended solid, 76.2% turbidity, 88.9% BOD, 79.7% COD and 93% color by EC-electroflotation, 100% decolorization by EC-electrochemical-AO, reduction of 78% COD, 81% BOD, 97% color by EC-ozonation and removal of 94% ammonia, 94% BOD, 95% turbidity, >98% phosphorus by aerated EC and peroxicoagulation. The major wastewater purification achievements, future potential and challenges are described to model the future EC integrated systems.

Morphometric parameters and food preference in relation to sex and reference hematological values for Upupa epops from Pakistan.

Objective: The study was conducted to investigate the gut content and record morphometric and hematological parameters in the common hoopoe (Upupa epops). Materials and Methods: Twenty samples of healthy birds (10 from each sex) were collected from different locations in Okara District, Punjab, Pakistan, from September 2020 to March 2021. Birds were captured live for blood samples and morphometric and gut analyses. Results: It was revealed that the concentrations of different hematological parameters were as follows: hemoglobin, 20.03g/dl; red blood cells, 3.28 × 106/µl; white blood cells, 326.67 × 103/µl; hematocrit, 56.47%; MCV, 173.33 FL; MCH, 57.4 pg; MCHC, 57.4 pg; PLT, 8.33/µl; and RDW, 8.33/µl. The percentages of neutrophils, lymphocytes, monocytes, and eosinophils were 84.67%, 11.67%, 2.00%, and 1.67%, respectively. The gut content of the common hoopoe mostly consisted of Coleoptera and Acrididae larvae. However, Lepidoptera, Gryllotalpidae, and sand were also recorded, along with seeds of Salvadora persica. Conclusions: There were no significant differences between male and female U. epops in feeding content, total weight of the gut, or weight of the empty gut. Regarding the morphometric parameters, there was a significant difference in both sexes' wingspan, body length, and body weight. Males were significantly heavier than females.

Role of positive mental health in reducing fears related to COVID-19 and general anxiety disorder in Khyber Pakhtunkhwa, Pakistan.

BACKGROUND: The outbreak of the novel coronavirus disease (COVID-19) has posed multiple challenges to healthcare systems. Evidence suggests that mental well-being is badly affected due to compliance with preventative measures in containing the COVID-19 pandemic. This study aims to explore the role of positive mental health (subjective sense of wellbeing) to cope with fears related to COVID-19 and general anxiety disorder in the Pashtun community in Pakistan. METHODS: A cross-sectional survey was conducted among 501 respondents from Khyber Pakhtunkhwa participating in an online-based study. We performed correlational analysis, hierarchical linear regression and structural equational modeling (SEM) to analyze the role of mental health in reducing fears and general anxiety disorder. RESULTS: The results of the SEM show that positive mental health has direct effects in reducing the fear related to COVID-19 (ß = - 0.244, p < 0.001) and general anxiety (ß = - 0.210, p < 0.001). Fears of COVID-19 has a direct effect on increasing general anxiety (ß = 0.480). In addition, positive mental health also has an indirect effect (ß = - 0.117, p < 0.001) on general anxiety (R2 = 0.32, p < 0.001) through reducing fear of coronavirus. CONCLUSION: Based on these findings, there is a need to develop community health policies emphasizing on promotive and preventive mental health strategies for people practicing social/physical distancing.

Epidemiological studies of sleep disorder in educational community of Pakistani population, its major risk factors and associated diseases.

Sleep is one of the most important functions of the life. The disturbance in sleep or quality of sleep leads to several dysfunctions of the human body. This study aimed to investigate the prevalence of sleep disorders, their possible risk factors and their association with other health problems. The data was collected from the educational community of the Pakistani population. The Insomnia Severity Index (ISI) was used to evaluate the insomnia and the sleep apnea was evaluated through a simple questionnaire method. The blood samples were collected to perform significant blood tests for clinical investigations. Current research revealed that the individuals in the educational community had poor sleep quality. A total of 1998 individuals from the educational community were surveyed, 1584 (79.28%) of whom had a sleep disorders, including insomnia (45.20%) and sleep apnea (34.08%). The measured onset of age for males and females was 30.35 years and 31.07 years respectively. The Clinical investigations showed that the sleep had significant impact on the hematology of the patients. Higher levels of serum uric acid and blood sugar were recorded with a sleep disorder. The individuals of the educational community were using the sleeping pills. The other associated diseases were mild tension, headaches, migraines, depression, diabetes, obesity, and myopia. The use of beverage, bad mood, medical condition, mental stress, disturbed circadian rhythms, workload and extra use of smartphone were major risk factors of sleep disorders. It was concluded that the insomnia was more prevalent than the sleep apnea. Furthermore, life changes events were directly linked with disturbance of sleep. Tension, depression, headaches, and migraine were more associated with sleep disorders than all other health issues.

The Psychometric Validation of FCV19S in Urdu and Socio-Demographic Association with Fear in the People of the Khyber Pakhtunkhwa (KPK) Province in Pakistan.

This study rests on two important considerations: the rapid increase of COVID-19 cases in Pakistan and also the marginalization of the people of the KPK province, which would make them more vulnerable in fearing COVID-19. We aim to translate and validate FCV-19S into the Urdu language and to identify the socio-demographic associations with fear in the people of the KPK. Using an online Google survey, we were able to sample 501 respondents from the KPK. The Cronbach alpha α value for the Urdu FCV-19S displayed good internal reliability at .846. The unidimensional structure of the FCV-19S in Urdu was confirmed, and all of the items were found to be statistically significant, ranging from 0.59 to 0.80. The results of the confirmatory factor analysis show that fit indices are all within an acceptable limit. The FCV-19S was also significantly and positively correlated with preventive behavior (r = .328, p < .01) and general anxiety (r = .458, p < .01). The results of independent sample t tests show that women (t = 4.086, p < 0.001), married people (t = - 2.709, p < .001), and unemployed people (t = - 3.199, p < 0.001) of the KPK experienced great fear of COVID-19. We conclude that that the Urdu version of the FCV-19S is a valid and reliable tool and must be used by healthcare practitioners, government bodies, and researchers, to identify the prevalence of fear and to subsequently plan improved social and health policies to reduce anxiety in the public.

Evaluation of mental health and anxiety level among hepatitis C patients during COVID-19 pandemic in Pakistan.

BACKGROUND: This study was conducted to check anxiety level and mental stress in the 200 confirmed hepatitis C patients during the COVID-19 pandemic. The Chinese version of the Beck Anxiety Inventory (BAI) score index was used to measure the anxiety level of HCV-positive patients. BAI score index of different demographic factors such as gender, age, occupation, and education of all the sampled population was calculated. RESULTS: The highest BAI score was recorded in people in the age group of 25-45 years (54.5%). Respondents from public sector employees, own businesses, and postgraduates were highly anxious. A significant difference in BAI score was also recorded between male and female respondents as 33.77% of females were at a severe level of anxiety compared to 17.07% of males. Furthermore, quarantined hepatitis C patients had a significantly higher BAI score (39.5) as compared to non-quarantined patients (27.12), and respondents with HCV infection also had a high BAI score of 37.25 compared to healthy individuals (4.1). Most of the respondents were willing to adopt protective measures against COVID-19. CONCLUSION: This study concluded that people with infectious diseases like hepatitis C had high anxiety levels and mental stress in the COVID-19 pandemic and needed psychological aids for better mental health to handle pandemic conditions.

Dataset on the fear, preventive behaviour and anxiety disorder during the COVID-19 pandemic in Khyber Pakhtunkhwa, Pakistan.

The outbreak of COVID-19 has raised numerous challenges to the present world. Due to the rapid spread of coronavirus, the high death toll, and enforcement of lock-down, people around the globe have faced fearful situations. Researches have also shown that a massive increase in psychological and mental health disorders is reported during the ongoing pandemic. The present cross-sectional data reflects the condition of the coronavirus fear, mental health, preventive behaviour, and anxiety disorder among the people of Khyber Pakhtunkhwa (KPK), Pakistan. At the time of data collection, the condition of lockdown and mobility restrictions were imposed by the provincial government due to which manual/physical collection of data was not possible. An online survey was designed using Google form facility to gather data from the respondents. After getting confirmation from pilot testing, the survey link was distributed through various online platforms including social media. Besides utilizing personal contact points in the KPK, social applications like Facebook, WhatsApp, and LinkedIn were also used for the dissemination of the survey. A total number of 501 respondents have furnished their responses and the survey was completed in a short period of time and the data were analyzed using SPSS. This data may be of great interest to researchers, policymakers, research organizations, social and mental health practitioners who wish to explore other dimensions of fear and anxiety among the masses caused by an ongoing pandemic (COVID-19).

Application of optimized large surface area date stone (Phoenix dactylifera ) activated carbon for rhodamin B removal from aqueous solution: Box-Behnken design approach.

Box-Behnken model of response surface methodology was used to study the effect of adsorption process parameters for Rhodamine B (RhB) removal from aqueous solution through optimized large surface area date stone activated carbon. The set experiments with three input parameters such as time (10-600min), adsorbent dosage (0.5-10g/L) and temperature (25-50°C) were considered for statistical significance. The adequate relation was found between the input variables and response (removal percentage of RhB) and Fisher values (F- values) along with P-values suggesting the significance of various term coefficients. At an optimum adsorbent dose of 0.53g/L, time 593min and temperature 46.20°C, the adsorption capacity of 210mg/g was attained with maximum desirability. The negative values of Gibb's free energy (ΔG) predicted spontaneity and feasibility of adsorption; whereas, positive Enthalpy change (ΔH) confirmed endothermic adsorption of RhB onto optimized large surface area date stone activated carbons (OLSADS-AC). The adsorption data were found to be the best fit on the Langmuir model supporting monolayer type of adsorption of RhB with maximum monolayer layer adsorption capacity of 196.08mg/g.

Synthesis of 1,5-benzodiazepine and its derivatives by condensation reaction using H-MCM-22 as catalyst.

A simple and versatile method for the synthesis of 1,5-benzodiazepines is via condensation of o-phenylenediamines (OPDA) and ketones in the presence of catalytic amount of H-MCM-22 using acetonitrile as solvent at room temperature. In all the cases, the reactions are highly selective and are completed within 1-3 h. The method is applicable to both cyclic and acyclic ketones without significant differences. The reaction proceeds efficiently under ambient conditions with good-to-excellent yields.