Examining resilience among child protection professionals during COVID-19: A global comparison across 57 countries.

BACKGROUND: The COVID-19 pandemic led to numerous challenges for child protection professionals (CPPs). However, limited research has investigated the interwoven concepts of coping, resilience, and mental distress among CPPs during COVID-19 on a global scale. OBJECTIVES: This study aimed to explore CPPs' practice, resilience, and mental distress during COVID-19, the relationship between their resilience and mental distress, the global stability of the Multi-System Model of Resilience (MSMR), and how CPPs' resilience varied according to the Human Development Index (HDI). METHODS: Data were collected from 420 CPPs in 57 countries across five continents between July and September 2021. Participants completed an online questionnaire on demographics, resilience, mental distress, coping, and perceptions of child protection during the pandemic in their native languages. The analyses compared the countries grouped according to HDI using means comparisons, correlations, and multiple linear regressions. A two-path analysis was also performed to identify variables associated with behavioral resilience engagement and mental distress. RESULTS: The findings indicated that CPPs' perceptions of COVID-19's impact on child maltreatment varied in correlation with their country's HDI. There were also significant HDI-based differences regarding the perceived opportunity to engage in resilient behavior and its helpfulness. Years of professional experience, internal resilience, and external resilience were shown to be significant predictors of mental distress among CPPs during the pandemic, and resilience mediated how years of experience predicted mental distress. CONCLUSIONS: This study emphasized the importance of experience and internal resilience for CPPs' psychological well-being. It also provides empirical evidence to support the MSMR theory on a global scale. Additionally, it demonstrates how the perceived changes in child maltreatment during COVID-19 may be associated with regional HDI. Lastly, the opportunities CPPs had to engage in resilient behavior and how much this helped them was associated with regional HDI, but not in the way originally predicted. Study results also hold implications for how practice and policy may be altered to help CPPs cope better during times of crisis and generally.

Silane-Grafted MXene (Ti3C2T X ) Membranes for Enhanced Water Purification Performance.

The current communication describes the modifications of MXene (Ti3C2T x ) with silane grafting reaction for membrane preparation for enhanced water purification. The MXene was successfully grafted with n-octadecyltrichlorosilane (MODCS), n-octyltrichlorosilane (MNOCS), and triphenylchlorosilane (MTPCS) in order to make a hydrophobic MXene that could be able to bind with the organic matrix/polymers. The modified MXenes were transformed into thin membranes by forming an MXene/polyvinyl alcohol (PVA) composite over a filter paper support, that is, MCE (mixed cellulose ester filter paper). MXene membranes were also formed without the MCE support by using PVA and glutaraldehyde (PVA/GA) where GA was used as a cross-linker to stabilize PVA and make it water-resistant. The conditions of membrane formation were optimized to investigate optimum compatible conditions with the modified materials. The resulting membranes were tested for the removal of various organic pollutants that included mesitylene (or trimethylbenzene); polyaromatic hydrocarbons (chrysene, as a model); biphenyl; bisphenol A; benzene, toluene, ethylbenzene, and styrene; methylene blue; and Sudan II dyes. The MTPCS PVA/GA cross-linked membrane showed the best results for a pollutant removal efficiency up to 98%. Overall, all six types of membranes showed the removal efficiency in the range of 52-98%. It was observed that the membrane exhibits reusability up to five cycles.

Child protective services during COVID-19 and doubly marginalized children: International perspectives.

BACKGROUND: Alongside deficits in children's wellbeing, the COVID-19 pandemic has created an elevated risk for child maltreatment and challenges for child protective services worldwide. Therefore, some children might be doubly marginalized, as prior inequalities become exacerbated and new risk factors arise. OBJECTIVE: To provide initial insight into international researchers' identification of children who might have been overlooked or excluded from services during the pandemic. PARTICIPANTS AND SETTING: This study was part of an international collaboration involving researchers from Brazil, Canada, Colombia, Israel, South Africa, Uganda, the UK and the USA. Researchers from each country provided a written narrative in response to the three research questions in focus, which integrated the available data from their countries. METHOD: Three main questions were explored: 1) Who are the children that were doubly marginalized? 2) What possible mechanisms may be at the root? and 3) In what ways were children doubly marginalized? The international scholars provided information regarding the three questions. A thematic analysis was employed using the intersectional theoretical framework to highlight the impact of children's various identities. RESULTS: The analysis yielded three domains: (1) five categories of doubly marginalized children at increased risk of maltreatment, (2) mechanisms of neglect consisting of unplanned, discriminatory and inadequate actions, and (3) children were doubly marginalized through exclusion in policy and practice and the challenges faced by belonging to vulnerable groups. CONCLUSION: The COVID-19 pandemic can be used as a case study to illustrate the protection of children from maltreatment during worldwide crises. Findings generated the understanding that child protective systems worldwide must adhere to an intersectionality framework to protect all children and promote quality child protection services.

Photocatalytic Z-Scheme Overall Water Splitting: Recent Advances in Theory and Experiments.

Photocatalytic water splitting is considered one of the most important and appealing approaches for the production of green H2 to address the global energy demand. The utmost possible form of artificial photosynthesis is a two-step photoexcitation known as "Z-scheme", which mimics the natural photosystem. This process solely relies on the effective coupling and suitable band positions of semiconductors (SCs) and redox mediators for the purpose to catalyze the surface chemical reactions and significantly deter the backward reaction. In recent years, the Z-scheme strategies and their key role have been studied progressively through experimental approaches. In addition, theoretical studies based on density functional theory have provided detailed insight into the mechanistic aspects of some breathtakingly complex problems associated with hydrogen evolution reaction and oxygen evolution reaction. In this context, this critical review gives an overview of the fundamentals of Z-scheme photocatalysis, including both theoretical and experimental advancements in the field of photocatalytic water splitting, and suggests future perspectives.

Transparent, self-cleaning, scratch resistance and environment friendly coatings for glass substrate and their potential applications in outdoor and automobile industry.

In this research work six novel combinations of Hydroxy Ethyl Meth Acrylate based copolymers have been synthesized and commercial titania, after activation was added by adopting simple strategy to manufacture super-hydrophobic, cost effective, transparent, antifogging, self-cleaning and antimicrobial coating on the glass sheet which will be helpful for outdoor and automobile windscreen. The super-hydrophobic covering was set up by dip covering procedure and coated specimen have been characterized for Wetting behaviour, transparency and SEM analysis. Likewise, the dependability of the coating was evaluated at conditions comparable strengthening at higher temperatures (4-400 °C), illumination by UV spectrum at basic and acidic limits, Results revealed that developed material has good adhesion with glass and shows transparency more than 97%, and water contact edge (CA) of 135 ± 2°. Furthermore, the covering displays astounding self-cleaning property. All the outcomes demonstrated that such kind of coatings could be used many modern level applications on automobile wind screen and glass-windows in building and other glasses where protection from UV radiation, anti-fogging and cleaning is required. Such type of coating material can also be used to preserve architectural work leather and other decoration and artwork. The graphical representation is given in Fig. 1.

The magnitude and determinants of violence against healthcare workers in Pakistan.

Objectives: To determine the magnitude and determinants of violence against healthcare workers (HCWs) and to identify the predominant types and causes of violence experienced by them. Methodology: A cross-sectional survey based on structured questionnaire adopted from previous surveys and qualitative data was conducted in 4 large cities and 12 districts in 3 provinces of Pakistan. The survey covered 8579 from all cadres of HCWs, including doctors, nurses, technicians, support staff, ambulance workers, vaccinators, lady health visitors, midwives and lady health workers (LHWs). The predictors of overall violence experienced, physical violence experienced and verbal violence experienced were separately analysed for tertiary care hospitals, secondary care hospitals, primary care hospitals and field-level HCWs. Logistic regression was used to compute adjusted ORs with 95% CIs for the association of different factors with the violence experienced. Results: More than one-third (38.4%) reported having experienced any form of violence in the last 6 months. Verbal violence was the most commonly experienced form (33.9%), followed by physical violence (6.6%). The main reasons for physical violence were death of patients (17.6%), serious condition of patients (16.6%) and delay in care (13.4%). Among the different types of field HCWs, emergency vehicle operators were significantly more likely to experience verbal violence compared with LHWs (adjusted OR=1.97; 95% CI 1.31 to 2.94; p=0.001). Among hospital HCWs, those working in private hospitals were significantly less likely to experience physical violence (adjusted OR=0.52; 95% CI 0.38 to 0.71; p=0.001) and verbal violence (adjusted OR=0.57; 95% CI 0.48 to 0.68; p=0.001). Conclusion: Violence against HCWs exists in various forms among all cadres and at different levels of care. The gaps in capacity, resources and policies are evident. Specific strategies need to be adopted for different types of HCWs to protect them against violence.*The study was conducted under the framework of ICRC's Healthcare in Danger Initiative for protection of healthcare against Violence.

Phytogenic Synthesis of Nickel Oxide Nanoparticles (NiO) Using Fresh Leaves Extract of Rhamnus triquetra (Wall.) and Investigation of Its Multiple In Vitro Biological Potentials.

Chemically nickel oxide nanoparticles (NiONPs) involve the synthesis of toxic products, which restrict their biological applications. Hence, we developed a simple, eco-friendly, and cost-efficient green chemistry method for the fabrication of NiONPs using fresh leaf broth of Rhamnus triquetra (RT). The RT leaves broth was used as a strong reducing, capping, and stabilizing agent in the formation of RT-NiONPs. The color change in solution from brown to greenish black suggests the fabrication of RT-NiONPs which was further confirmed by absorption band at 333 nm. The synthesis and different physicochemical properties of RT-NiONPs were investigated using different analytical techniques such as UV-Vis (ultraviolet-visible spectroscopy), XRD (X-ray powder diffraction), FT-IR (Fourier-transform infrared spectroscopy), SEM (scanning electron microscopy), TEM (transmission electron microscopy), EDS (energy-dispersive X-ray spectroscopy), DLS (dynamic light scattering) and Raman. Further, RT-NiONPs were subjected to different in vitro biological activities and revealed distinctive biosafe and biocompatibility potentials using erythrocytes and macrophages. RT-NiONPs exhibited potential anticancer activity against liver cancer cell lines HUH7 (IC50: 11.3 µg/mL) and HepG2 (IC50: 20.73 µg/mL). Cytotoxicity potential was confirmed using Leishmanial parasites promastigotes (IC50: 27.32 µg/mL) and amastigotes (IC50: 37.4 µg/mL). RT-NiONPs are capable of rendering significant antimicrobial efficacy using various bacterial and fungal strains. NiONPs determined potent radical scavenging and moderate enzyme inhibition potencies. Overall, this study suggested that RT-NiONPs can be an attractive and eco-friendly candidate. In conclusion, current study showed potential in vitro biological activities and further necessitate different in vivo studies in various animal models to develop leads for new drugs to treat several chronic diseases.

Controlled Assembly of Cu/Co-Oxide Beaded Nanoclusters on Thiolated Graphene Oxide Nanosheets for High-Performance Oxygen Evolution Catalysts.

The use of water splitting modules is highly desired for the sustainable production of H2 as a future energy carrier. However, the sluggish kinetics and demand of high anodic potential are the bottlenecks for half-the cell oxygen evolution reaction (OER), which severely hamper the overall conversion efficiency. Although transition metal oxides based electrocatalysts have been envisioned as cost-effective and potential contenders for this quest, nevertheless, their low conductivity, instability, and limited number of active sites are among the common impediments that need to be addressed to eventually enhance their inherent catalytic potential for enhanced OER activity. Herein, the controlled assembly of transition metal oxides, that is, Cu@CuOx nanoclusters (NCs, ≈2 nm) and Co@CoOx beaded nanoclusters (BNCs, ≈2 nm), on thiol-functionalized graphene oxide (G-SH) nanosheets is reported to form novel and highly efficient electrocatalysts for OER. The thiol (-SH) functionality was incorporated by selective epoxidation on the surface of graphene oxide (GO) to achieve chemically exfoliated nanosheets to enhance its conductivity and trapping ability for metal oxides in nanoscale dimensions (≈2 nm). During the electrocatalytic reaction, overpotentials of 290 mV and 310 mV are required to achieve a current density of 10 mA cm-2 for BNCs and NCs, respectively, and the catalysts exhibit tremendous long-term stability (≈50 h) in purified alkaline medium (1 m KOH) with no dissolution in the electrolyte. Moreover, the smaller Tafel slopes (54 mV/dec for BNCs and 66 mV/dec for NCs), and a Faradic efficiency of approximately 96 % indicate not only the selectivity but also the tailored heterogeneous electrons transfer (HET) rate, which is required for fast electrode kinetics. It is anticipated that such ultrasmall metal oxide nanoclusters and their controlled assembly on a conducting surface (G-SH) may offer high electrochemical accessibility and a plethora of active sites owing to the drastic decrease in dimensions and thus can synergistically ameliorate the challenging OER process.

Facile green synthesis approach for the production of chromium oxide nanoparticles and their different in vitro biological activities.

Green synthesis of nanoparticles using plants has become a promising substitute for the conventional chemical synthesis methods. In the present study, our aim was to synthesize chromium oxide nanoparticles (Cr2 O3 NPs) through a facile, low-cost, eco-friendly route using leaf extract of Rhamnus virgata (RV). The formation of Cr2 O3 NPs was confirmed and characterized by spectroscopic profile of UV-Vis, EDX, FTIR, and XRD analyses. The UV-visible spectroscopy has confirmed the formation of Cr2 O3 NPs by the change of color owing to surface plasmon resonance. The bioactive functional groups present in the leaf extract of RV involved in reduction and stabilization of Cr2 O3 NPs were determined by FTIR analysis. Based on XRD analysis, crystalline nature of Cr2 O3 NPs was determined. The morphological shape and elemental composition of Cr2 O3 NPs were investigated using SEM and EDX analyses, respectively. With growing applications of Cr2 O3 NPs in biological perspectives, Cr2 O3 NPs were evaluated for diverse biopotentials. Cr2 O3 NPs were further investigated for its cytotoxicity potentials against HepG2 and HUH-7 cancer cell lines (IC50 : 39.66 and 45.87 µg/ml), respectively. Cytotoxicity potential of Cr2 O3 NPs was confirmed against promastigotes (IC50 : 33.24 µg/ml) and amastigotes (IC50 : 44.31 µg/ml) using Leishmania tropica (KMH23 ). The Cr2 O3 NPs were further evaluated for antioxidants, biostatic, alpha-amylase, and protein kinase inhibition properties. Biocompatibility assay was investigated against human macrophages which confirmed the nontoxic nature of Cr2 O3 NPs. Overall, the synthesized Cr2 O3 NPs are biocompatible and nontoxic and proved to possess significant biopotentials. In future, different in vivo studies are needed to fully investigate the cytotoxicity and mechanism of action associated with these Cr2 O3 NPs.

Synthesis, Characterization, and Applications of Silk/Bentonite Clay Composite for Heavy Metal Removal From Aqueous Solution.

Bentonite clay is an abundant and low-cost adsorbent and silk fibroin, a naturally occurring protein, and both have a low capacity to remove lethal heavy metal ions from aqueous solution separately. To enhance their metal adsorbing capacity, a new silk fibroin-based bentonite composite was prepared for improving water quality by eliminating heavy metal ions i.e., lead, cadmium, mercury, and chromium. The as-synthesized composite shows better metal sorption capacity than either of them alone. To analyze their structural properties and characteristic functional groups, X-ray diffraction and Fourier-transform infrared spectroscopy were used. The specific surface area for silk/bentonite composite was about 4 m2/g that is smaller than the unmodified bentonite (23 m2/g) which indicates the impregnation of bentonite onto the silk fibroins. Scanning electron microscopy results shows the changes in morphology from plate aggregates to rosette like arrangements. The XRD results of clay/composite shows an increase in basal spacing (d001, from 1.55 to 3.34 nm) in comparison to pristine clay. FTIR results show the presence of organic moiety in SF clay composite. The mechanism of adsorption based on complex formation and ion exchange were proposed briefly. Various adsorption isotherms and kinetic models were applied for the removal of Pb(II), Cd(II), Hg(II), and Cr(VI). As the kinetic study was concerned, kinetic data fitted well to pseudo second order kinetics because experimental values of qe are much closer to the calculated values. The adsorption equilibrium was best studied by Langmuir isotherm whose regression coefficient values (0.985-0.995) are best when compared to Freundlich adsorption isotherm (0.954-0.990) and are indicative of homogeneity of adsorption sites on the SF/clay composite. The monolayer adsorption capacity for Cd(II), Pb(II), Hg(II), and Cr(VI) was found to be 11.35, 11.1, 10.5, and 10.2 mg/g, respectively.

Ultrasmall Co@Co(OH)2 Nanoclusters Embedded in N-Enriched Mesoporous Carbon Networks as Efficient Electrocatalysts for Water Oxidation.

Metal nanoclusters (NCs, size ≤2 nm) are emerging materials in catalysis owing to their unique catalytic and electronic properties such as high surface/volume ratio, high redox potential, plethora of surface active sites, and dynamic behavior on a suitable support during catalysis. Herein, in situ growth of ultrasmall and robust Co@ß-Co(OH)2 NCs (≈2 nm) hosted in a honeycomb-like 3D N-enriched carbon network was developed for water-oxidation catalysis with extremely small onset potential (1.44 V). Overpotentials of 220 and 270 mV were required to achieve a current density of 10 mA cm-2 and 100 mA cm-2 , respectively, in alkaline medium (1 m KOH). More promisingly, at η10 =240 mV, the prolonged oxygen evolution process (>130 h) with faradaic efficiency >95 % at a reaction rate of 22 s-1 at 1.46 V further substantiated the key role of the ultrasmall supported NCs, which outperformed the benchmark electrocatalysts (RuO2 /IrO2 ) and NCs reported so far. It is anticipated that the high redox potential of NCs with regeneratable active sites and their concerted synergistic effects with the N-enriched porous/flexible carbon network are inherently worth considering to enhance the mass/charge transport owing to the nanoscale interfacial collaboration across the electrode/electrolyte boundary, thereby efficiently energizing the sluggish/challenging oxygen evolution process.

Metal Nanoclusters: New Paradigm in Catalysis for Water Splitting, Solar and Chemical Energy Conversion.

A sustainable future demands innovative breakthroughs in science and technology today, especially in the energy sector. Earth-abundant resources can be explored and used to develop renewable and sustainable resources of energy to meet the ever-increasing global energy demand. Efficient solar-powered conversion systems exploiting inexpensive and robust catalytic materials for the photo- and photo-electro-catalytic water splitting, photovoltaic cells, fuel cells, and usage of waste products (such as CO2 ) as chemical fuels are appealing solutions. Many electrocatalysts and nanomaterials have been extensively studied in this regard. Low overpotentials, catalytic stability, and accessibility remain major challenges. Metal nanoclusters (NCs, ≤3 nm) with dimensions between molecule and nanoparticles (NPs) are innovative materials in catalysis. They behave like a "superatom" with exciting size- and facet-dependent properties and dynamic intrinsic characteristics. Being an emerging field in recent scientific endeavors, metal NCs are believed to replace the natural photosystem II for the generation of green electrons in a viable way to facilitate the challenging catalytic processes in energy-conversion schemes. This Review aims to discuss metal NCs in terms of their unique physicochemical properties, possible synthetic approaches by wet chemistry, and various applications (mostly recent advances in the electrochemical and photo-electrochemical water splitting cycle and the oxygen reduction reaction in fuel cells). Moreover, the significant role that MNCs play in dye-sensitized solar cells and nanoarrays as a light-harvesting antenna, the electrochemical reduction of CO2 into fuels, and concluding remarks about the present and future perspectives of MNCs in the frontiers of surface science are also critically reviewed.

Potential phytochemicals in the fight against skin cancer: Current landscape and future perspectives.

Skin cancer is a life threatening disease and their prevalence and risk has been increasing over the past three decades causing significant loss to human health worldwide. Mostly skin cancer has developed resistance against chemotherapy and radiotherapy. Therefore, development of novel, cost effective and efficient treatment methods are needed. Phytochemicals extracted from medicinal plants and dietary sources are often biologically active and has attracted the attention of researchers and pharmaceutical industries around the world. Many in vitro and in vivo studies of these bioactive compounds have shown potential antioxidant, anti-proliferative, anti-inflammatory and anti-angiogenic effects in the fight against skin cancer. These phytochemicals also regulate several other molecular processes such as angiogenesis, metastasis and cell cycle to combat skin cancer. The present review provides perspectives on the key phytochemicals, their therapeutic potentials, bioavailability and molecular mechanism of action in the cancer therapeutics. Current challenges and future directions for research are also critically discussed.

Nanomedicines for developing cancer nanotherapeutics: from benchtop to bedside and beyond.

Cancer is a devastating disease and remains a significant cause of mortality and morbidity in both developed and developing countries. Although there are large number of drugs that can be used for the treatment of cancer, the problem is selective and specific killing of cancerous cells without harming the normal cells. There are some biological barriers to potential drug delivery in cancer cells like hepatic, renal, abnormal vasculature, dense extracellular matrix, and high interstitial fluid pressure. The physicochemical characteristics of nanoparticles (NPs) such as size, shape, and surface charge may also have significant effects on tumor penetration. NPs coated with drug can be used to overcome these biological barriers to enhance targeted delivery. This literature survey encompasses the biological barriers to potential drug delivery in cancer cells, elaborate on designing strategies to enhance NPs penetration and distribution inside the tumor interstitium. Scientists are now doing great efforts to design next-generation of nanomedicines (NMs) that need to be better targeted with high specificity and efficacy to kill cancer cells. These challenges need to be overcome through collaborations among academia, pharmaceutical industries, and regulatory agencies to eradicate this global menace. Furthermore, this review article has critically discussed the recent developments, controversies, challenges, emerging concepts, and future perspectives in cancer NMs.

Understanding communication pathways to foster community engagement for health improvement in North West Pakistan.

BACKGROUND: This paper describes the community engagement process undertaken to ascertain the focus, development and implementation of an intervention to improve iodised salt consumption in rural communities in North West Pakistan. The Jirga is a traditional informal structure, which gathers men respected within their community and acts in a governing and decision-making capacity in the Pukhtoon culture. The Jirga system had a dual purpose for the study: to access men from the community to discuss the importance of iodised salt, and as an engagement process for the intervention. METHODS: A number of qualitative data collection activities were undertaken, with Jirga members and their wives, male and female outreach workers and two groups of women, under and over 40 years old. The aim of these was to highlight the communication channels and levers of influence on health behaviour, which were multiple and complex and all needed to be taken into consideration in order to ensure successful and locally sensitive community engagement. RESULTS: Communication channels are described within local families and the communities around them. The key influential role of the Jirga is highlighted as linked both to the standing of its members and the community cohesion ethos that it embodies. Engaging Jirga members in discussions about iodised salt was key in designing an intervention that would activate the most influential levers to decision making in the community. Gendered decision-making processes within the household have been highlighted as restricting women's autonomy. Whilst in one respect our data confirm this, a more complex hierarchy of decisional power has been highlighted, whereby the concept of 'wisdom'- an amalgamation of age, experience and education- presents important possibilities. Community members with the least autonomy are the youngest uneducated females, who rely on a web of socially and culturally determined ways to influence decision-making. CONCLUSIONS: The major lines of communication and influence in the local community described are placed within the wider literature on community engagement in health improvement. The process of maximisation of local cultural knowledge as part of a community engagement effort is one that has application well beyond the particular setting of this study.

Assessing Incidence Patterns and Risk Factors for Cutaneous Leishmaniasis in Peshawar Region, Khyber Pakhtunkhwa, Pakistan.

Pakistan faces critical challenges pertaining to cutaneous leishmaniasis (CL), where it's distribution is more or less patchy. The goal of this study was to assess the incidence of CL as well as to identify potential risk factors in Peshawar region, Khyber Pakhtunkhwa, Pakistan. The study was conducted in the dermatology outpatient unit at Kuwait Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan. Longitudinal out-patient department visit data for 9,631 CL patients spanning a 42-mo (April 2011-October 2014) period was analyzed using autoregressive integrated moving average (ARIMA) time series models ARIMA(1,0,0)(0,1,0)12 and ARIMA(0,0,0)(0,1,0)12. The ARIMA concluded that the number of patients was increasing over time. Over the duration, frequency of male patients (58.2%) was higher. The mean age of CL patients was 16.4 (confidence interval = 16.14-16.70) yr and the majority of the patients were aged 5-20 yr (52.6%). Inflow of CL patients peaked close to February and March, followed by a decline until its lowest point in the months of August and September (P < 0.001). Two hundred individuals, including 88 cases and 112 controls, were matched by gender and age categories (<5, 5-20, >20 yr) to derive 63 matched pairs. Using univariate conditional logistic regression analyses of the matched pairs, we found that living in congested rooms (>6 persons), having family members with lesions (active/scars), keeping cattle inside dwellings at night, and having in-door vegetation were established as factors that significantly increased the risk of CL. On the other hand, living in houses constructed with bricked walls or wooden roofs (thatched/beam), ownership of treated bed nets, and having meshed windows were proven to be protective against CL. It was evident that the disease incidence has been on a gradual rise over the past few years. It was concluded that household clustering, house construction, and conventional behavioral practices (living with cattle) greatly impact the epidemiology of CL in the region. Conclusions from this study have significant implications for prospective control programs.

Increasing Awareness and Use of Iodised Salt in a Marginalised Community Setting in North-West Pakistan.

Iodine deficiency is still prevalent in parts of Pakistan, despite the introduction of a national Iodine Deficiency Disorder Control Programme in 1994. The purpose of this study was to gain an understanding of the knowledge, attitudes and practice regarding the use of iodised salt in a brick kiln community, and to use this information to design an intervention to increase its consumption. A cross-sectional survey was used to assess the use of iodised salt and focus group discussions explored the attitudes and barriers to its use. Thematically analysed transcripts informed the design of a 4-month intervention. Iodised salt sales and urine iodine concentration (UIC) were monitored to assess the effectiveness of the intervention. At baseline, 2.6% of households reported use of iodised salt and barriers included its higher cost and belief about a negative impact on reproduction. During the intervention, sales of salt labelled as iodised increased by 45%, however this was not reflected in an increase in UIC. This study highlighted the positive impact of education and awareness raising on iodised salt consumption in a hard to reach, marginalised community. However, issues regarding adequate iodisation by local producers and appropriate storage also need to be urgently addressed at a provincial level.

Dermatological manifestations of dengue fever.

BACKGROUND: Each year dengue related infections are rising in tropical countries. There is not enough data available on dermatological manifestations of dengue fever. This study was conducted to investigate prevalence and type of dermatological manifestations of dengue fever (DF). Dengue Haemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS). METHODS: A Prospective study was contacted in Department of Medicine, Shaikh Zayed Hospital, Lahore, from 3rd Oct to 20th Nov 2010. Specific serological tests for DF were done in all 60 patients admitted with suspected diagnosis of DF, DHF or DSS. Forty-eight confirmed cases were evaluated for age, gender, mucocutaneous features and outcome of the disease. RESULTS: Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged 5-68 years with a mean of 31.5 +/- 15.2. DF, DHF and DSS were found in 71%, 19% and 10% respectively. Common dermatological presentations were oral mucous membrane congestion (66.67%), generalised morbiliform rash (64.58%) and eye congestion (64.58%). Purpuric spots along with mucous membrane congestion, generalised morbiliform rash and eyes congestion was observed in 20.83%, 12.5% and 6.25% patients respectively. All except one patient improved clinically. One patient died of respiratory distress and haemorrhage on second day of admission. CONCLUSION: Dermatological features are significantly noticeable in dengue fever patients. These may help us in early diagnosis and better management of patients.

Clinical characteristics of patients with dengue fever: report of 48 patients in 2010.

BACKGROUND: Dengue fever is a mosquito born viral disease. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3-14 days after the infective bite. Mortality can occur in dengue hemorrhagic fever and dengue shock syndrome unless prompt and adequate management is provided. OBJECTIVE: To determine the clinical and epidemiological characteristics along with outcome of patients with dengue fever (DF) dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). DESIGN: Prospective, follow-up study. PLACE AND DURATION OF STUDY: Department of Medicine, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore from 3rd Oct 2010 to 20th Nov 2010. PATIENTS AND METHODS: Specific serological tests for dengue fever were done in all 60 patients admitted with suspected diagnosis of DF, DHF and DSS. Forty-eight confirmed cases were evaluated for age, gender, clinical features and outcome of the disease. RESULTS: Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged from 5 years to 68 years with the mean of 31.5 +/- 15.2 years. DF, DHF and DSS were found in 71%, 19% and 10% cases respectively. Common presentations were fever (100%), skin rash (83.33%), myalgia (69.75%), restlessness (66.67%) and rigors and chills (66.67%). All, except one patient improved clinically. One patient died on second day of admission. CONCLUSION: Dengue fever, a viral infection is re-emerging as a serious public health problem. Fever, rash, myalgia with rigors and chills were common presenting features.

Fixed drug eruption and intradermal provocation tests.

OBJECTIVE: To determine the role of Intradermal Provocation (IDP) tests in Fixed Drug Eruption (FDE). STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Dermatology Unit, Shaikh Zayed Hospital, Lahore, from August 2004 to July 2006. METHODOLOGY: The tests were performed in 96 patients in two stages. At stage I, suspected drugs were given intradermally. Changes at injection site in FDE lesions or any systemic effects were observed. In patients showing no response to IDP, Oral Provocation (OP) was performed (stage II) and its effects in FDE lesions or any systemic effect were observed. The positive response of FDE lesions after IDP and OP were compared with local changes at injection site. Control intradermal tests were repeated in normal persons with drugs and in FDE patients with distilled water on normal skin. RESULTS: At stage I, 46 positive cases had local signs of erythematous indurated nodule with or without hemorrhagic centre, urticarial weal with hemorrhagic centre and erythematous indurated nodule with central vesicle. At stage II, 41 patients had similar local signs. The changes at injection site to those of FDE lesions were compared. Z-test for proportions showed no significant difference between groups (p-value > 0.05). Control tests were negative. CONCLUSION: The drug producing erythematous indurated nodule with or without hemorrhagic centre, vesicle or urticarial weal with hemorrhagic centre at injection site was the most likely drug causing fixed eruption.