The relationship between children's emotional development tasks fulfilment and Strength and Difficulties Rutter Questionnaire assessment on elementary school-aged children's mental health.

OBJECTIVE: To assess the emotional development of school-aged children. METHODS: The descriptive, analytical study was carried out on children of elementary schools in the Semarang City area in January 2022. Included were children aged 6-12 years with active elementary school status. Data was collected using the 25-item Strength and Difficulties Rutter Questionnaire. The questionnaire was filled manually by the subject along with the guardian or teacher. Data was analysed using SPSS 20. RESULTS: Of the 326 children, 174(53.21%) were girls and 153(46.79%) were boys. Overall, 171(52.3%) subjects were aged <10 years, while 156(47.7%) were aged 10-12 years. There were 295(90.21%) children with normal prosocial behaviour, 206(63%) with normal emotional status, 264(80.73%) with normal conduct, 133(40.67%) with normal hyperactivity level, and 91(27.83%) with normal equation with peers. CONCLUSIONS: Different domains of the Strength and Difficulties Questionnaire showed varying degrees of pro-social behaviour, emotional status, conduct, hyperactivity level and peer interaction among the subjects.

Factors Responsible for Nonselection of Donors in Living Related Kidney Transplantation.

OBJECTIVES: Living donor kidney transplant is the preferred method of renal transplant in Pakistan as deceased donor transplant has not yet been estab-lished. However, many patients who are dialysis-dependent, particularly younger patients, lack suitable living related donors. We aimed to determine factors contributing to nonselection of donors for living related renal transplant in Pakistan. MATERIALS AND METHODS: For this cross-sectional study, we included patients seen at the Sindh Institute of Urology & Transplantation Karachi, Pakistan) from March to November 2019. Potential donors were adult family members who accompanied patients with end-stage kidney disease to the clinic. Demographic and clinical information were recorded on predesigned proforma. After workup and baseline investigations had been completed, potential living related donors were selected. Factors leading to nonselection of donors were noted for those who did not qualify for donation. We used SPSS version 20 for analysis. RESULTS: During the study period, 253 potential donors (151 males, 102 females) with mean age of 35.68 ± 6.14 years were found to be ineligible for kidney donation. ABO incompatibility was the most common factor leading to nonselection (n = 101; 39.92%), followed by diabetes mellitus (n = 71; 28.06%), hypertension (n= 50; 19.76%), renal disease (n = 15; 5.92%), liver disease (n = 8; 3.16%), crossmatch positive (n = 5; 1.97%), and ischemic heart disease (n = 3; 1.18%). No differences were shown between potential male and female donors regarding factors leading to nonselection; diabetes was significantly more prevalent among those <40 years of age (P = .025). CONCLUSIONS: ABO incompatibility, diabetes mellitus, and hypertension were the most common factors leading to nonselection of potential donors in living related kidney transplant. More efforts are needed to expand the donor pool by considering second- or third-degree relatives to tackle the scarcity of organs for transplantation.

Investigating associations between climate change anxiety and mental health impact on vulnerable populations: A qualitative analysis.

Climate anxiety has a negative impact on the mental health and psychological wellbeing of the vulnerable population. The goal is to assess many factors that affect mental health and psychological wellbeing, as well as how climate change affects mental health in Pakistan's vulnerable population. This study provides evidence-based insights on the long- and medium-term impacts of extreme weather events on mental health. We conducted semi-structured interviews with a sample of 72 students aged 10-16 years, employing an exploratory qualitative design. The resulting process identified themes and questions for future research on climate change and its psychological effects on children's mental health. As a result, positive emotions embedded in children's climate strategic actions in parent and community contexts helped to mitigate children's perceptions of negative emotions (such as climate anxiety, phobias, fear, sleep disorders, depression, sadness, and substance abuse). Climate change's effects can have a significant impact on mental health. We will be discussing effective strategies to address the expected mental health issues among children caused by climate change. The discussion paper offers a set of recommendations for addressing the mental health impacts of climate change, including improving mental health support systems, integrating climate change education into services, and developing targeted interventions for vulnerable populations.

L'anxiété climatique a un impact négatif sur la santé mentale et le bien-être psychologique de la population vulnérable. L'objectif est d'évaluer de nombreux facteurs qui affectent la santé mentale et le bien-être psychologique, ainsi que la manière dont le changement climatique affecte la santé mentale de la population vulnérable du Pakistan. Cette étude fournit des informations fondées sur des données probantes sur les impacts à long et moyen terme des événements météorologiques extrêmes sur la santé mentale. Nous avons mené des entretiens semi-structurés avec un échantillon de 72 étudiants âgés de 10 à 16 ans, en utilisant une conception qualitative exploratoire. Le processus qui en a résulté a identifié des thèmes et des questions pour de futures recherches sur le changement climatique et ses effets psychologiques sur la santé mentale des enfants. En conséquence, les émotions positives intégrées dans les actions stratégiques climatiques des enfants dans les contextes parental et communautaire ont contribué à atténuer les perceptions des enfants concernant les émotions négatives (telles que l'anxiété climatique, les phobies, la peur, les troubles du sommeil, la dépression, la tristesse et la toxicomanie). Les effets du changement climatique peuvent avoir un impact significatif sur la santé mentale. Nous discuterons de stratégies efficaces pour résoudre les problèmes de santé mentale attendus chez les enfants causés par le changement climatique. Le document de travail propose un ensemble de recommandations pour faire face aux impacts du changement climatique sur la santé mentale, notamment en améliorant les systèmes de soutien en santé mentale, en intégrant l'éducation au changement climatique dans les services et en développant des interventions ciblées pour les populations vulnérables.

Population genetic analysis of Plasmodium vivax vir genes in Pakistan.

Plasmodium vivax variant interspersed repeats (vir) refer to the key protein used for escaping the host immune system. Knowledge in the genetic variation of vir genes can be used for the development of vaccines or diagnostic methods. Therefore, we evaluated the genetic diversity of the vir genes of P. vivax populations of several Asian countries, including Pakistan, which is a malaria-endemic country experiencing a significant rise in malaria cases in recent years. We analyzed the genetic diversity and population structure of 4 vir genes (vir 4, vir 12, vir 21, and vir 27) in the Pakistan P. vivax population and compared these features to those of the corresponding vir genes in other Asian countries. In Pakistan, vir 4 (S=198, H=9, Hd=0.889, Tajima's D value=1.12321) was the most genetically heterogenous, while the features of vir 21 (S=8, H=7, Hd=0.664, Tajima's D value =-0.63763) and vir 27 (S =25, H =11, Hd =0.682, Tajima's D value=-2.10836) were relatively conserved. Additionally, vir 4 was the most genetically diverse among Asian P. vivax populations, although within population diversity was low. Meanwhile, vir 21 and vir 27 among all Asian populations were closely related genetically. Our findings on the genetic diversity of vir genes and its relationships between populations in diverse geographical locations contribute toward a better understanding of the genetic characteristics of vir. The high level of genetic diversity of vir 4 suggests that this gene can be a useful genetic marker for understanding the P. vivax population structure. Longitudinal genetic diversity studies of vir genes in P. vivax isolates obtained from more diverse geographical areas are needed to better understand the function of vir genes and their use for the development of malaria control measures, such as vaccines.

Risk Factors of Oral Squamous Cell Carcinoma with Special Emphasis on Areca Nut Usage and Its Association with Clinicopathological Parameters and Recurrence.

Introduction: Oral squamous cell carcinoma (OSCC) is the most prevalent type of head and neck cancer and is associated with high mortality, particularly in Southeast Asian countries. Areca nut usage, smoking, and alcohol consumption are the most common risk factors for OSCC. Areca nut chewing is highly prevalent in Pakistan and has been attributed to an increase in OSCC cases. This study aimed to determine the association between areca nut usage and various clinicopathological features of OSCC and further evaluate the association of clinicopathological parameters of OSCC with tumor recurrence. Materials and Methods: The study was conducted using the data of 228 patients with OSCC resected at Liaquat National Hospital, Karachi, Pakistan, over 5 years between 2018 and 2022. Clinicopathological data were collected from hospital archives, and associations between various risk factors and clinicopathological parameters were determined. Results: Males were more commonly affected (77.2%), and the most common age group was <50 years (54.4%). Areca nut usage was reported in 59.6% of cases, and the buccal mucosa was the most common site (62.7%). Areca nut usage was significantly associated with male gender, greater tumor size, greater depth of invasion (DOI), higher tumor stage, nodal stage, presence of perineural invasion (PNI), and recurrence. In addition, multivariate analysis revealed that OSCC recurrence was significantly associated with older age, larger tumor size and DOI, nodal metastasis, and areca nut usage. Conclusion: Areca nut-related OSCCs were associated with poor prognosis and recurrence in our study population. Furthermore, OSCC recurrence was associated with various clinicopathological parameters, such as larger tumor size, a higher DOI, and nodal metastasis.

Use and perception of risk: traditional medicines of Pakistani immigrants in Norway.

BACKGROUND: Pakistani immigrants are the largest non-Western ethnic minority group in Norway. Traditional medicines (TM) are extensively used in Pakistan, and studies show that ethnic minorities also use them to recover from illness after migration to the Western world. This study aims to explore Pakistani immigrants' experiences and perceptions of risk regarding the use of TM to treat illnesses. METHODS: A qualitative study was conducted through in-depth interviews (n = 24) with Pakistani immigrants in Norway from February to March 2023. Participants were recruited through purposive and snowball sampling methods. The data was analyzed using Braun & Clarke's reflexive thematic analysis (RTA) using Nvivo. RESULTS: RTA revealed three main themes and six sub-themes. The main themes were: (a) House of knowledge, (b) Choosing the best possible approach for health restoration, and (c) Adverse effects of TM used. A total of 96 different TM were identified, including herbs, food items, animal products, minerals, herbal products, and ritual remedies. All participants used TM to restore health in acute and chronic diseases, and many used TM along with conventional medicines. The participants' mothers were the primary source of knowledge about TM, and they passed it on to the next generation. They also frequently used religious knowledge to recover from illness. Although TM is considered safe because of its natural origin, some participants experienced adverse effects of TM, but none of them reported it to the health authorities. CONCLUSION: The study helps to understand the experiences and perceptions of risk of Pakistani immigrants in Norway regarding traditional practices for treating health complaints. Public health policies to improve the health of these immigrants should consider the importance of TM in their lives. Further research is necessary to explore the safety and toxicity of those TM that are common in Pakistani households in Norway.

Genetic diversity and epidemiological insights into cutaneous leishmaniasis in Pakistan: a comprehensive study on clinical manifestations and molecular characterization of Leishmania species.

Cutaneous leishmaniasis (CL) stands out as a significant vector-borne endemic in Pakistan. Despite the rising incidence of CL, the genetic diversity of Leishmania species in the country's endemic regions remains insufficiently explored. This study aims to uncover the genetic diversity and molecular characteristics of Leishmania species in CL-endemic areas of Baluchistan, Khyber Pakhtunkhwa (KPK), and Punjab in Pakistan. Clinical samples from 300 CL patients were put to microscopic examination, real-time ITS-1 PCR, and sequencing. Predominantly affecting males between 16 to 30 years of age, with lesions primarily on hands and faces, the majority presented with nodular and plaque types. Microscopic analysis revealed a positivity rate of 67.8%, while real-time PCR identified 60.98% positive cases, mainly L. tropica, followed by L. infantum and L. major. Leishmania major (p = 0.009) showed substantially greater variation in nucleotide sequences than L. tropica (p = 0.07) and L. infantum (p = 0.03). Nucleotide diversity analysis indicated higher diversity in L. major and L. infantum compared to L. tropica. This study enhances our understanding of CL epidemiology in Pakistan, stressing the crucial role of molecular techniques in accurate species identification. The foundational data provided here emphasizes the necessity for future research to investigate deeper into genetic diversity and its implications for CL control at both individual and community levels.

Assessing emergency room leadership of ObGyn residents in a public university teaching hospital of Sindh, Pakistan: a cross-sectional survey.

BACKGROUND: Leadership is a critical competency for medical professionals, yet it is often neglected in medical training. For ObGyn residents, leadership training is particularly crucial as it significantly impacts both maternal and newborn outcomes, as well as the operational efficiency of healthcare teams. The main objective of this study was to assess the perceptions of obstetrics and gynecology residents who served as group leaders in the emergency team at the Department of Gynecology, Ward 3, Dr. Ruth K.M. Pfau Civil Hospital Karachi. METHODS: A Cross-sectional survey was conducted with purposively sampled 28 year-4 residents who worked as group leaders during last 3 years (from 2018 to 2020) of their residency program at the emergency team in the department of Gynecology Ward 3 Dr Ruth KM Pfau Civil Hospital Karachi. The perceptions on leadership were assessed on 25 items scale sent through a questionnaire on email. Grading of responses was done using a 4-point ordinal scale where 1 meant little importance and 4 was regarded as having great importance. Data was summarized with relevant descriptive statistics and was analyzed on SPSS version 22. RESULTS: The mean age of residents was 30.36. The mean leadership scores of the group of residents were calculated to be 77.50 (SD ± 9.57) while 14(50%) residents showed good and 14 (50%) showed excellent leadership skills based on cumulative scores. Of the 25 traits examined in this study, the highest reported trait was humility 3.82 (± 0.39) followed by empowerment 3.68 (± 0.77) and effective communication 3.68 (± 0.77). While responding about learning experiences, 89.3% of participants felt that the experience enhanced their decision-making skills and boosted their confidence in dealing with emergencies. CONCLUSION: Our study highlights the critical importance of leadership development in the training of ObGyn residents, particularly in high-pressure emergency settings. The findings reveal that residents value leadership traits such as humility, empowerment, and effective communication, which are essential for building teamwork and ensuring optimal patient outcomes and patient satisfaction.

Genetic polymorphisms in FABP2, CYP2E1, and TP53 genes are potentially associated with colorectal cancer susceptibility.

Colorectal cancer (CRC) is among the most prevalent cancers with a high mortality rate. Both genetic and environmental factors contribute to CRC development. This study aimed to assess the association of single nucleotide polymorphisms (SNPs) in the fatty acid binding protein-2 (rs1799883), Cytochrome P450 2E1 (rs3813865), TP53 (rs1042522), and Murine double minute 2 (rs1042522) genes with CRC. A cross-sectional case-control study was conducted at the Institute of Molecular Biology and Biotechnology from May 2020 to March 2021, involving CRC patients (N = 100) and controls (N = 100) recruited from the Multan district in Pakistan. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) were employed to investigate the studied SNPs. The association of SNPs in all genes with CRC was examined either individually or in various combinations. Genotypes at three SNPs, rs1799883 in FABP2, rs3813865 in CYP2E1, and rs1042522 in TP53, were found to be associated with the development of CRC, while rs1042522 in MDM2 was not. Patients who were married, smoked, lacked exercise habits or had a family history of CRC were at a greater risk of acquiring the disease. FABP2 gene rs1799883, CYP2E1 gene rs3813865, and TP53 gene rs1042522 polymorphisms are significant in the development of CRC in Pakistani participants.

Molecular detection of Anaplasma bovis, Candidatus Anaplasma boleense and Rickettsia spp. in ticks infesting small ruminants.

Anaplasma spp. and Rickettsia spp. are intracellular vector-borne pathogens and harbored by a wide range of ticks and vertebrate hosts. Aim of this study was to molecularly characterize Anaplasma spp. and Rickettsia spp. in different ticks collected from livestock hosts in nine districts of Khyber Pakhtunkhwa (KP), Pakistan. In total, 862 ticks were collected from cattle, goats and sheep. Highest tick's infestation was observed on cattle 56.14% (32/57), followed by goats 45.45% (40/88), and sheep 42.05% (45/107). Rhipicephalus microplus (305/862, 35.38%) was predominant species, followed by Haemaphysalis sulcata (243/862, 28.19%), Hyalomma anatolicum (133/862, 15.42%), Haemaphysalis bispinosa (120/862, 13.92%), and Hyalomma kumari (61/862, 7.07%). A subset of 135 ticks were screened for Anaplasma spp. and Rickettsia spp. based on the amplification of partial 16 S rDNA and outer-membrane protein A (ompA) fragments, respectively. In total, 16 ticks (11.85%) were positive for Anaplasma spp. and Rickettsia spp. Obtained 16 S rDNA sequences for Anaplasma spp. detected in Ha. bispinosa and Ha. sulcata showed 99.98% identity with Anaplasma bovis, while other detected in Rh. microplus showed 99.84% identity with Candidatus Anaplasma boleense. Similarly, detected ompA sequence in Ha. sulcata showed 100% identity with Rickettsia sp. and 97.93% with Rickettsia slovaca, and another sequence detected in Rh. microplus showed 100% identity with Candidatus Rickettsia shennongii. In phylogenetic trees, these sequences clustered with corresponding species from Pakistan, China, Turkey, South Korea, South Africa, and Herzegovina. This is the first study reporting detection of A. bovis in Ha. bispinosa and Ha. sulcata, Ca. A. boleense in Rh. microplus collected from goats, and R. slovaca-like in Ha. sulcata. Our results enforce the need for regular surveillance of Rickettsiales in hard ticks infesting livestock in the region.

A homozygous missense variant in YTHDC2 induces azoospermia in two siblings.

Male infertility is a complex multifactorial reproductive disorder with highly heterogeneous phenotypic presentations. Azoospermia is a medically non-manageable cause of male infertility affecting ∼1% of men. Precise etiology of azoospermia is not known in approximately three-fourth of the cases. To explore the genetic basis of azoospermia, we performed whole exome sequencing in two non-obstructive azoospermia affected siblings from a consanguineous Pakistani family. Bioinformatic filtering and segregation analysis of whole exome sequencing data resulted in the identification of a rare homozygous missense variant (c.962G>C, p. Arg321Thr) in YTHDC2, segregating with disease in the family. Structural analysis of the missense variant identified in our study and two previously reported functionally characterized missense changes (p. Glu332Gln and p. His327Arg) in mice showed that all these three variants may affect Mg2+ binding ability and helicase activity of YTHDC2. Collectively, our genetic analyses and experimental observations revealed that missense variant of YTHDC2 can induce azoospermia in humans. These findings indicate the important role of YTHDC2 deficiency for azoospermia and will provide important guidance for genetic counseling of male infertility.

Performance of a negative binomial-GLM in spatial scan statistic: a case study of low-birth weights in Pakistan.

Spatial cluster analyses of health events are useful for enabling targeted interventions. Spatial scan statistic is the stateof- the-art method for this kind of analysis and the Poisson Generalized Linear Model (GLM) approach to the spatial scan statistic can be used for count data for spatial cluster detection with covariate adjustment. However, its use for modelling is limited due to data over-dispersion. A Generalized Linear Mixed Model (GLMM) has recently been proposed for modelling this kind of over-dispersion by incorporating random effects to model area-specific intrinsic variation not explained by other covariates in the model. However, these random effects may exhibit a geographical correlation, which may lead to a potential spatial cluster being undetected. To handle the over-dispersion in the count data, this study aimed to evaluate the performance of a negative binomial- GLM in spatial scan statistic on real-world data of low birth weights in Khyber-Pakhtunkhwa Province, Pakistan, 2019. The results were compared with the Poisson-GLM and GLMM, showing that the negative binomial-GLM is an ideal choice for spatial scan statistic in the presence of over-dispersed data. With a covariate (maternal anaemia) adjustment, the negative binomial-GLMbased spatial scan statistic detected one significant cluster covering Dir lower district. Without the covariate adjustment, it detected two clusters, each covering one district. The district of Peshawar was seen as the most likely cluster and Battagram as the secondary cluster. However, none of the clusters were detected by GLMM spatial scan statistic, which might be due to the spatial correlation of the random effects in GLMM.

Spider diversity in different habitats at District Mardan, Khyber Pakhtunkhwa Pakistan.

Spider species are important for maintaining ecological balance, controlling insect populations, and providing potential sources of medicinal compounds. Highlighting the importance of spider species, the present study was aimed at exploring the diversity of spider fauna and species richness in various habitats in District Mardan, Khyber Pakhtunkhwa, Pakistan, from March 2021 to December 2021. Spiders were collected through different methods: pitfall traps, cryptic searching, ground hand collection, aerial hand collection, and vegetation beating. Then, the captured spiders were washed in alcohol and preserved in a combination of 80% alcohol and 20% glycerol for further observation. Identification was carried out with the help of available spider identification keys and literature. A total of 578 specimens representing 29 species from 17 families and 26 genera were collected and identified. Family Lycosidae was the most dominant family (13.49%), followed by Salticidae (10.2%), Araneidae (8.47%), Tetragnathidae (7.61%), Pholicidae (6.4%), Oxyopidae (5.88%), Thomisidae (5.7%), Clubionidae (5.53%), Sicariidae (5.19%), Scytodidae (5.01%), Corinnidae (4.67%), Agelenidae (4.32%), Cheiracanthiidae and Sparassidae (4.15%), Oecobiidae and Hersiliidae (3.97%) and Theridiidae was the rarest among all (1.21%). The most commonly identified species are Hippasa partita, Lycosa poonaesis, Lycosa terrestris, Draposa oakleyi, Plexippus paykulli, Menemerus nigli, Thyene imperialis, Thyene bivittate and Hasarius adansoni. Argiope versicolor, Neoscona theisi, Tetragnatha extensa, Crossopriza lyoni, and Oxyopes Javanus. During the present study, it was observed that spider species were abundantly found in warm areas from May to August, which demonstrates that the spider fauna of the study area is very rich but has yet to be explored.

Phytosociology and ecological framework of forest tree species in the Toormang Valley, Dir Lower, Hindu Kush Range, Pakistan.

The phytosociological survey was conducted during 2018-2020. The research area was classified into five ecological zones based on habitat, physiognomy and species composition. Pc-Ord software was used for cluster analysis and four vegetation communities were established. The Quercus baloot-Quercus incana community is situated in Sair at an altitude of 1196 (mean ± SE) m altitude with a 14.1 ± 0 slope angle and contains eleven tree species. The Pinus wallichiana- Ailanthus altissima community had a relatively small number of tree species reported in Shakawlie at 1556 (mean ± SE) with a 17.5 ± 0 slope angle. The Pinus wallichiana- Quercus incana community is distributed in Wali Kandao and Mangi Kandao at altitudes of 2030.5 (mean ± SE) m and the slope angle was 19.2 ± 1.4. This community possesses a total of twenty-one tree species and is highly diverse. Similarly, the Populus alba - Platanus orientalis group was present in Banr Pate, with an altitude of 1613 (mean ± SE) m and a 16.3 slope angle. The principal component analysis (PCA) and non-metric multidimensional scaling (NMS) ordination methods were applied to study the relationships between ecological and soil variables with trees species. The NMS ordination of axis 1 was significantly correlated with Sand% (p<0.2), Nitrogen% (p<0.1) and Pb (mg/kg) (r= 0.876751, p<0.05), while the ordination of axis 2 was significantly correlated with Silt% (p<0.2), Sand% (p<0.2), Organic matter% (p<0.2), K (mg/kg) (r=0.882433, p<0.02), Fe (mg/kg)(r=0.614833, p<0.2), Ca (mg/kg) (r=0.721712, p< 0.2) and Zn (mg/kg) (r=0.609545, p<0.2). Similarly, the PCA ordination of axis 1 revealed that it was significantly correlated with phosphorus, calcium and slope angle, while that of axis 2 was significantly correlated with altitude, zinc and manganese.

Factors Affecting on Environmental Strategy in SMEs manufacturing Firms of a developing country: Mediating role of Green Employee Behavior.

Background: Sustainability in small and medium-sized enterprises (SMEs) which engage heavily in manufacturing provides them with an essential platform for implementing environmental strategy, which is aimed at reducing environmental damage and promoting environmental protection. This study aims to examine the impact of the reduction in resource use, the greening of processes and products on environmental strategy and the mediating role of green employee behaviour. Methods: Primary data gathered with the help of questionnaires from employees of SMEs manufacturing in developing countries, Pakistan. The research gathered data from 211 participants by applying a pre-tested instrumental questionnaire and structural equation modelling (SEM) for data analysis. Results: The results confirmed all direct effects, including a reduction in resource use, the greening of processes and products and green employee behaviour of environmental strategies in small and medium manufacturing firms. Also, confirmed partial mediation effect of green employee behavior between greening of processes and products and environmental strategy. Conclusion: The current study clearly showed the need for programs and infrastructures that support resource reduction and greening businesses in SMEs. Companies' implementation of green processes and technologies allows SMEs to take an environmentally responsible stand and become part of the movement toward sustainability. The research stresses the importance of green employee conduct as a mediator, the central point being the individual employee being engaged and aware of the subject and willing to participate in environmentally friendly practices. Therefore, small and medium enterprises should enlighten their staff to practice green behaviour, give them what they need and empower them to be change drivers that will trigger sustainability throughout the organisations.

Molecular characterization and antibiotic susceptibility of Shiga toxin- producing Escherichia coli (STEC) isolated from raw milk of dairy bovines in Khyber Pakhtunkhwa, Pakistan.

This study investigated the virulence potential and antibiotic susceptibility analysis of non-O157 Shiga toxin-producing Escherichia coli (STEC) serogroups, which are significant cause of food borne diseases. A study collected 800 samples of dairy bovine raw milk through various sources, 500 from milk shops, 200 from dairy farms, 26 from milk collection centers, and 74 from street vendors. Using a standard method, E. coli was detected in 321 out of the 800 samples collected. Out of the 321 E. coli-positive samples isolated, 148 were identified as STEC using selective media, specifically Cefixime Tellurite Sorbitol MacConkey's Agar (CT-SMA). Out of the 148 positive samples, 40 were confirmed as STEC non-O157 strains using multiplex PCR, indicating a prevalence of 5% (40 out of 800 samples). STEC isolates were subjected to antimicrobial susceptibility testing, and all isolates were resistant to at least one or more antimicrobials tested through the disk diffusion method, revealed high resistance to Amoxicillin 100%, Ceftriaxone 50%, and Penicillin 44.5%, and notably 44% of the strains exhibited Streptomycin resistance, while Enrofloxacin 55%, Florfenicol 50% and Norfloxacin 44%, demonstrated the highest susceptibility. Out of 40 STEC non-O157, twelve were subjected to Multi Locus Sequence Typing (MLST) sequencing through Illumina Inc. MiSeq platform's next-generation sequencing technology, United States. The genome investigation evidenced the persistence of twelve serotypes H4:O82, H30:O9a, H4:O82, H16:O187, H9:O9, H16:O113, H30:O9, H32:O, H32:O, H32, H32, and H38:O187, linked to the potential infections in humans. Conclusion: STEC isolates showed resistance to multiple antimicrobials, raising concerns for both animal and public health due to widespread use of these drugs in treatment and prevention. The study contributes new insights into monitoring STEC in raw milk, emphasizing the critical role of whole genome sequencing (WGS) for genotyping and sequencing diverse isolates. Still a deficiency in understanding STEC pathogenesis mechanisms, ongoing surveillance is crucial for safeguarding human health and enhancing understanding of STEC genetic characteristics.

Predicting oral hygiene practices through health behavior, perceived stress and self-efficacy in undergraduate dental students of Pakistan: a national survey.

BACKGROUND: Dental students face the rigorous demands of coursework, which can lead to feelings of inadequacy and stress. These pressures can negatively influence self-efficacy and cause neglect in practicing healthy behaviors that encompass oral health. Identifying the associations of these variables with oral hygiene practices can help in the formulation of interventions tailored toward supporting young students. Therefore, this study aimed to investigate the impact of health behaviors, perceived stress and self-efficacy on oral hygiene practices among undergraduate dental students in Pakistan. METHODS: A national online survey was carried out among 904 students across the dental colleges of Pakistan. The survey assessed general health behaviors such as tobacco use, sleep, and exercise, among other demographic variables. Perceived stress was evaluated via the Perceived Stress Scale (PSS-10), and self-efficacy was evaluated via the General Self-Efficacy Scale (GSES). Twice daily brushing, brushing for 2 min, and changing toothbrushes after 3 months informed oral hygiene practice of the participants. RESULTS: The students experienced moderate perceived stress (20.82 ± 5.92) and high self-efficacy (29.19 ± 5.43). The majority of participants were in their third year (31.9%), were female (65.9%), and resided in home during their studies (64.4%). Perceived stress was observed to have no significant effect on the oral practice of participants. Female gender, non tobacco user, regular exercise, frequent dental visits and higher self-efficacy were associated with good oral hygiene practices. CONCLUSIONS: The results highlight the importance of addressing stress, enhancing self-efficacy and encouraging healthy behaviors among dental students to improve their oral health, which could be reflected in their professional practice and personal well-being. This study contributes to the understanding of behavioral determinants and emphasizes the need for supportive measures to foster better health behaviors in future dental professionals.

Shared decision making for patients needing dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance therapy: a comparison between Pakistani patients' and clinicians' perspective.

INTRODUCTION: Shared decision making (SDM) involves presenting patients with relevant information about a health issue and reaching a clinical decision based on their preferences. However, its application in orthodontics lacks documentation. OBJECTIVE: This study aimed to assess and compare the perspectives of patients and clinicians on SDM in different cases. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Pakistan, involving 90 patients categorized into three groups (dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance treatment). Following clinical assessment and treatment plan discussions, patients and clinicians completed a 12-item dyadic observing patient involvement in decision making (OPTION) questionnaire, to gauge their perspectives on SDM. Mean OPTION scale scores were compared using paired sample t-tests between clinicians and patients, and intergroup comparisons utilized paired sample t-tests and Pearson correlation coefficients. RESULTS: OPTION scores were similar between patients/parents and clinicians. However, statistically significant differences were found regarding the questions about "different sources of information", "different options (including the possibility of doing nothing)" and "concerns regarding management", with the patients giving overall lower OPTION scores. Patients gave lower SDM OPTION scores for conventional orthodontic treatment, but higher scores for orthopedic and orthognathic surgery, as compared to the clinicians. CONCLUSIONS: The current study revealed an overall consensus in the mean total scores of OPTION scales between patients and clinicians. However, when stratified, patients showed higher SDM scores for orthopedic and orthognathic cases, and lower scores for conventional orthodontic treatment.

Genetic structure of apical membrane antigen-1 in Plasmodium falciparum isolates from Pakistan.

Plasmodium falciparum apical membrane antigen-1 (PfAMA-1) is a major candidate for the blood-stage malaria vaccine. Genetic polymorphisms of global pfama-1suggest that the genetic diversity of the gene can disturb effective vaccine development targeting this antigen. This study was conducted to explore the genetic diversity and gene structure of pfama-1 among P. falciparum isolates collected in the Khyber Pakhtunkhwa (KP) province of Pakistan. A total of 19 full-length pfama-1 sequences were obtained from KP-Pakistan P. falciparum isolates, and genetic polymorphism and natural selection were investigated. KP-Pakistan pfama-1 exhibited genetic diversity, wherein 58 amino acid changes were identified, most of which were located in ectodomains, and domains I, II, and III. The amino acid changes commonly found in the ectodomain of global pfama-1 were also detected in KP-Pakistan pfama-1. Interestingly, 13 novel amino acid changes not reported in the global population were identified in KP-Pakistan pfama-1. KP-Pakistan pfama-1 shared similar levels of genetic diversity with global pfama-1. Evidence of natural selection and recombination events were also detected in KP-Pakistan pfama-1.

Effects of COVID-19 Illness and Vaccination Infodemic Through Mobile Health, Social Media, and Electronic Media on the Attitudes of Caregivers and Health Care Providers in Pakistan: Qualitative Exploratory Study.

BACKGROUND: The COVID-19 pandemic has had a significant impact on different countries because of which various health and safety measures were implemented, with digital media playing a pivotal role. However, digital media also pose significant concerns such as misinformation and lack of direction. OBJECTIVE: We aimed to explore the effects of COVID-19-related infodemics through digital, social, and electronic media on the vaccine-related attitudes of caregivers and health care providers in Pakistan. METHODS: This study employs a qualitative exploratory study design with purposive sampling strategies, and it was conducted at 3 primary health care facilities in the province of Sindh, Pakistan. Seven focus group discussions with health care providers and 60 in-depth interviews with caregivers were conducted using semistructured interviews through virtual platforms (ConnectOnCall and Zoom). Transcripts were analyzed through thematic analysis. RESULTS: Our study reveals the pivotal role of electronic media, mobile health (mHealth), and social media during the COVID-19 pandemic. Four major themes were identified: (1) sources of information on COVID-19 and its vaccination, (2) electronic media value and misleading communication, (3) mHealth leveraging and limitations during COVID-19, and (4) social media influence and barriers during COVID-19. Health care providers and caregivers reported that the common sources of information were electronic media and mHealth, followed by social media. Some participants also used global media for more reliable information related to COVID-19. mHealth solutions such as public awareness messages, videos, call ringtones, and helplines promoted COVID-19 prevention techniques and vaccine registration. However, the overwhelming influx of news and sociobehavioral narratives, including misinformation/disinformation through social media such as WhatsApp, Facebook, and Twitter, were found to be the primary enablers of vaccine-related infodemics. Electronic media and mHealth were utilized more widely to promote information and communication on the COVID-19 pandemic and vaccination. However, social media and electronic media-driven infodemics were identified as the major factors for misinformation related to COVID-19 and vaccine hesitancy. Further, we found a digital divide between the urban and rural populations, with the use of electronic media in rural settings and social media in urban settings. CONCLUSIONS: In a resource-constrained setting like Pakistan, the usage of mHealth, social media, and electronic media for information spread (both factual and mis/disinformation) related to COVID-19 and its vaccination had a significant impact on attitudes toward COVID-19 vaccination. Based on the qualitative findings, we generated a model of digital communications and information dissemination to increase knowledge about COVID-19 and its prevention measures, including vaccination, which can be replicated in similar settings for other disease burdens and related infodemics. Further, to mitigate the infodemics, both digital and nondigital interventions are needed at a larger scale.