Monitoring land subsidence in the Peshawar District, Pakistan, with a multi-track PS-InSAR technique.

Peshawar is one of the most densely populated cities of Pakistan with high urbanization rate. The city overexploits groundwater resources for household and commercial usage which has caused land subsidence. Land subsidence has long been an issue in Peshawar due to insufficient groundwater removal. In this research, we employ the persistent scatterer interferometry synthetic aperture radar (PS-InSAR) technique with Sentinel-1 imaging data to observe the yearly land subsidence and generate accumulative time-series maps for the years (2018 to 2020) using the SAR PROcessing tool (SARPROZ). The PS-InSAR findings from two contiguous paths are combined by considering the variance over the overlapping area. The subsidence rates in the Peshawar are from -59 to 17 mm/yr. The results show that subsidence is -28.48 mm/yr in 2018, the subsidence reached -49.02 mm/yr in 2019, while in 2020, the subsidence reached -49.90 mm/yr. The findings indicate a notable rise in land subsidence between the years 2018 and 2020. Subsidence is predicted in the research region primarily due to excessive groundwater removal and soil consolidation induced by surficial loads. The correlation of land subsidence observations with groundwater levels and precipitation data revealed some relationships. Overall, the proposed method efficiently monitors, maps, and detects subsidence-prone areas. The utilization of land subsidence maps will enhance the efficiency of urban planning, construction of surface infrastructure, and the management of risks associated with subsidence.

Drinking water quality of various sources in Peshawar, Mardan, Kohat and Swat districts of Khyber Pakhtunkhwa province, Pakistan / Qualidade de água potável de váris fontes dos distritos de Peshawar, Mardan, Kohat e Swat da província de Khyber Pakhtunkhwa, Paquistão

Abstract The present study involves the chemical and bacteriological analysis of water from different sources i.e., bore, wells, bottle, and tap, from Peshawar, Mardan, Swat and Kohat districts of Khyber Pakhtunkhwa (KP) province, Pakistan. From each district, 50 water samples (10 samples from each source), regardless of urban and rural status, were collected from these sources and analysed for sulphates, nitrates, nitrites, chlorides, total soluble solids and coliforms (E. coli). Results indicated that majority of the water sources had unacceptable E. coli count i.e.> 34 CFU/100mL. E. coli positive samples were high in Mardan District, followed by Kohat, Swat and Peshawar district. Besides this, the some water sources were also chemically contaminated by different inorganic fertilizers (nitrates/nitrites of sodium, potassium) but under safe levels whereas agricultural and industrial wastes (chloride and sulphate compounds) were in unsafe range. Among all districts, the water quality was found comparatively more deteriorated in Kohat and Mardan districts than Peshawar and Swat districts. Such chemically and bacteriologically unfit water sources for drinking and can cause human health problems.

Resumo O presente estudo envolve a análise química e bacteriológica de água de diferentes fontes, ou seja, furo, poços, garrafa e torneira, dos distritos de Peshawar, Mardan, Swat e Kohat da província de Khyber Pakhtunkhwa (KP), Paquistão. De cada distrito, 50 amostras de água (10 amostras de cada fonte), independentemente do status urbano e rural, foram coletadas dessas fontes e analisadas para sulfatos, nitratos, nitritos, cloretos, sólidos solúveis totais e coliformes (E. coli). Os resultados indicaram que a maioria das fontes de água tinha uma contagem inaceitável de E. coli, ou seja, > 34 UFC / 100 mL. As amostras positivas para E. coli foram elevadas no distrito de Mardan, seguido por Kohat, Swat e distrito de Peshawar. Além disso, algumas fontes de água também foram contaminadas quimicamente por diferentes fertilizantes inorgânicos (nitratos/nitritos de sódio, potássio), mas em níveis seguros, enquanto os resíduos agrícolas e industriais (compostos de cloreto e sulfato) estavam em níveis inseguros. Entre todos os distritos, a qualidade da água foi considerada comparativamente mais deteriorada nos distritos de Kohat e Mardan do que nos distritos de Peshawar e Swat. Essas fontes de água química e bacteriologicamente impróprias para beber podem causar problemas à saúde humana.

Drinking water quality of various sources in Peshawar, Mardan, Kohat and Swat districts of Khyber Pakhtunkhwa province, Pakistan

Abstract The present study involves the chemical and bacteriological analysis of water from different sources i.e., bore, wells, bottle, and tap, from Peshawar, Mardan, Swat and Kohat districts of Khyber Pakhtunkhwa (KP) province, Pakistan. From each district, 50 water samples (10 samples from each source), regardless of urban and rural status, were collected from these sources and analysed for sulphates, nitrates, nitrites, chlorides, total soluble solids and coliforms (E. coli). Results indicated that majority of the water sources had unacceptable E. coli count i.e.> 34 CFU/100mL. E. coli positive samples were high in Mardan District, followed by Kohat, Swat and Peshawar district. Besides this, the some water sources were also chemically contaminated by different inorganic fertilizers (nitrates/nitrites of sodium, potassium) but under safe levels whereas agricultural and industrial wastes (chloride and sulphate compounds) were in unsafe range. Among all districts, the water quality was found comparatively more deteriorated in Kohat and Mardan districts than Peshawar and Swat districts. Such chemically and bacteriologically unfit water sources for drinking and can cause human health problems.

Resumo O presente estudo envolve a análise química e bacteriológica de água de diferentes fontes, ou seja, furo, poços, garrafa e torneira, dos distritos de Peshawar, Mardan, Swat e Kohat da província de Khyber Pakhtunkhwa (KP), Paquistão. De cada distrito, 50 amostras de água (10 amostras de cada fonte), independentemente do status urbano e rural, foram coletadas dessas fontes e analisadas para sulfatos, nitratos, nitritos, cloretos, sólidos solúveis totais e coliformes (E. coli). Os resultados indicaram que a maioria das fontes de água tinha uma contagem inaceitável de E. coli, ou seja, > 34 UFC / 100 mL. As amostras positivas para E. coli foram elevadas no distrito de Mardan, seguido por Kohat, Swat e distrito de Peshawar. Além disso, algumas fontes de água também foram contaminadas quimicamente por diferentes fertilizantes inorgânicos (nitratos/nitritos de sódio, potássio), mas em níveis seguros, enquanto os resíduos agrícolas e industriais (compostos de cloreto e sulfato) estavam em níveis inseguros. Entre todos os distritos, a qualidade da água foi considerada comparativamente mais deteriorada nos distritos de Kohat e Mardan do que nos distritos de Peshawar e Swat. Essas fontes de água química e bacteriologicamente impróprias para beber podem causar problemas à saúde humana.

Spatiotemporal variation in the vegetation cover of Peshawar Basin in response to climate change.

Climate factors like temperature, precipitation, humidity, and sunshine time exert a profound influence on vegetation. The intricate interplay between the two is crucial to understand in the face of changing climate to develop mitigation strategies. In the current exploration, we delve how climate variability (CV) has impacted the vegetation in the Peshawar Basin (PB) using remote sensing data tools. The trend of climatic variability was investigated using the modified Mann-Kendall test and Sen's slope statistics. The changing climatic parameters were regressed on the Moderate Resolution Imaging Spectroradiometer (MODIS) normalized difference vegetation index (NDVI). The NDVI was further analyzed for spatiotemporal variability under land surface temperature (LST) influence. Results revealed that among the climate factors, average annual temperature and solar radiation have a significant (p < 0.05) negative impact on vegetation while precipitation and relative humidity significantly (p < 0.05) influence NDVI positively. The overall positive trend shows that vegetation improved between 2001 and 2020 with time, however some years (2010, 2012, 2014, 2016, and 2017) with low NDVI. NDVI varied in space considerably due to climatic extremes brought on by CV and the urbanization of agricultural land. NDVI regressed on LST showed that there was no or very little vegetation in the grids with high LST. The study concluded that the region is significantly impacted by both CV-related extreme weather events and anthropogenic activities. The vegetation is improving, but it is in danger of being destroyed by deforestation due to CV and human activities that exacerbate the risk of future calamities. To protect vegetation and avoid disasters, there is an immense need for adaptation and mitigation measures to deal with the region's fast-changing environment. The study urges local authorities to create climate-resilient governmental policies and supports regional sustainable development and vegetation restoration.

Retrospective Analysis of Biologic Agent Utilization in Severe Asthma: Impact on Exacerbation Rates, Forced Expiratory Volume in the First Second (FEV1), Eosinophils, and IgE Levels.

Introduction Severe uncontrolled asthma is challenging to manage and impacts lung function and symptoms. Biologic agents targeting inflammatory pathways have transformed asthma management. This retrospective chart review aimed to assess biologic therapy in severe uncontrolled asthma patients and evaluate outcomes. Methods The study analyzed medical records of 30 patients receiving biologic therapy for severe asthma at a tertiary care center in Peshawar, Pakistan, from December 2022 to Jun 2023. Ethical approval was obtained, and patient demographics, biologic agent usage, and clinical parameters were collected. Clinical outcomes were evaluated after six months, including forced expiratory volume in the first second (FEV1), eosinophil count, IgE levels, and exacerbation rates. Results After six months, biologic treatment significantly improved FEV1 (48.7% to 62.4%), reduced eosinophils (540 cells/µL to 290 cells/µL) and IgE levels (410 IU/mL to 280 IU/mL), and decreased exacerbations (4.6 to 1.9). Subgroup analysis based on age and sex showed consistent lung function improvements. Conclusion Biologic agents effectively targeted inflammatory pathways, improving asthma control in severe uncontrolled asthma patients. This study provides valuable insights into biologic therapy for severe asthma, offering new possibilities for patient outcomes. Larger studies are needed to validate findings and optimize personalized treatment strategies.

Evaluation Of Normal Diameter Of Infra-Renal Aorta In A Pakistani Population Using Contrast-Enhanced Computed Tomography.

BACKGROUND: It is a common observation that the aortic size of Pakistani population is relatively less as compared to western population. Till now there is no study which has measured the dimensions of abdominal aorta in local population.The standard diameter of an artery across the body is critical for clinicians to recognize when an artery has become aneurysmal. This study aims to present the results of a local population's normal diameter of an infrarenal aorta and how it varies by age, gender, weight, height, body mass index (BMI) and body surface area (BSA). METHODS: This cross-sectional observational study was conducted in Vascular Surgery Department, at Combined Military Hospital (CMH), Peshawar, from July 2020 to November 2021.Participants in the study included all patients who underwent a contrast-enhanced computed tomography (CT) scan of the abdomen for any reason other than cardiovascular disease.The infrarenal abdominal aorta's mean internal diameter (anteroposterior and transverse diameter) was assessed. SPSS v 23 was used to analyze the data and present it as frequency and percentages. The Pearson correlation coefficient assessed the correlation between aortic diameters, weight, height, BMI, and BSA. RESULTS: Recruitment of a total of 250 patients was done in this study. Males were 194 (77.6%), while the rest were female patients. The patients' mean age was 39.6±12.8 years. The mean anteroposterior (AP) diameter of the infrarenal aorta was 16.13±2.32 mm. The mean transverse diameter (TD) was 15.96±2.34 mm. The infrarenal diameter of the aorta was smaller in women when compared to men, and the calibre of the aorta increased with the increasing age of the patients. There was a statistically significant positive relationship between their age and the average diameter of the infrarenal aorta (p<0.001) among both men and women. CONCLUSIONS: Clinicians and vascular surgeons will benefit from the findings in diagnosing and treating abdominal aortic aneurysms. Hence, thoughtful consideration should be made before formulating intervention protocols.

Raised Glycated Hemoglobin (HbA1c) Level as a Risk Factor for Myocardial Infarction in Diabetic Patients: A Hospital-Based, Cross-Sectional Study in Peshawar.

Background Diabetes is a rapidly rising chronic illness in developing countries. The main objective of this research is to compare the frequency of myocardial infarction (MI) in controlled and uncontrolled diabetics in Pakistan, especially in the underprivileged district of Peshawar, and to determine raised blood glucose as a risk factor for MI. Methodology This cross-sectional study involving 237 diabetic patients aged 30-80 years was conducted in three major tertiary care hospitals in Peshawar, Pakistan. The inclusion criteria were diabetic patients with glycated hemoglobin (HbA1C) levels of less than 7% considered to be "controlled diabetics" and above 7% considered to be "uncontrolled diabetics." Data were collected using structured questionnaires, past medical records, and patient history and were analyzed using SPSS software (IBM Corp., Armonk, NY, USA). The study was concluded in March 2022. Results The highest number of MIs occurred in diabetics with HbA1c levels of 8-9% (47.9% of all MIs). There was a significant association between increasing HbA1c levels and the incidence of MI (p = 0.002). The adjusted prevalence odds ratio for MI in uncontrolled diabetics was 6.105 (95% confidence interval = 2.42-15.43), that is, six times increased incidence of MI in patients with HbA1c of more than 7%. Furthermore, with a 1% increase in HbA1c, there was a 10% increase in the proportion of MIs. Conclusions From this study, it is clear that HbA1c levels of 8-9% were most significantly associated with the risk of MI in uncontrolled diabetics, and with rising levels of HbA1c, the risk of MI increased significantly. Thus, this study highlights the importance of HbA1c control in diabetic patients to prevent a heart attack.

Detailed macro and micromorphology of grasses caryopsis using scanning electron and light microscopy.

Micromorphology of 15 grass caryopsis was investigated through scanning electron microscopy for its implications in the identification of grasses. Both macro and micromorphological characters especially caryopsis shape and surface morphology were found significant in the taxonomic diagnosis. Shape morphology of caryopsis varied among the species and lanceolate, fusiform, narrow ellipsoidal, ovate, elliptical, plano-convex, fusiform, linear ovate, broadly elliptical, broadly pllipsoidal, plano-convex, oblique ovate, and subglobose shapes were recorded. Digitaria nodosa (3.31 × 0.7 mm) and Echinochloa crus-galli (3.26 × 1.44 mm) had the largest caryopsis size, while Acrachne racemosa (0.76 × 0.54 mm) and Eragrostis minor (0.62 × 0.38 mm) had the smallest caryopsis size. Macro and micromorphological characters were useful for the diagnosis of genus and species. Utilizing both qualitative and quantitative character taxonomic key at generic and species level were made.

Current practices of waste management in teaching hospitals and presence of incinerators in densely populated areas.

BACKGROUND: Hospital waste management (HWM) practices are the core need to run a proper health care facility. This study encompasses the HWM practices in teaching hospitals of Peshawar, Pakistan and examine the enforcement of Pak HWM (2005) rules and risks through transmission of pathogens via blood fluids, air pollution during waste incineration and injuries occurring in conjunction with open burning and dumping. METHODS: A questionnaire based on World Health Organization (WHO) recommendations was used to survey the selected private and public teaching hospital (n = 16). Site visits and personnel observations were also included in the data. It was spatio-statistically analyzed using descriptive statistics, Krushkal-wallis and Fisher's exact tests. RESULTS: The findings revealed that the lack of HWM practices in all surveyed hospitals (p > 0.05), besides statistical difference (p < 0.017) in waste generation/day. No proper segregation of waste from generation point to final disposal was practiced. However, the performance of private teaching hospitals (50%) was found better in terms of HWM personnel and practices. In surveyed hospitals, only nine hospitals (56.3%) were found with the incinerator facility while rest of the hospitals (43.7%) practiced open dumping. Moreover, operational parameters of the incinerators were not found satisfactory and located in densely populated areas and emitting hazardous gases. CONCLUSION: Proper HWM practices are not being followed in the light of WHO guidelines. Hospital waste impose serious menace to healthcare workers and to nearby population. WHO issued documents for improving HWM practices but triggered no change in Pakistan. To improve the situation, insights in this context is need for enforcement of rules.

Prevalence and determinants of violence against health care in the metropolitan city of Peshawar: a cross sectional study.

BACKGROUND: Violence against healthcare personnel is a major public health problem. Healthcare personnel are at the frontline dealing with people in stressful and unpredictable situations. Therefore, this study was conducted to determine the prevalence and associated factors of violence against health care personnel. METHODS: A cross sectional study was conducted in the district Peshawar. Healthcare personnel from public and private sectors working in both the primary and tertiary levels of healthcare were invited to participate. Violence was assessed through a structured questionnaire previously used in Pakistan and was defined as experiencing and/or witnessing any form of violence in the last 12 months. Mental health was assessed through the General Health Questionnaire. Logistic regression was used to estimate the association of violence against healthcare personnel with psychological distress and demographic characteristics. Data entry and analysis were conducted in STATA 14. RESULTS: A total of 842 healthcare personnel participated in the study. The prevalence of violence experienced and/or witnessed by healthcare personnel in Peshawar was 51%. Verbal violence remained the predominant form of violence and almost half of the healthcare personnel (45%) were exposed to it. A quarter of the respondents (24%) reported physical violence alone or in combination with other forms of violence. In almost two third of the incidents the perpetrators were either attendants, relatives or the patients. The emergency unit and wards within healthcare facilities were the most common places where violent events took place. The major factors responsible for the violent incidents were communication failure, unreasonable expectations and perceived substandard care. No uniform policy/procedure existed to manage the incidents and the healthcare personnel adopted different responses in the wake of violent events targeting health care. Working in public healthcare facilities and having a larger number of co-workers/colleagues significantly increased the risk of violence in the healthcare settings while being a paramedic significantly reduced the risk as compared to physicians. CONCLUSIONS: Violence against healthcare personnel is a serious public health issue and the prevalence is quite high. A holistic effort is needed by all stakeholders including healthcare community, the administration, lawmakers, law enforcement, civil society, and international organizations.

Knowledge, Attitude, and Practices Toward COVID-19 in Primary Healthcare Providers: A Cross-Sectional Study from Three Tertiary Care Hospitals of Peshawar, Pakistan.

An online cross-sectional study was carried out to evaluate the knowledge, attitude, and practice about coronavirus disease 2019 (COVID-19) among primary health care providers (PHPs) at three tertiary care hospital, Peshawar, Pakistan. Data was collected via email and online social media platforms. Statistical package for social science (SPSS) version 25.0 was used for data analysis. Among the total participants (n = 114), 74 (66.7%) were male and 37 (33.3%) were female. The mean scores for knowledge, attitude and practice were 12.7 ± 0.89, 8.9 ± 4.1 and 7.3 ± 1.2, respectively. Most of the participants knew the term COVID-19 and its mode of transmission (90%), signs and symptoms (84%) and risk factors (72%) associated with it. Most of the participants agreed that COVID-19 can be transmitted through coughing and sneezing (74.3%) and 84.6% were in favor that COVID-19 can be prevented by adopting preventive measures. Around 68.8% of the participants disagreed with the use of antibiotics in the prevention of COVID-19. Ninety percent of the respondents were avoiding close contact with the people having cough and flu-like symptoms. Most PHPs had good knowledge, positive attitude and reasonable practices regarding COVID-19. Moreover, focused training programs for PHPs at the Government level can further improve their understanding of risks and preventive strategies related to COVID-19, which will help them to provide appropriate care to their patients as well as to protect themselves from this infection.

Sociodemographic and Clinical Features in Patients Presented With Accidental and Deliberate Self-Poisoning: A Comparative Study from Lady Reading Hospital Medical Teaching Institution, Peshawar, Pakistan.

Objectives To evaluate the sociodemographic and clinical characteristics of patients presented with acute self-poisoning at a tertiary care hospital in Pakistan. Methods and Patients A comparative study was conducted at Lady Reading Hospital MTI between May 2018 to May 2019 for a duration of 12 months. All patients diagnosed with acute self-poisoning were included in the study. Patients with inconclusive diagnosis, who were dead prior to the arrival to the hospital, or had an incomplete history of poison exposure were excluded from the study. At the time of arrival to the emergency department, the patient was first stabilized. Patients were grouped into two according to the type of exposure, i.e., accidental self-poisoning and deliberate self-poisoning (DSP). Sociodemographic and clinical characteristics of patients were recorded in a preformed proforma. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 26 (IBM Corp., Armonk, NY, USA). Results The mortality rate in patients with accidental poisoning was 9.62%, whereas it was 26.28% in DSP patients. Data were stratified according to the mode of poisoning, i.e., accidental vs DSP, and variables were assessed in patients who did not survive. It was found that 60% of patients who died in the accidental group were aged 0-15 years. In contrast, only one patient between aged 0-15 years died in the DSP group and the majority of the deaths occurred in those aged 25.1-35 years (31 [75.6%]). Conclusions In conclusion, women more often attempted suicide, whereas males suffered accidental poisoning more frequently. Firstly, we found a female predominance in the DSP group, whereas males were more prevalent in with young children experiencing accidental poisoning. Longer time from ingestion of poison to the arrival is associated with poor patient prognosis.

Internet Gaming Disorder In Students Of Peshawar: A Cross Sectional Survey.

BACKGROUND: Internet gaming, though getting popular, is becoming a risk to physical and psychological health, especially in adolescents, as it contributes to sedentary lifestyle. To gauge the extent of the problem in our setup, we decided to find the frequency of internet gaming disorder in students of Peshawar and identify their motives for playing these games. METHODS: This Cross-sectional survey was conducted from February to December 2018 and included students of Private and Public institutes of Peshawar. They were invited to complete a questionnaire comprising of Internet Gaming Disorder Scale-Short Form (IGDS-SF9), which includes 9 questions, with some additional demographic questions. The data were analysed using SPSS v.25. RESULTS: The mean age of the sample (n=2116) was 21.5±2.1 years with the age range of 16-28 years. The cronbach's alpha reliability of IGDS-SF9 in our study was 0.805. Majority of the participants were males (n=1261, 59.6%) and were from Private sector institutes (n=1314, 62.1%). A total of 32 (1.5%) students reported having Internet Gaming disorder. The results of chi square test showed that significantly more male students played games for social motives (p=.032), whereas significantly more female students played games for coping motives (p=.001). Pearson correlation results showed a significant positive correlation between time spent on gaming and internet gaming disorder (p=.000) and between internet gaming disorder with recreation as a motive (p=.027). CONCLUSIONS: Internet Gaming is getting common in our setup and IGDS-SF9 can be effectively used in our population because of its reliability.

Pedestrian's exposure to road traffic crashes in urban environment: A case study of Peshawar, Pakistan.

This study was aimed at exploring accident statistics and suggesting counter measures to mitigate road traffic crashes in Peshawar, Pakistan, and was conducted in 2015-16. Data was extracted from all 30 police stations in cantonment, city and rural circles for the 2003-12 period. A total of 3,280 crashes were reported, including 856(26%) fatal and 2,424(74%) non-fatal ones. Moreover, 602(69%) fatalities and 1,782(59%) injuries of overall road traffic fatalities and injuries during the period studied were borne by pedestrians. No regular annual pattern was noticed for overall and pedestrians' fatalities and injuries. Detailed RTCs' analysis, police officials' interviews and engineering judgement during field visits indicate that there is a dire deficiency of physical infrastructure for pedestrians, signage and markings. There is a need to improve post-crash evaluation and implement counter measures for speed control.

Use of internet by the teaching faculty of Peshawar Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan.

This study was planned to examine the hard and soft form of learning resources available on the internet accessed by the teaching faculty. This study was conducted at the Peshawar Medical College, Peshawar, Pakistan from January 2to April 2017. As the target population was not too large, no sampling technique was employed and census-based approach was adopted. For data collection, the pre-tested questionnaire was distributed among 115 faculty members of both basic and clinical sciences groups with a response rate of 66(57.39%). Data was analysed using SPSS. Among the respondents, 38(57.6%) were males and 28(42.4%) were females. A majority 51 (77.27%) of the respondents used the internet for teaching and research. Library was the most frequently 22 (33.33%) used place for the internet use. Low internet speed, virus on computers and a lack of modern trainings were the major barriers. E-journals, e-books, online databases and theses and dissertations were the major sources consulted by the participants.

Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan.

OBJECTIVE: To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. METHODS: Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB. RESULTS: Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases. Of 610 contacts who could be studied, 41 (17.4%) were diagnosed with MDR-TB and 10 (4.2%) had TB. The most common symptoms observed were cough, chest pain and fever. CONCLUSIONS: The high incidence of MDR-TB among close contacts emphasize the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease.

High frequency of methicillin-resistant Staphylococcus aureus in Peshawar Region of Pakistan.

Staphylococcus aureus is an increasing problem in clinical practice because of reduced susceptibility to available antibiotics. The objective of the study was to determine the frequency of Methicillin-resistant S. aureus (MRSA) in Peshawar, Pakistan. Clinical isolates of S. aureus were subjected to determination of antibiotic resistance, MICs and inducible clindamycin resistance (ICR). Out of total 280 S. aureus isolates, the frequency of MRSA was 36.1 % (n = 101). MRSA infection was found higher among the age group 50-59 years (60.71 %, OR 3.09), followed by 20-29 years (47.5 %, OR 1.74). Frequency of MRSA in female and male was 39.8 and 34 % respectively. MRSA was more frequent in blood specimens (48.7 %, OR 2.14). The frequency of community and hospital acquired MRSA was 42 and 34.8 % respectively. MRSA showed high resistance (100 %) to penicillin and cefoxitin followed by erythromycin (99 %). While MRSA exhibited 100 % susceptibility to vancomycin and linezolid. We have also found 7 vancomycin intermediate sensitive S. aureus (VISA) isolates. ICR was observed in 15.84 % (n = 16) of MRSA isolates. It is concluded that MRSA is potential threat to public health in Peshawar. Vancomycin and linezolid could be prescribed as a drug of choice in treating MRSA associated infections. In addition, ICR should be routinely checked to avoid clindamycin treatment failure.

Molecular characterization of Hepatitis C virus 3a in Peshawar.

BACKGROUND: The purpose of this study was to explore molecular epidemiology of HCV genotype 3a in Peshawar based on sequencing and phylogenetic analysis of Core region of HCV genome. METHODS: Chronically infected Hepatitis C virus infected patients enrolled under the Prime Minister Hepatitis C control program at three Tertiary care units of Peshawar [Khyber Teaching Hospital Peshawar, Lady Reading Hospital Peshawar, Hayat Abad Medical Complex Peshawar] were included in this cross sectional observational study. Qualitative detection of HCV and HCV genotyping was carried out by a modified reverse transcription-polymerase chain reaction (RT-PCR) and type specific genotyping assay. The Core gene of HCV genotype 3a was amplified, cloned and sequenced. The sequences obtained were used for phylogenetic analysis using MEGA 6 software. RESULTS: Among the 422 (82.75 %) PCR positive samples, 192 (45.5 %) were identified as having HCV genotype 3a infection. HCV Core gene sequencing was carried out randomly for the characterization of HCV 3a. Nucleotide sequence analysis of the obtained viral genomic sequences based on partial HCV 3a Core gene sequences with reference sequences from different countries showed that our sequences clustered with some local and regional sequences with high bootstrap values. CONCLUSION: HCV 3a is highly prevalent in Peshawar, Pakistan and its phylogenetics based on Core gene sequences indicate the prevalence of different lineages of HCV 3a in Peshawar which may have consequences for disease management strategies causing more economic pressure on the impoverished population due to possible antiviral resistance.

Evaluation of mycotoxins, mycobiota, and toxigenic fungi in selected medicinal plants of Khyber Pakhtunkhwa, Pakistan.

Medicinal plants are used worldwide to treat a variety of ailments. Due to the provenance of medicinal plants, they are subjected to contamination by moulds, which may be responsible for spoilage and production of mycotoxins. The investigation was designed to throw light on mycological and mycotoxicological status of some medicinal plants from Pakistan and the result showed 30 % and 26.7 % samples were contaminated with aflatoxins and ochratoxin A, respectively. Mould contamination was present in 90 % samples, of which 70 % exceeded the permissible limits. Opium poppy, licorice root, and Indian rennet were most contaminated samples. The predominant moulds found were Aspergillus flavus, Aspergillus niger, Aspergillus parasiticus, and Penicillium spp. and 31 % of the 47 isolates tested were found to be toxigenic. The findings indicate that the contamination in the medicinal plants may contribute to adverse human health problems. This information would prove helpful for regulatory agencies to establish limits for these contaminants in medicinal plants and will explore ways for export of herbal products to countries where more stringent permissible limits of mycotoxins exist. The study is first of its kind in the country reporting natural occurrence of mycotoxins in medicinal plants in Pakistan.