Addressing the humanitarian crisis in Afghanistan through $10 billion Afghani assets: what are the challenges and opportunities at hand?

BACKGROUND: The current humanitarian crisis in Afghanistan started after the US and international allies' withdrawal. This has put the country in a dire situation as the globalized infrastructure supporting Afghanistan came to halt. Moreover, 10 billion USD of Afghanistan's assets were frozen by the U.S and other international organizations after the Taliban takeover. This further exacerbated the humanitarian crisis and quickened the economic collapse in Afghanistan. These assets should be freed to support the people of Afghanistan. MAIN BODY: In order to address this situation, international oversight is needed to allow these funds to be returned and used by the Central Bank of Afghanistan without misappropriation by the Taliban. We suggest a number of short term interventions and long term considerations to improve the situation in Afghanistan with the $10 billion in frozen assets. In the short term, economic stability and the hunger crisis should be addressed by funding international organizations such as the World Food Program and national Afghani NGOs. In the long term funds should be used to build back the economy, build healthcare infrastructure, and support the development of women and children. CONCLUSION: At this juncture, the world and international organizations have a moral and ethical responsibility to ensure the 10 billion in funds go to the owners, the people of Afghanistan. With oversight and fund distribution to the right partners, progress can be made by providing support in security, healthcare, education and food resources. This calls for action to deliver $10 billion of assets to the Afghan people in a transparent manner, avoiding further tension and disasters in the country.

Tongue ulcer in a patient with COVID-19: a case presentation.

BACKGROUND: The emergence of COVID-19 has devastated many parts of the world. From asymptomatic to symptomatic, the virus causes a wide spectrum of presentations. COVID-19 patients may present with oral manifestations. In Afghanistan, where COVID-19 has severely strained the health care system, much of the population lacks proper oral hygiene. This makes the oral cavity a perfect site for SARS-CoV-2 to manifest clinical signs. CASE PRESENTATION: A 62-year-old male was evaluated in the Dentistry Teaching Clinic of Kabul University of Medical Sciences for a painful erosive lesion on dorsal surface of his tongue. He also complained of fever, cough, and taste alteration. He was referred to Afghan Japan Hospital for COVID-19 testing and tested positive. He was followed on for the treatment of SARS-CoV2. After 2 weeks, the patient tested negative and returned to the dentistry clinic for follow-up. Although there were no other signs of COVID-19, the painful erosive lesion on his tongue persisted. Oral evaluation were performed and the patient was advised to practice good hygiene. After 10 days, we observed an asymptomatic geographic tongue without fever and myalgias and the lesion of dorsal surface of tongue improved from severe condition to moderate. CONCLUSION: In conclusion, patients with suspected or confirmed SARS-CoV-2 should be screened for symptoms and physical findings in the oral mucosa To prevent such an outcome, awareness programs need to be implemented for the diagnosis and management of clinical symptoms among patients.

Optimal Antithrombotic Therapy for Patients with STEMI Undergoing PCI at High Risk of Bleeding.

PURPOSE OF REVIEW: In the review, we briefly describe antithrombotic drugs and the use evidence from evidence-based medicine to elucidate the optimal antithrombotic management for patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary stenting (PCI) at high risk of bleeding. RECENT FINDINGS: Mandatory use of intravenous anticoagulants and dual antiplatelet agents is the cornerstone strategy in acute and long-term antithrombotic management to optimize the clinical benefit of patients with STEMI undergoing PCI. Nevertheless, with the increasing occurrence of STEMI in old population with high risk of bleeding and renal insufficiency, as well as the specificity of high bleeding risk groups, the optimization of antithrombotic therapy still remains uncertain. Bivalirudin is the optimized intravenous anticoagulant agent for these patients based on the guideline recommendations and clinic data. Timely and potent ticagrelor and prasugrel with aspirin usage can increase the clinical benefit for the patients without increasing the clinical bleeding risk. At present, the multi-center, prospective clinical studies of EVOLVE short DAPT, MASTER DAPT, and POEM trials, targeting patients with high risk of bleeding, are in experimental stage. These clinical trials will provide more objective and optimal antithrombotic management strategy for the patients.

Knowledge, attitude, and practices toward malaria among hospital outpatients in Nangarhar, Afghanistan: A cross-sectional study.

Background: In the Eastern Mediterranean region, Afghanistan ranks third for the world's highest burden of malaria. The vast majority (95%) of malaria cases in Afghanistan are attributed to Plasmodium falciparum and 5% to Plasmodium vivax. Most cases occur in low-altitude regions, especially in the eastern province of Nangarhar, where agriculture and farming are predominant. To better understand the public sentiment toward malaria, this study aimed to understand the knowledge, attitude, and practice of patients toward malaria who visited public and private hospitals of Nangarhar province. Methods: A cross-sectional descriptive study was conducted on Nangarhar residents who visited the adult Outpatient departments of eight local public and private health facilities. Data collection took place from 1st August 2022 to 15th September 2022. Results: Of 700 participants, 37.9% (n = 265) identified as male and 62.1% (n = 435) identified as female. The majority of participants (84.6 %) were within the (18-40) age range, followed by 12.7% in the (41-60) age range, and 2.7% were aged 61 years or older. Moreover, 99.7% (n = 698) of the participants had heard of malaria. The main sources of information about malaria were family members (31.3%, n = 219), television (32.6%, n = 228), Internet (12.6%, n = 88), school (11.3%, n = 79), and health facilities (31.4%, n = 220). Most respondents correctly identified mosquito bites as the primary mode of malaria transmission (72.6%, n = 508). Others suggested that transmission could occur by close contact with a malaria patient (14.0%, n = 98) and drinking contaminated water (17.3%, n = 121). The majority of participants (70.6%) agreed that malaria is a serious and life-threatening disease. A significant number of participants (96.6%) reported owning an insecticide-treated mosquito net at home, and 87.0% reported using the net. Conclusion: Overall, participants reported good knowledge, attitude, and practice toward malaria. This may be linked to the awareness campaigns and preventive programs in Nangarhar province that have contributed to participant's willingness to prevent malaria and treat themselves if they get infected. Public health campaigns are difficult in Afghanistan with weak governance and conflict, and thus, populations may find themselves at risk if health promotion activities are stopped.

Geostatistical analysis for spatial distribution of anemia (Hb level) among women of reproductive age and determinant factors.

The study was designed to assess the geostatistical spatial distribution of anemia and determinant factors among the women of reproductive age group (RAG) in Gilgit district, Pakistan. The Hb levels for 15-25 RAG, 26-35 RAG, and 36-45 group showed 10.22 g/dL, 10.41 g/dL, and 9.90 g/dL levels, respectively, while the Hb level showed a nugget/sill ratio of 0.21 inferring strong for the 15-25 group, weak for the 26-36, and moderate for 36-45 spatial dependence. Furthermore, 15-25 RAG showed 8% severe and 33.34% sufficient cases and 26-35 showed 12% severe and 29.33% sufficient results in their Hb level, whereas 36-45 had 9.34% severe and 29.33% sufficient.

Assessing the multitargeted antidiabetic potential of three pomegranate peel-specific metabolites: An in silico and pharmacokinetics study.

Diabetes is a chronic metabolic disorder that occurs due to impaired secretion of insulin, insulin resistance, or both. Recent studies show that the antidiabetic drugs used to control hyperglycemic levels are associated with undesirable adverse effects. Therefore, developing a safe and effective medicine with antidiabetic potential is needed. In this context, in silico studies are considered a rapid, effectual, and cost-effective method in drug discovery procedures. It is evident from the literature that plant-based natural components have shown promising outcomes in drug development to alleviate various diseases and hence have diversified the screening of potential antidiabetic agents. Purposely, in the present study, an in silico approach was performed on three Punica granatum peel metabolites (punicalin, punicalagin, and ellagic acid). All these three compounds were docked against nine protein targets involved in glucose metabolism (GFAT, PTP1ß, PPAR-ᵞ, TKIR, RBP4, α-amylase, α-glucosidase, GCK, and AQP-2). These three pomegranate-specific compounds demonstrated significant interactions with GFAT, PTP1ß, PPAR-ᵞ, TKIR, RBP4, α-amylase, α-glucosidase, GCK, and AQP-2 protein targets. Specifically, punicalin, punicalagin, and ellagic acid revealed significant binding scores (-9.2, -9.3, -8.1, -9.1, -8.5, -11.3, -9.2, -9.5, -10.1 kcal/mol; -10, -9.9, -8.5, -8.9, -10.4, -9.0, -10.2, -9.4, -9.0 kcal/mol; and -8.1, -8.0, -8.0, -6.8, -8.7, -7.8, -8.3, -8.1, -8.1 kcal/mol, respectively), with nine protein targets mentioned above. Hence, punicalin, punicalagin, and ellagic acid can be promising candidates in drug discovery to manage diabetes. Furthermore, in vivo and clinical trials must be conducted to validate the outcomes of the current study.

A report of Kabul internet users on self-medication with over-the-counter medicines.

Self-medication (SM) with over-the-counter (OTC) medications is a prevalent issue in Afghanistan, largely due to poverty, illiteracy, and limited access to healthcare facilities. To better understand the problem, a cross-sectional online survey was conducted using a convenience sampling method based on the availability and accessibility of participants from various parts of the city. Descriptive analysis was used to determine frequency and percentage, and the chi-square test was used to identify any associations. The study found that of the 391 respondents, 75.2% were male, and 69.6% worked in non-health fields. Participants cited cost, convenience, and perceived effectiveness as the main reasons for choosing OTC medications. The study also found that 65.2% of participants had good knowledge of OTC medications, with 96.2% correctly recognizing that OTC medications require a prescription, and 93.6% understanding that long-term use of OTC drugs can have side effects. Educational level and occupation were significantly associated with good knowledge, while only educational level was associated with a good attitude towards OTC medications (p < 0.001). Despite having good knowledge of OTC drugs, participants reported a poor attitude towards their use. Overall, the study highlights the need for greater education and awareness about the appropriate use of OTC medications in Kabul, Afghanistan.

Antioxidant activity and phytochemical analysis of fennel seeds and flaxseed.

Natural herbs are now receiving more attention due to the growing demand for their antioxidant properties. This study compared flaxseed and fennel seeds for their nutritional composition, bioactive moieties, and antioxidant activity-the study comprised two different phases. According to methods, phase I analyzed flaxseed and fennel seeds for proximate composition, mineral profile, dietary fiber, and amino acid content. In phase II, seeds were extracted using three different solvents, i.e., ethanol 80%, acetone 80%, and distilled water, to probe the total phenolic and flavonoid content. Antioxidant activity was measured using DPPH and a FRAP in the final phase. Current study revealed that flaxseed had higher protein (17.33 ± 0.02%), fat content (36.76 ± 0.02%), potassium (763.66 ± 4.04 mg/100 g), iron (5.13 ± 0.03 mg/100 g), phosphorus (581.46 ± 4.07 mg/100 g), magnesium (406.60 ± 5.12 mg/100 g), and zinc (3.30 ± 0.49 mg/100 g), respectively. In fennel seed, high dietary fiber (53.2 ± 0.01 g/100 mg), calcium, manganese, and sodium (588.93 ± 7.77, 20.30 ± 0.95, and 57.34 ± 0.33 mg/100 g, respectively) were found. Acetone showed better extraction efficiency than acetone, ethanol, and distilled water. Moreover, acetone flaxseed extract showed higher total phenolic content (84.13 ± 7.73 mgGAE/g), flavonoid content (5.11 ± 1.50 mgQE/g), and FRAP (5031 ± 15.92 µMFe2+/g) than fennel seed extract. This study showed that, among both herbs, flaxseed extract may have pharmacological potential in preventing illnesses and may be suggested for use in the food industry as a natural antioxidant.

Basic life support knowledge among healthcare providers in Afghanistan: a cross-sectional study of current competencies and areas for improvement.

Basic life support (BLS) is a type of emergency care provided by healthcare workers and public safety professionals to individuals experiencing cardiac arrest, respiratory distress, or other cardiopulmonary emergencies. Despite having a high burden of cardiovascular disease and trauma from conflict in Afghanistan, little is known about the level of BLS knowledge Afghani healthcare workers have. A cross-sectional study was conducted in Kabul, Afghanistan, to assess healthcare workers' training and knowledge of BLS. The study, which took place from March to June 2022 across multiple public and private hospitals, was approved by the institutional ethics committee of Ariana Medical Complex. The sample size was calculated using a nonprobability convenience sampling method, and the study population consisted of healthcare workers actively working in a health center who were willing to complete a questionnaire. The results of the study showed that most participants (71.3%) were in the 21-30-year-old age range, and a third (32.3%) were doctors. 95.3% of participants had poor knowledge of BLS, with a mean score of 4.47±1.58 out of 13. Additionally, it was evident from questionnaire responses that providers are not adequately performing BLS. These findings suggest that further work, including regular BLS courses, is necessary to improve the knowledge and practice of BLS by healthcare workers in Afghanistan.

Characterization of ultrasonically extracted flaxseed polysaccharide gum and assessing its lipid-lowering potential in a rat model.

Flaxseed polysaccharide gum (FPG) was extracted through the ultrasound-assisted process using water as a solvent with a yield ranging from 8.05 ± 0.32% to 12.23 ± 0.45% by changing different extraction variables. The extracted FPG was analyzed for its functional groups and antioxidant potential. The maximum DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical scavenging activity (≈100%) of FPG was noted at concentrations beyond ≈10 mg·ml-1. The maximum inhibition percentage through ABTS (2,2'-azino-bis 3-ethylbenzothiazoline-6-sulfonic acid) (72.4% ± 1.9%) was noted at 40 mg·ml-1, which was observed to be less when compared to DPPH at the same concentration. The total antioxidant potential of the FPG solution at a concentration of 10 mg·ml-1 was equivalent to 461 mg ascorbic acid, which tends to increase with concentration at a much lower scope. The in vivo trial suggested that the least weight gain was noted in experimental groups G2 and Gh2. A significant reduction in total cholesterol was noticed in G1 (-14.14%) and G2 (-17.72%) and in Gh1 (-22.02%) and Gh2 (-34.68%) after 60 days of the trial compared to the baseline values. The maximum reduction in total triglyceride was observed in Gh2 (-25.06%) and Gh1 (-22.01%) after 60 days of the trial. It was an increasing trend in high-density lipoprotein cholesterol (HDL-c) in different experimental groups G2 (10.51%) than G1 (5.35%) and Gh2 (48.96%) and Gh1 (31.11%), respectively, after 60 days of study interval. Reduction of -5.05% and - 9.45% was observed in G1 and G2, while similar results were observed in Gh1 and Gh2. Conclusively, results suggested a possible protective role of FPG against hyperlipidemia.

ViSHWaS: Violence Study of Healthcare Workers and Systems-a global survey.

OBJECTIVE: To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education. METHODS: The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ2 test was performed to determine the association between gender and different violence forms. RESULTS: A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26-35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26-65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55-65 age group, which lost statistical significance. CONCLUSION: This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.

Giant congenital melanocytic nevus in an Afghan child.

We report an 8-year-old Afghan female with giant congenital melanocytic nevus (GCMN) which covered the entire back. The GCMN extended to anterolateral parts of the trunk surrounded by multiple satellite melanocytic nevi.

A Case of Symptomatic Myocardial Bridge Treated with Calcium Channel Blocker.

Myocardial bridge (MB) is a congenital coronary anomaly in which a portion of the coronary artery courses intramyocardium instead of the normal trajectory on the epicardial surface. We report a case study with a 44-year-old man from Faryab Province in Afghanistan who presented chest pain and dizziness while suffering a common cold. After full investigation, the patient underwent coronary angiography which showed a myocardial bridge at the middle portion of the left anterior descending artery (LAD) with a significant stenosis causing ischemia. We treated the patient with a calcium channel blocker as initial treatment. The patient tolerated the medication well and remained asymptomatic during two years follow-up.

Facemask Usage Among Pedestrians in Most Crowded Urban Districts of Kabul, Afghanistan, During the Third COVID-19 Wave: An Observational Study.

The COVID-19 has spread to everywhere since its emergence from Wuhan. In countries with a low vaccination rate, the use of facemasks is essential to limit the risk of COVID-19 transmission. We have conducted this study in June 2021 to estimate the prevalence of facemask usage, and investigate the use of different types of facemasks and their distribution among pedestrians in the most crowded urban districts of Kabul during the third COVID-19 wave in Afghanistan. Using a multistage sampling method, a total of 5,000 pedestrians were selected from five most crowded urban districts of the city. The data was gathered by an observational method. The percentage, mean, and standard deviation were used to describe the variables. The χ2 test analysis was used to assess the relationship between two categorical variables. Of the 5,000 observations, the most common age group was 10-39 years with high participation of male (87.2%). A total of 2,013 (40.3%) people used facemasks (95% CI). Females used facemasks significantly more than males (64.6% versus 36.7%, P < 0.001). Among the pedestrians who used a facemask, most of them (88.6%) wore their facemask correctly. In conclusion the prevalence of facemask use in Kabul was fairly low especially among elderly people (≥ 60 years). Hence, the observed rates probably cannot protect the community against the COVID-19. Therefore, it is important to emphasize the public health recommendations via educational programs and national campaigns to support the strict use of facemasks in public places.

Public Perception and Preparedness to Fight Against the Third Wave of COVID-19 in Kabul, Afghanistan.

The avalanche of Corona Virus 2019 (COVID-19) cases has placed an unprecedented load on Afghanistan's government and public health authorities, putting the country in jeopardy. The primary goal of this research was to shed light on the country's capital, Kabul, and to examine the existing preparedness and perceptions of its population in the midst of COVID-19's third wave, which could result in decentralization and fragmentation of the already overburdened health-care system. An online, cross-sectional survey was conducted by the lecturers of the Kabul University of Medical Sciences between April 15, 2021 and April 25, 2021, to evaluate the preparedness of the Kabul citizens amidst the third wave of COVID-19. About 1736 citizens from Kabul participated in the survey. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. All categorical variables were reported using frequencies and percentages. The findings revealed that the most common source of COVID-19-related information was social media (74.8%). In addition, 34.4% of subjects had previously been infected with COVID-19. It was reassuring to see that 78.4% of residents said they knew more about COVID-19 than they did about prior COVID-19 waves. A majority (81.5%) expressed willingness to resist the third wave, but 89.4% said that the country's government would be unable to develop an effective COVID-19 vaccine within the next 6 months. The findings of this present study indicates that citizens of Kabul are active in obtaining accurate information and disseminating it in the community. The citizens also reported sufficient COVID-19 related knowledge; however, they were more motivated to fight against the third wave of COVID-19. In regards to vaccination, they believed that the government could not vaccinate the public anytime soon. Hence, the enactment of non-pharmaceutical measures is important in the fight against the pandemic.

High rates of COVID-19 vaccine refusal among Afghan pregnant women: a cross sectional study.

Severe Acute Respiratory Syndrome Corona Virus Type-2 (SARS-COV-2) was first detected in China and created a global pandemic rapidly. Subsequently after serious efforts different types of vaccines produced against the virus and recommended for all people including pregnant women. The aim of this study was to realize the willingness of pregnant women to accept the COVID-19 vaccine in Kabul Afghanistan. For this purpose, a cross-sectional study was conducted in gynecology wards of several hospitals in Kabul, Afghanistan from 10th of July to 20th of August 2021 through direct interview with the pregnant women who had come for prenatal care to the healthcare centers. The collected data were analyzed through Statistical Package for Social Studies (SPSS) version 25. Simple descriptive analysis computed for demographic characteristics and bi-variable (Chi-square) analysis was carried out to find out the associations of taking vaccine with demographic variables. A p-value of < 0.05 was considered significant at 95% confidence interval. A total of 491 who were completed the inclusion criteria included in the analysis. A small portion of pregnant women (8.6%) illustrated the intent to get the COVID-19 vaccine if it is recommended by the health authorities in Afghanistan. Our study found a high rate of COVID-19 vaccine refusal among pregnant women in Kabul, Afghanistan. They showed the concern on adverse effects of the vaccine as the main reason for refusal, emphasizing the need to reduce the misconception on vaccine efficacy and campaigns to enhance awareness on the vaccine safety and benefits for mothers and babies.

Self-reported adherence to preventive practices during the third wave of COVID-19 in Afghanistan.

Objective: The study objectives were aimed to highlight the areas where public awareness is needed to enhance preventive practices among the public. Hence, to avoid the spread of virus in public settings. In addition, the study has provided compelling data and evidence on the coronavirus disease-2019 trend for health policymakers to make strategic decisions. Introduction: The coronavirus disease-2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus type-2. The disease has spread across the globe. In Afghanistan, thousands of confirmed cases with hundreds of deaths have been reported. In addition, due to insufficient healthcare workforce, insecurity, fragile healthcare infrastructure, low coronavirus disease-2019 vaccination and low testing capacity, the true nature of the pandemic is unlcear. Method: An online survey of the general population in Afghanistan was conducted from April-May 2021. Convenience sampling technique was used to recruit the respondents. Social media platforms were used (WhatsApp, Twitter and Facebook Messenger) to disseminate the electronic survey instrument. Written informed consent was taken from the participants before the filling questionnaires. Data collection was guided through a self-administered questionnaire developed by the researchers according to the World Health Organization guidelines. The sample size was calculated using EPI software. The inclusion criteria were being 18 years or older and having access to the Internet to fill out the online questionnaire. IBM SPSS Statistics version 25.0 was used for analysis. Descriptive statistics (frequencies, percentages) and bi-variable (chi-square) analyses were done. A p value of <0.05 was considered significant at a 95% confidence interval. Results: From 1094 respondents, 78% were male. The majority of respondents were aged ⩽30 years and had an undergraduate education. Nearly 1 in 3 participants were healthcare workers, and 70% lived in households with five or more family members. Overall, 70% of the respondents reported good preventive practices. The majority of the participants reported covering their mouth and nose while coughing and sneezing and cleaning their hands regularly and using alcohol. Meanwhile, 80% of the participants wore a mask when going outside. Moreover, people with post-graduate education had a higher level of preventive practices than those with an undergraduate education.The results of logistic regression revealed participants residence in Kabul, healthcare workers, family size less than 5, avoid meeting people outside, gender, and avoiding 3Cs, were the significant determinants of adhering to good preventive practices. Conclusion: Generally, the public in Afghanistan followed infection prevention rules. However, certain areas require further improvement, such as observing social distance and avoiding shaking hands when meeting others. Negligence of these prevention practices can lead to an increase in infection transmission among people. Public awareness should be continued to keep the people supportive of the government policies.

Hijab or Niqab Interacts with Facemasks Usage at Healthcare Settings in Kabul, Afghanistan: A Multi-Center Observational Study.

Purpose: We aimed to understand the extent of facemask usage resulting from the third wave of the COVID-19 pandemic in an Afghan context. In Afghanistan, new COVID-19 variants, low vaccination rates, political turmoil, and poverty interact not only with the third wave of the COVID-19 pandemic but also with facemask usage. Methods: We collected data (n = 1970) by visually observing the usage and type of facemasks used among visitors entering healthcare facilities in Kabul. We conducted an observational study observing the use of facemasks among 1279 men and 691 women. Results: While 71% of all participants adhered to wearing facemasks, 94% of these users wore surgical masks, and 86% wore all types of facemasks correctly. Interestingly, women adhered to wearing facemasks more than men. Specifically, of all the participants who were not wearing masks, 20% were men, and only 8% were women. Even though men were more in number in our study (64.9%), women have a higher adherence rate to wearing facemasks than men. Conclusions: We conclude that gender socialization and expectations of women to wear the niqab or hijab interact with their adherence to wearing facemasks. Additionally, since Afghanistan is one of the poorest countries in the world, which has witnessed a considerable period of political turmoil, we spotlight that our findings are rare in scholarship as they represent a distinct non-Western Islamic society with a low scale of COVID-19 vaccination. Therefore, more research is needed to assess the general population's socioeconomic and geopolitical barriers to facemask use, given that Afghanistan is an underrepresented social context. Our findings are expected to aid health policymakers in developing novel prevention strategies for the country.

Risk Factors for Calcific Aortic Valve Disease in Afghan Population.

Objective: Evidence from previous studies suggests that calcific aortic valve disease (CAVD) is not an unavoidable consequence of aging, and may be linked to explicit risk factors. However, little is known regarding the Afghan population in this context. The current study aimed to identify the clinical features of CAVD and determine independent risk factors for CAVD in the Afghan population. Patients and Methods: A case-control study was conducted among 1072 Afghan participants (age >18 years) from January 2018 to December 2020. The study participants were divided into two groups based on echocardiographic findings: 536 individuals with CAVD and 536 age- and sex-matched controls. Data were collected using questionnaires from the medical records of all cases and controls. The independent predictors of CAVD were evaluated using multivariate logistic regression analysis. Results: The mean age of study participants was 65.3 ± 13.5 years (range, 20-100 years). Of the 536 patients with CAVD, 77 (14.4%) had aortic valve stenosis, 415 (77.4%) had aortic valve calcification, and 44 (8.2%) had bicuspid aortic valve. Multivariate logistic regression analysis revealed that sedentary lifestyle (odds ratio [OR] = 2.517, p = 003), diabetes mellitus (DM) (OR = 1.902, p = 006), high body mass index (BMI ≥ 30 kg/m2) (OR = 1.776, p = 005), good socioeconomic status (OR = 1.724, p = 021), and hypertension (OR = 1.664, p ˂0.001) were independent risk factors for CAVD in the Afghan population. Conclusion: It was observed that sedentary lifestyle, diabetes mellitus, high BMI (≥ 30 kg/m2), good socioeconomic status, and hypertension are independent risk factors for the development of CAVD compared to those with a normal aortic valve in the Afghan population.