Effect of COVID-19 lockdown on health of women in Pakistan - Socioeconomic perspective.

Objectives: This study investigates the dimensions of women's experiences during the COVID-19 lockdown in Pakistan, considering their historical vulnerability to natural disasters. Methods: A cross-sectional study was conducted in Pakistan from May to September 2020 at Services institute of medical Sciences, Lahore. An online survey collected socio-demographic data, household responsibilities, and access to medical services using a self-designed questionnaire. Women aged 18 years and above (n=1307) were included through convenience sampling. Data analysis utilized SPSS 20.0. Results: Of the surveyed women, 10 (14.9%) experienced improved health outcomes, while 39 (58.27%) faced poor health outcomes. Proper access to medical services was reported by 29 (43.3%) participants, while 38 (57.1%) had no access. Two women (3.0%) conceived during the lockdown. 45 (67.2%) women lived in nuclear families, and 21 (31.3%) in joint family systems. Additionally, 46 (68.7%) women were significantly burdened with household chores, while 21 (31.3%) had a normal routine. Among COVID-19-positive respondents, 70% reported weight gain from increased screen time and sedentary lifestyle. Difficulties in managing children's online classes were reported by 34.6% of participants. Moreover, 84% had a monthly income below one hundred thousand PKR. Among women aged 23-28 years, 30.9% had adverse effect on their husband's income, and 4.7% experienced unemployment. Unfortunately, 16% of respondents lost a relative due to COVID-19. Even with access to health facilities. Conclusion: The COVID-19 lockdown in Pakistan led to adverse socioeconomic and health outcomes for women. These findings highlight the measures needed to address women's challenges amid pandemic impact.

Qualitative exploration of factors associated with shared decision-making in diabetes management: a health care provider's perspective.

OBJECTIVE: Internationally, patient-doctor interaction has shifted from the paternalist model to the shared decision-making (SDM) model, which is an essential part of effective management of chronic illnesses, especially diabetes. It is a relatively new concept in Pakistan, and data about healthcare providers' perspectives are lacking. The aim was to explore significant facilitators and barriers to effective SDM as perceived by endocrinologists. DESIGN: A qualitative research using in-depth interviews based on grounded theory was done. It was written in line with the Consolidated Criteria for Reporting Qualitative Research checklist. SETTING: The interviews were conducted at the workplace of the endocrinologist between April and July 2019. PARTICIPANTS: Prominent endocrinologists of Pakistan residing in Lahore were approached for in-depth interviews. The transcripts were analyzed simultaneously, and theme saturation was achieved in 11 interviews. MAIN OUTCOME MEASURES: Thematic analysis of data done using grounded theory. RESULTS: Four major and two minor themes were identified. The most cited barriers to effective SDM from the doctors' side were the shortage of time during consultations and the absence of formal training of clinicians in communication skills. However, the patients' hesitation in questioning the doctor, perceiving him as a paternalist 'messiah' in society and lack of education limits their ability to understand and comprehend treatment options. CONCLUSION: There are many barriers perceived by providers as well as clients/patients by effectively using SDM. Local cultural context is influencing a lot.

Q192R paraoxonase1 polymorphism is a risk factor for cataract in Pakistani population.

Cataract, the lens opacity, is among major causes of blindness in Pakistani population. In recent past, oxidative stress is suggested to play crucial role in loss of transparency. Along with other antioxidants, Paraoxonase 1 (PON1) has also shown decreased activity in patients suffering from cataract. The aim of current study was to examine the possible association of PON polymorphism with predisposition of cataract formation in local population. The study was conducted on 51 cataract patients and 50 control subjects considering all ethical issues. DNA was extracted from whole blood and PON1 polymorphism was identified using tetra primer ARMS-PCR method for both positions L55M and Q192R. Tetra primer ARMS-PCR results revealed that association between L55M polymorphism and cataract was insignificant while 192R genotype PON1 frequency was higher among the people suffering from cataract (78.4%) as compared to control subjects (56%), (odds ratio=2.857, confidence interval=1.197-6.820). Hence, R allele is likely to be a risk factor for cataract with allele frequency (82.3%) and (odds ratio=4.552, confidence interval=1.716-12.073, p-value=0.002). PON1 Q192R polymorphism is likely to be a risk factor for cataract development in Pakistani population while PON1 L55M was not found to be associated with cataract.

Diabetes Distress Among Type 1 Diabetic Adolescents in a Tertiary Care Hospital in Pakistan.

BACKGROUND AND AIM:  Diabetes distress, a term used to describe negative emotions associated with diabetes, is the key factor responsible for the elevated risk of psychological burden and compromised self-management. The aim of this study is to determine the prevalence of diabetes-related distress among adolescent patients with type 1 diabetes (T1D) and to ascertain various factors associated with it. METHODOLOGY: In this cross-sectional study, 117 T1D patients with age 12-20 years visiting a diabetic clinic in the Department of Endocrinology and Metabolism, Services Hospital Lahore from February 2022 to August 2022 were enrolled. The patient's demographic and clinical details were noted in a pre-designed proforma. T1D distress scale (T1DDS) was utilized as the tool for measuring diabetes distress and distress was classified as severe, moderate, and no/little distress. RESULTS: Of the total 117 T1D patients, 34.2% (n=40) had diabetes-related distress, out of which 31.6% had moderate and 2.6% had severe distress. The average total distress score was 1.73 ± 0.52 and higher mean scores were of powerlessness, negative social perception, and eating distress. Distress was higher among females, in those with the onset of diabetes in teens rather than in childhood. There is a significant impact of glycated hemoglobin (HbA1c) on the severity of diabetes distress as demonstrated by Pearson's correlation (r=.570, n= 117, p = <.001) Conclusion: The present study highlights the association of diabetes distress in adolescents with various factors, most significantly poor glycemic control, and therefore emphasizes the need for developing psychological interventional strategies in routine diabetes care to improve the mental well-being and self-management of diabetic patients.

Association of PON2 and PON3 polymorphism with risk of developing cataract.

PURPOSE: Paraoxonases (PON) are calcium bound enzymes offering protection against oxidative stress by working as endogenous free-radical scavenging molecules. Oxidative stress has been implicated in pathophysiology of many diseases including cataract. Lens opacity is an age related disorder which is a principal cause of blindness in Pakistani population. Relationship of PON2 and PON3 polymorphism with genetic predisposition for incidence of cataract has not been investigated till date. Objective of the current study was to explore possible association between PON2 and PON3 polymorphism with incidence of cataract in local population. METHODS: Our study design comprised of fifty-one cataractous and fifty-nine healthy individuals. Identification of single nucleotide polymorphism (SNP) at positions (C311S and G148A) for PON2 and C133A for PON3 was conducted using restriction fragment length polymorphism (RFLP). RESULTS: Statistical analysis revealed significant association of PON2 G148 allele with incidence of cataract. GG allele was found to be higher in cataract patients as compared to control (p < 0.001) suggesting distribution of PON2 G148A genotype and allele frequency is linked with cataractogenesis. There was no noticeable association between PON2 C311S and PON3 C133A. Significant difference was observed in distribution of 311CS/148A combined genotype with highest frequency in control individuals (88.89%), while 311S/148G combined genotypes showed the highest frequencies among the cataract patients (71.42%). CONCLUSION: Our data suggests mutation at G148A might be related with incidence of cataract in studied population.