Efficacy and Safety of the RBD-Dimer-Based Covid-19 Vaccine ZF2001 in Adults.

BACKGROUND: The ZF2001 vaccine, which contains a dimeric form of the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 and aluminum hydroxide as an adjuvant, was shown to be safe, with an acceptable side-effect profile, and immunogenic in adults in phase 1 and 2 clinical trials. METHODS: We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to investigate the efficacy and confirm the safety of ZF2001. The trial was performed at 31 clinical centers across Uzbekistan, Indonesia, Pakistan, and Ecuador; an additional center in China was included in the safety analysis only. Adult participants (≥18 years of age) were randomly assigned in a 1:1 ratio to receive a total of three 25-µg doses (30 days apart) of ZF2001 or placebo. The primary end point was the occurrence of symptomatic coronavirus disease 2019 (Covid-19), as confirmed on polymerase-chain-reaction assay, at least 7 days after receipt of the third dose. A key secondary efficacy end point was the occurrence of severe-to-critical Covid-19 (including Covid-19-related death) at least 7 days after receipt of the third dose. RESULTS: Between December 12, 2020, and December 15, 2021, a total of 28,873 participants received at least one dose of ZF2001 or placebo and were included in the safety analysis; 25,193 participants who had completed the three-dose regimen, for whom there were approximately 6 months of follow-up data, were included in the updated primary efficacy analysis that was conducted at the second data cutoff date of December 15, 2021. In the updated analysis, primary end-point cases were reported in 158 of 12,625 participants in the ZF2001 group and in 580 of 12,568 participants in the placebo group, for a vaccine efficacy of 75.7% (95% confidence interval [CI], 71.0 to 79.8). Severe-to-critical Covid-19 occurred in 6 participants in the ZF2001 group and in 43 in the placebo group, for a vaccine efficacy of 87.6% (95% CI, 70.6 to 95.7); Covid-19-related death occurred in 2 and 12 participants, respectively, for a vaccine efficacy of 86.5% (95% CI, 38.9 to 98.5). The incidence of adverse events and serious adverse events was balanced in the two groups, and there were no vaccine-related deaths. Most adverse reactions (98.5%) were of grade 1 or 2. CONCLUSIONS: In a large cohort of adults, the ZF2001 vaccine was shown to be safe and effective against symptomatic and severe-to-critical Covid-19 for at least 6 months after full vaccination. (Funded by the National Science and Technology Major Project and others; ClinicalTrials.gov number, NCT04646590.).

Effect of screen time on behavior of pre-schoolers in Islamabad.

Objective: Early years of childhood form the basis of intelligence, personality, social behaviour, and capacity to learn and nurture oneself as an adult. Our objective was to find out the effects of screen time on behavior of pre-schoolers, which could provide scientific grounds to the control of digital screen time. Method: A cross sectional survey was conducted in four private preschools of Islamabad from June -November 2021. A sample size of 200 children ages three-five years were selected through multistage random sampling using a parental questionnaire. Children were grouped based on daily screen time of ≤60 minutes or >60 minutes. Analysis was made based on the Child behavior checklist for ages eighteen months-five years results. Cronbach's alpha coefficient was found to be 0.925. It was analyzed using SPSS version 22. Chi-square test, independent sample t-test and multi linear regression were applied to determine the association and significance levels between the variables. Results: Study results indicate increased screen time was statistically significant with child's age, education level and employment status of mothers. It was observed that pre-schoolers with screen time of > 60 minutes tend to suffer more from withdrawal syndrome (11.94±3.91, p = 0.014) sleep problems (10.97±3.20, p = 0.010) and Autism spectrum problems (17.66±5.89, p = 0.047) as compared to pre-schoolers with screen time ≤60 minutes. Strongest predictor of outcome variable was found to be mothers education level (ß = 21.53). Conclusion: Study findings revealed that excessive screen time has deleterious effect and is associated with behavioural problems of pre-schoolers.

Development of a protocol for conducting a randomized control trial on effects of artificial intelligence on nutritional status of children post cardiac surgery.

OBJECTIVE: To assess the effect of diet-related mobile application based on artificial intelligence on the nutritional status of children post-cardiac surgery, and to compare their diet-related problems with their counterparts having the usual diet. METHODS: The two-arm double-blind randomised controlled trial will be conducted at a tertiary care hospital in Rawalpindi, Pakistan, over an expected duration of 6 months from March to August 2021. Intervention group A will be given a diet-related mobile application based on artificial intelligence, while usual-care group B will be handed a pamphlet with instructions related to post-operative diet on discharge. RESULTS: The findings will improve perception about the influence of artificial intelligence on nutritional status of children post-cardiac surgery. If proven to be effective, this mobile application can be used in other hospitals. CONCLUSIONS: The study protocol will give an indication that whether diet-related mobile application can contribute to improving the nutritional status of children post-cardiac surgery. As the pandemic has forced people to minimise hospital visits, this is the right time to evaluate the utility of such an application. Randomised controlled trial: Study was registered on clinicaltrial.gov with trial identity number NCT04782635.

Comparison of Critical Thinking among undergraduate medical students of Conventional and Integrated curricula in Twin Cities.

Objectives: To compare critical thinking of undergraduate medical students of institutes following traditional and integrated curriculum at Twin cities. Methods: The current cross-sectional study was conducted in medical colleges of Twin Cities from February 2021 till August 2021. Two medical colleges one with conventional and other with integrated mode of curriculum were included. One hundred medical students were selected by simple random sampling from each conventional and integrated medical college. Free critical thinking test tool was used for data collection. The tool was composed of five sections, Arguments, Assumptions, Deductions, Inferences and interpreting information. Data entry and analysis was done by using SPSS version 20. Chi-Square test of independence was run to determine the association of critical thinking with type of curriculum. Independent sample t-test was applied to find out the mean difference in the critical thinking of medical students following the two different curriculums. Results: In current study 200 students were included. Majority were females (n= 155, 77.5%). The overall percentage of good critical thinking was found to be 49%. Majority of the students (n=57, 58.2%) having good critical thinking were found associated with integrated curriculum (p < 0.024, OR= 0.524, 95% CI= 0.3 - 0.92). There was statistically significant difference of critical thinking between institutes following two different curriculum strategies. Total critical thinking score was also found statistically significantly [MD= 5.00, 95% CI, (-1.05-8.96), p<0.013], more with integrated curriculum (133.48±15.6) as compared to conventional curriculum (128.47 ± 11.43). Conclusion: Critical thinking was found high among the students with the integrated curriculum as compared to the conventional.

SLC4A11 mutations causative of congenital hereditary endothelial dystrophy (CHED) progressing to Harboyan syndrome in consanguineous Pakistani families.

BACKGROUND: Autosomal recessive corneal hereditary endothelial dystrophy (CHED) is a rare congenital disorder of cornea. Mutations in SLC4A11 gene are associated with CHED phenotype. CHED is also an early feature of Harboyan syndrome. The aim of the present study was to identify genetic mutations in the SLC4A11 gene in CHED cases belonging to inbred Pakistani families. Furthermore, all homozygous mutation carriers were investigated for hearing deficit. METHODS AND RESULTS: This study included consanguineous CHED families presented at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan from June 2018 to September 2018. DNA was extracted from blood samples. Direct sequencing of SLC4A11 gene was performed. All identified variants were evaluated by in silico programs i.e., SIFT, PolyPhen-2, and MutationTaster. Pathogenicity of the two identified splice site variants was analyzed by Human Splicing Finder and MaxEnt Scan. Screening of five CHED families revealed a total of three previously un reported (p.Arg128Gly, c.2241-2A > T and c.1898-2A > C in family CHED19, CHED22 and CHED26 respectively) and two already reported homozygous disease causing variants (p.Arg869Cys and p.Val824Met in family CHED24 and CHED25 respectively) as predicted by mutation taster. All of these variants segregated with disease phenotype and were not detected in controls. CONCLUSION: Affected individuals of the five CHED families screened in this study had the disease due to SLC4A11 mutations and progressing to Harboyan syndrome. Identification of previously unreported mutations aid to heterogeneity of SLC4A11 and CHED pathogenesis as well as helped to provide genetic counseling to affected families.

Risk factors, causative organisms and sensitivity patterns of infective keratitis in a tertiary care hospital in Rawalpindi.

OBJECTIVE: To determine the risk factors, causative organisms, sensitivity patterns and treatment outcomes of infective corneal ulcers. METHODS: The prospective cohort study was conducted from January 2018 to December 2019 at the Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan, and comprised eyes of patients with corneal ulcer. Corneal scrapes were sent for microbiological assessment. Variables studied were age, gender, risk factors, onset and duration of symptoms, best corrected visual acuity, treatment and complications. Data was analysed using SPSS 20. RESULTS: Of the 65 eyes of as many patients, 40(61.5%) were from female patients and 25(38.4%) from males. The most common local risk factor was ocular surgery 19(29.2%), followed by ocular trauma 15(23.1%). Diabetes was present in 29(44.6%) cases. Culture results after corneal scrapings were positive for 39(60%) samples, while 26(40%) had no growth. Bacterial growth was present in 20(51.3%) eyes, fungal in 11(28.2%) and polymicrobial organisms were present in 8(20.5%). The most common pathogens were pseudomonas 10(25.6%) that were most sensitive to ciprofloxacin. By the end of the follow-up, 40(61.5%) cases showed improvement. CONCLUSIONS: Isolated pseudomonas was the most common pathogen. Prompt diagnosis with culture sensitivity tests are needed in developing countries to avoid blindness due to infective corneal ulcers.

Measurement of Service Quality Gaps in Dental Services using SERVQUAL in Public Hospitals of Rawalpindi.

OBJECTIVES: To measure service quality gaps in dental services provided at public hospitals of the district, Rawalpindi. METHODS: A cross-sectional survey was conducted in two of the public hospitals of the district, Rawalpindi from April to October 2019. Non-probability consecutive sampling was used to include a total number of 400 patients, equally divided between Rural health center (RHC) and Tehsil headquarter (THQ). Face to face interviews were done using a 32-item SERVQUAL in the form of a structured questionnaire where one part of the questionnaire was filled before the treatment and the other after the treatment. Cronbach's alpha coefficient was found to be 0.90. It was analyzed using SPSS version 25 with descriptive and parametric tests, and further multiple linear regression was done. RESULTS: The quality of services provided to patients was significantly lower than their expectations in both RHC (-14.48 ± 7.96) and THQ (-9.97 ± 7.97). Independent t-test showed a significant difference in service quality between both the hospitals (-4.41), with a better quality of services in THQ. Association of service quality gap was statistically significant with gender, education, occupation, monthly income, and the number of visits to the hospital with p-value < 0.05. The type of hospital was the strongest predictor (ß = 4.12) of the outcome variable. CONCLUSION: The findings reveal that patients' expectations exceed their perception of dental services provided in public hospitals. THQ provided a better quality of services compared to RHC.

Health status of geriatrics in Gujrat, Pakistan.

OBJECTIVE: To determine the overall health status of the elderly in an area Pakistan's Punjab province. METHODS: The cross-sectional study was conducted from April to June 2016 in Tehsil Kharian of district Gujrat, Punjab, Pakistan district, and comprised people aged 60 years or more who were enrolled through multistage random sampling. To measure the health status, and adapted and modified version of Short Form-36 health survey was used. SPSS 23 was used for data analysis. RESULTS: Of the 395 subjects, 254(65%) were males, and the overall mean age was 69.18} 8.93 years. Of the total, 151(38%) subjects reported having no health issues. Among those who reported health issues, 63(16%) had joint problem as their primary health illness. Health status score suggested 286(72%) participants to have poor health, and in the 60-69 years age group, females were more likely to report poor health status compared to males (p<0.05). CONCLUSIONS: The majority of the elderly subjects reported to have poor health status, and females reported more health issues compared to males..

Co-morbid depression in individuals with type 2 diabetes mellitus.

It was a descriptive cross-sectional study conducted to determine the frequency of depression and association with factors in type 2 diabetics in diabetic clinic of Fauji Foundation Hospital Rawalpindi from 1st January - 30th June 2014. In all 110 diabetic patients were selected using convenient Sampling. Data was collected by using a pre- tested structured proforma. Beck's Depression Inventory (BDI) scale was used to screen depression. There were 20 males (18.2%) and 90 females (81.8%) in this study. Females had more mood disturbances and depression as compared to males, however difference was not statistically significant (p<0.769). 28.2% individuals had mild mood disturbances, while borderline clinical depression was present in 23.6% of study group, 20.9% were having moderate depression and 9.1% were having severe depression, rest 1.2% had extreme depression. Overall 55.5% respondents had depression in this study. Obesity was present in 60% of diabetics, 62.7% were hypertensives and 26.4% had ischaemic heart disease. Depression was statistically significantly associated with hypertension (p< 0.002).

Role of topical antibiotics in prophylaxis against endophthalmitis following intravitreal antibiotics.

OBJECTIVE: To compare the prophylactic use of antibiotic with placebo to prevent post intra-vitreal endophthalmitis and other complications. METHODS: A prospective, cohort study was conducted at Ophthalmology Department, Fauji Foundation Hospital (FFH), from June 2016 to July 2017. A total of 1082 eyes of 673 patients were enrolled in this study. Patients were selected at non-random and divided into two groups. In Group-I, non - exposed, placebo eye drops were given after intravitreal bevacizumab injections and in Group-II, exposed, ofloxacin eye drops were given after intravitreal bevacizumab injections. RESULTS: Total 1082 eyes were given intravitreal bevacizumab injection in 673 patients. No patients in Group-I, non - exposed, receiving placebo eye drops developed post intra vitreal endophthalmitis, whereas only 01 (0.1%) patient developed post intravitreal endophthalmitis in Group-II, exposed, receiving ofloxacin eye drops. In inferential statistics the P- value was also statistically insignificant [x2 (1, N=1082) =0.95, P>0.05]. CONCLUSION: This study showed that topical antibiotic, as a prophylaxis after intravitreal injections has no role in the prevention of post intravitreal endophthalmitis and other complications.

Panoramic View Of Challenges And Opportunities For Primary Healthcare Systems In Pakistan.

BACKGROUND: Pakistan has a broad system of primary health care facilities to achieve mission of "Health for all". Over the last seven years health expenditure by government of Pakistan has been increased to attain this goal. This study was conducted with the aim to assess all blocks of service readiness (basic equipment, basic amenities, laboratory capacity, standard precautions and essential medicines) in public-primary health care facilities of tehsil Rawalpindi, Pakistan. METHODS: A cross-sectional survey was carried out utilizing two separate structured questionnaires for basic health units and rural health centres. Information was collected from administrative heads along with other staff where required, of all public-primary health care facilities of Tehsil Rawalpindi. Data were analysed by using SPSS version.17. RESULTS: A total of 26 health facilities were assessed; only 56% BHUs had a sign board that was available in readable form. BHUs with women medical officer as administrative head constituted 52%. Backup for electricity and toilet were the most neglected areas. Basic amenities, standard precautions and laboratory capacity of Basic Health Units (BHUs) showed a clear deviation from standards and is thus a challenge for Pakistan's Primary Health care (PHC). On the other hand for Rural Health Centres (RHCs), most were on the way to meet expectations. CONCLUSIONS: Pakistan's government is undoubtedly putting efforts in order to achieve targets of primary healthcare but it needs better mainstreaming of political, institutional and social commitments with modified standards for PHC.

Improving nutritional status of children using artificial intelligence-based mobile application postsurgery: randomised controlled trial.

Background: Malnutrition is a common problem in children postsurgery especially in low-middle-income countries. Health-based mobile apps play an important role for better nutritional status. Methods: This is a two-arm randomised controlled trial, which was conducted at a tertiary care hospital, Rawalpindi. The study duration was 6 months from February 2021 to July 2021. The sample size with power of 80% and significance level of 5% was calculated to be 88. The intervention group was given a diet-related mobile app, and the usual care group was handed a pamphlet with diet instructions on discharge. Findings: The mean weight of all participants was 15 (SD 5.7) kg at the time of discharge. However, at the end of the 8th week, the mean weight of the participants in the usual care group was 16.5 (SD 7.2) kg and that of the intervention group was 17.1 (SD 5) kg. The average calorie consumed by the usual care group was 972 (SD 252) kcal and 1000.75 (SD 210) kcal by the intervention group after 8 weeks of discharge. The average protein consumed by the usual care group was 34.3 (SD 12.5) g and 39 (SD 6.4) g by the intervention group after 8 weeks of discharge. Interpretation: This study showed strength for the future of scalable modern technology for self-nutrition monitoring. There was a slight increase in the weight and nutritional intake of both groups. Trial registration number: NCT04782635.

Effect of antenatal counselling on exclusive breastfeeding.

BACKGROUND: The promotion and support of breastfeeding is a global priority. However, in reality most of the mothers are unable to practice exclusive breastfeeding. Most mothers discontinue breastfeeding because of lack of confidence in their ability to breastfeed, problem with infant suckling, breast pain, perception of insufficient milk, in addition to other unspecified difficulties. Some these problems can be solved if the women are counselled antenataly about the benefits of breastfeeding and prepared mentally for exclusive breastfeeding. The aim of the study was to determine whether the mothers with antenatal counselling on breastfeeding would improve their exclusive breast feeding and compare this with that of the mothers without antenatal counselling. It was a cross-sectional comparative study which took place at the Maternity ward of Fauji Foundation Hospital, Rawalpindi. METHODS: Hundred mothers selected by consecutive non probability sampling divided in two groups. Group A: 50 mothers who were counselled on breastfeeding and Group B: 50 mothers who were not counselled on breastfeeding. Fifty mothers practicing breast feeding after antenatal counselling in the maternity ward of Fauji Foundation Hospital, Rawalpindi were recruited in the study. Another fifty mothers practicing breastfeeding without antenatal counselling were asked to take part in the study as a control group. Performa was completed and an informed consent was obtained. RESULTS: As compared to the not counselled group, the mothers who initiated breastfeeding immediately after birth were statistically significantly higher (p < 0.046) in the counselled group (84% and 96% respectively). Similarly the number of counselled mothers who practiced exclusive breastfeeding was statistically very highly significantly more (p < 0.001) than the not counselled group (68% and 16% respectively). CONCLUSION: Antenatal counselling helps in motivating the mothers for initiation of breastfeeding immediately after birth and practicing exclusive breastfeeding for first six months of infant's life. Existing antenatal counselling on breastfeeding is inadequate in the population studied and needs to be strengthened.

Endophthalmitis Postintravitreal Bevacizumab Injections: Incidence, Management, and Visual Outcome in Tertiary Care Center in Pakistan.

PURPOSE: The purpose is to study the incidence, characteristics, management, and visual outcome of endophthalmitis postintravitreal bevacizumab (Avastin®) injections. METHODS: Retrospective cohort study conducted at Fauji Foundation Hospital that is a tertiary care center in Rawalpindi, Pakistan. The study duration was from January 1, 2015 to March 31, 2020. A total of 2321 eyes of 1407 patients were treated with Intravitreal bevacizumab (IVB) in a minor operation theater using standard aseptic measures. We studied the incidence, clinical characteristics, treatment, and visual outcomes of endophthalmitis post-IVB. RESULTS: Seven eyes (0.30%) out of 2321 eyes developed post-IVB endophthalmitis during the study period. Three eyes (42.8%) were culture positive and four eyes (57.2%) were culture negative. Five eyes (71.4%) showed visual improvement and two eyes (28.6%) did not show visual improvement. CONCLUSION: Prompt intravitreal antibiotic along with vitreous tap in cases of postintravitreal endophthalmitis may prevent vision loss which provides a useful alternative to immediate pars plana vitrectomy that requires more expertise, equipment, and an operation theater.

Effect of maternal anaemia on birth weight.

BACKGROUND: Anaemia is a common medical problem in pregnancy. The extent up to which, maternal anaemia effects maternal and neonatal health is still uncertain. Maternal anaemia is commonly considered a risk factor for low birth weight (LBW) babies. Some studies have demonstrated a strong association between low haemoglobin before delivery and LBW babies. However, others have not found a significant association. Therefore, there is insufficient information to assess the overall adverse impact of anaemia during pregnancy. The aim of this study was to determine whether maternal anaemia would affect the birth weight of the baby and compare this with that of non-anaemic mothers. It was a cross-sectional comparative study carried out at the maternity ward of Fauji Foundation Hospital, Rawalpindi. METHODS: One hundred subjects divided into two groups each containing 50 subjects on the basis of consecutive non probability sampling were included in the study. Group-A included 50 Anaemic pregnant women and Group-B 50 non-anaemic pregnant women. Information was collected by direct interviewing method through a precoded structured questionnaire. The Hb level and birth weights were taken from the labour room record. RESULTS: The mean age of the mothers in anaemic group was found to be older than the non anaemic group, i.e., (29.44 versus 27.98), though the difference was statistically non significant. The number of low birth weight infants (64%) was statistically very highly significantly more (p<0.001) in the anaemic group of mothers than the non anaemic group (10%). CONCLUSION: The results of this study show an association of maternal anaemia in pregnancy with increased risk of LBW babies.

Topical Ocular Anesthetic Use among Welders of Rawalpindi City, Pakistan.

A descriptive cross-sectional survey was done from January to June 2018 in welding shops of Rawalpindi city, Pakistan. The objectives of the study were to determine the frequency of topical ocular anesthetic use among welders and to assess the knowledge and practices of welders regarding safety measures. One hundred and fifty-eight welders from age group of 20 years and above, having welding work experience of more than one year, were included in the study. The sampling strategy was non-random convenient sampling. A pretested structured questionnaire was used to collect data. Topical ocular anesthetic use among welders was found to be 45.6%. Statistically significant association was found between knowledge and practices of welders regarding their safety measures (p<0.05). On binary logistic regression, work experience was found to be the strongest predictor of good knowledge (OR = 4.15, 95% CI = 1.45 - 12.15) and practices (OR=10.46 95% CI = 2.92 - 37.51). Key Words: Welder, Topical anesthetic abuse, Knowledge, Practices, Perceptions.

Pakistani nursing students' perspectives of compassion: A convergent mixed methods study.

BACKGROUND: There has been increased research on the conceptualization of compassion in nursing. Nursing institutions expect educators to foster student compassion. However, limited research exists on students' perceptions of compassion in nursing. PURPOSE: To develop a comprehensive understanding of students' perspectives of compassion and compassionate care. METHODS: A convergent mixed methods design. A purposive sample of 117 students completed an exploratory questionnaire and 17 participated in interviews. Descriptive analysis was used for quantitative data, thematic analysis for qualitative data, and joint displays for mixed analysis. RESULTS: In total, 83% of students described compassion as "understanding and sharing patients' suffering" and 88% indicated that compassionate care entails "consciously trying to understand patients, their needs, and their suffering". The qualitative themes were, meanings of compassion and compassionate care, ways of developing and fostering compassion, antecedents of compassion and compassionate care, and compassion in practice. CONCLUSIONS: Nursing students realized the importance of compassion for patients and nurses and identified different acts of compassionate care. The students noted the compassionate care entails deliberately caring for the "whole person" and can be fostered through practice, observations, and reflection.

Huge Gastric and Ileal Trichobezoars Causing Small Bowel Obstruction.

The bezoar is the accumulation of undigestible food or fibre in the digestive tract, most commonly in stomach and proximal small bowel. Trichobezoar is an accumulation of hair. They may present as an independent mass in small bowel or with or without an extension into the small bowel. The trichobezoars are well described, in terms of surgical, diagnostic, and therapeutic procedures. However, there are very few reports on psychiatric literature and a dual presentation of gastric and ileal trichobezoars. The authors present a case report of a gastric with an ileal trichobezoar that is rarely reported in literature. A young girl with a history of trichophagia presented with features of small bowel obstruction. On physical examination, there was abdominal distension with a huge mobile mass on left side of umbilicus extending up to the epigestrium. There were dilated small bowel loops on abdominal radiograph. Ultrasound-abdomen also showed fluid-filled dilated small bowel loops. She was further investigated with CT scan abdomen, which showed a large mass occupying whole of the stomach and another mass in distal ileum causing small bowel obstruction, suggestive of trichobezoar. Through anterior wall gastrotomy, huge trichobezoar was removed from stomach; and through distal ileal entrotomy, ileal trichobezoar was removed.