Attitude and Acceptance towards COVID-19 Booster Doses among Literacy Advantaged Population in Pakistan: A Cross-Sectional Study.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected billions of lives and is expected to impose a significant burden on the economy worldwide. Vaccination is the only way to prevent the infection. However, convincing people to get themselves vaccinated is challenging in developing countries such as Pakistan. Therefore, a cross-sectional questionnaire-based study was conducted (n = 982 participants) all over Pakistan to evaluate the perception, knowledge, attitude, and acceptance of the general public towards the SARS-CoV-2 vaccine, in general, and a booster dose of SARS-CoV-2, in particular. The highest number of participants were from the province of Punjab (84.5%), followed by Islamabad (3.8%), Sindh (3.7%), Khyber Pakhtunkhwa (2.7%), Baluchistan (2.6%), Gilgit Baltistan (1.4%), and Azad Jammu and Kashmir (1.4%). A total of 915 participants were vaccinated against COVID-19, out of which 62.2% received one booster dose, followed by double booster doses (25.5%) and single vaccine shots (12.3%). The highest number of vaccinated participants were from Punjab (85.8%), followed by Islamabad (3.9%), Sindh (2.8%); Khyber Pakhtunkhwa (2.6%); Baluchistan (2.3%); Gilgit-Baltistan (1.3%); and Azad, Jammu, and Kashmir (1.2%). Among the vaccinated individuals, 71.4% were unemployed, 27.4% were employed (653), and 1.2% were retired from service. However, no significant association was observed among genders and educational levels in regard to acceptance of the booster vaccine. The outcomes of the study revealed that the increased acceptance of booster doses of the SARS-CoV-2 vaccines among the public was associated with the intent of personal and family protection. Moreover, individuals with low socioeconomic status and pregnant females showed the least acceptance towards the vaccine inoculation. The study also revealed a decline trend of accepting SARS-CoV-2 vaccine among children.

Perceived risk and perceptions of COVID-19 vaccine: A survey among general public in Pakistan.

BACKGROUND: The coronavirus disease has become a global pandemic, and it continues to wreak havoc on global health and the economy. The development of vaccines may offer a potential eradication of COVID-19. This study evaluated the general knowledge, attitude, and perception of COVID-19 vaccines in the Pakistani population. METHODS: A self-reporting e-survey and questionnaire-based survey from vaccination centers of different cities of Pakistan among 502 participants were conducted. The questionnaire comprised four sections inquiring demographics, vaccination status, and perception or attitude towards the vaccine. Univariate logistic regression was applied to predict the knowledge, attitude and behavior of participants. RESULTS: The mean age of participants was 50.8±20.3 years. 53% of the participants have both doses of vaccine administered. Pain on the site of injection (49.8%) was the most common symptom, followed by asthenia (43.0%), muscle pain (29.5%), and swelling (24.5%) on the site of vaccine administration. Females complain of more symptoms than males. More severe symptoms were reported after the first dose of vaccine administration; these symptoms subsided within a week for most participants. Overall, the respondents have a positive attitude towards the vaccine. 47.4% are sure about the vaccine's efficacy, 48.6% said getting vaccinated was their own decision, and 79.9% also recommended others to get vaccinated. CONCLUSION: The study concluded that the Pakistani population has a positive attitude but inadequate knowledge towards COVID-19 vaccines. Immediate awareness and vaccination education programs should be conducted by the authorities to complete the mass vaccination schedule.

Anti-hyperlipidemic and anti-diabetic evaluation of ethanolic leaf extract of Catharanthus roseus alone and in combination therapy

The use of plants in disease treatment is cost effective and relatively safe. This study was designed to investigate anti-hyperlipidemic and anti-diabetic activity of ethanolic leaf extract of Catharanthus roseus alone and in combination therapy in hyperlipidemic & diabetic mice. Eight groups comprising five mice each were used. Group A was hyperlipidemic control, group B, C, D received atorvastatin (20 mg/kg), leaf extract (200 mg/kg) and leaf extract in combination with atorvastatin (200 mg/kg and 20 mg/kg) orally for 15 days. Group E was diabetic control. Group F, G, H received sitagliptin (40 mg/kg), leaf extract (200 mg/kg) and extract in combination with sitagliptin (200 mg/kg and 40 mg/kg) orally for 7 days. Blood cholesterol levels were measured at 1st, 5th, 10th and 15th day and fasting blood sugar levels were measured at 2, 12, 24, 72 and 168 hours during treatment. One-way ANOVA with tukey- kramer multiple comparison test was used. The chemical characterization of ethanolic extract of Catharanthus roseus leaves showed presence of alkaloids, saponins, tannins and flavonoids. Ethanolic extract of Catharanthus roseus has significant anti-hyperlipidemic & anti-diabetic effects (p<0.05, p<0.01) when compared with control but had not cause significantly increase in anti-hyperlipidemic effects of atorvastatin. While significantly increased the antidiabetic effect of sitagliptin (p<0.05)

Epidemiological and Clinical Characteristics of COVID-19: A Retrospective Multi-Center Study in Pakistan.

The emergence of a pathogen responsible for a mysterious respiratory disease was identified in China and later called a novel coronavirus. This disease was named COVID-19. The present study seeks to determine the epidemiological and clinical characteristics of COVID-19 in Pakistan. This report will exhibit a linkage between epidemiology and clinical aspects which in turn can be helpful to prevent the transmission of the virus in Pakistan. A retrospective, multiple center study was performed by collecting the data from patients' with their demographics, epidemiological status, history of co-morbid conditions, and clinical manifestations of the disease. The data was collected from 31 public-sector and 2 private hospitals across Pakistan by on-field healthcare workers. A Chi-square test was applied to assess the relationship between categorical data entries. A total of 194 medical records were examined. The median age of these patients was found to be 34 years. A total of 53.6% active cases were present including 41.2% males and 12.4% females till the end of the study. Adults accounted for most of the cases (94.3%) of COVID-19. Fever (86.60%), cough (85.05%), fatigue (36.60%), dyspnea (24.74%), and gastrointestinal discomfort (10.31%) were among the most frequently reported signs and symptoms by the patients. However, 4.12% of the total patient population remained asymptomatic. The median duration of hospital stay was found to be 14 (0-19) days. The earliest source of the spread of the virus may be linked to the foreigners traveling to Pakistan. Spread among men was more as compared to women. A few cases were found to be positive, due to the direct contact with pets or livestock. Hypertension (7.73%), diabetes (4.64%), cardiovascular conditions (2.58%) were the most common co-morbidities. The percentage mortality was 2.50% with the highest mortality among elders.

Effect of calcium hypochlorite and chloramine on blood biochemistry and sodium pentobarbital induced sleeping time in mice.

Disinfectants are chemical agents used to eradicate, deactivate or kill microorganisms. Chemical disinfectants especially chlorine compound are extensively used for water sanitization. Among these calcium hypochlorite and chloramines are commonly used now a day. Large number of chemical compounds, drugs and endogenous substances are metabolized by hepatic enzymes known as cytochrome P450 enzyme system. Many chemicals are capable of enzyme induction. Enzyme induction may change the metabolism of other drugs and endogenous substances which may alter the plasma concentration of these chemicals. To evaluate the enzyme inducing ability of calcium hypochlorite and chloramine, sleeping time induced by sodium pentobarbital was noted in mice. Normal saline was taken as negative control. Rifampicin, chloramphenicol and grapefruit juice were taken as positive control group. On completion of dosing after 4 weeks, alteration in sleep induction and recovery times was noted and compared. Histological evaluation of liver was observed. A significant decrease in sleeping time was observed in calcium hypochlorite and chloramine treated groups. Both calcium hypochlorite and chloramine caused a significant change in liver enzymes and in the values of complete blood count. In histological evaluation both caused fat deposition in the hepatocytes. It was concluded from the study that both calcium hypochlorite and chloramine were hepatic microsomal enzyme inducer.

Evaluation of cytotoxicity and antiviral activity of ivermectin against Newcastle disease virus.

Cytotoxic and antiviral potential of ivermectin and ribavirin was evaluated. Cytotoxicity was checked on chick primary fibroblast cell line through MTT assay. Antiviral potential was determined against Newcastle disease virus on 9-day old chicken embryos. Six different concentrations (200, 100, 50, 25, 12.5 and 6.25µg/ml) of both the drugs were evaluated. The 100µg/ml concentration of ivermectin and higher were cytotoxic. The 25µg/ml concentration of ribavirin and higher were cytotoxic. Comparison of ivermectin and ribavirin showed that ivermectin was safe at 50µg/ml and lower concentrations. Ribavirin was protective for cell at 12.5µg/ml and 6.25µg/ml only. Comparison of antiviral activity indicated that ivermectin has strong antiviral potential at 100µg/ml and higher but same concentrations were cytotoxic. Ribavirin showed strong antiviral potential at all concentrations.

Determination of bacterial etiological agents, sensitivity pattern and clinical outcome of patients with bacterial endocarditis at Punjab Institute of Cardiology, Lahore.

OBJECTIVE: To determine the type of pathogens causing bacterial endocarditis, their in vitro drug susceptibility profile and the effect of empirical antibiotic therapy in endocarditis patients. METHODS: The prospective study was conducted at the Punjab Institute of Cardiology, Lahore, from January to November 2013. Blood samples of endocarditis patients in the 20-40 age group were collected and culture-positive patients were included in the study. Antibiotics given to patients as empirical therapy were noted. Antimicrobial susceptibility of the isolates against various antibiotics was determined in vitro by using Kirby Bauer disc diffusion technique. The results were interpreted as frequencies and percentages. RESULTS: Of the 110 endocarditis patients initially scanned, 60(54.5%) were culture-positive and represented the study sample. Of them, 31(51.7%) were men and 29(48.3%) were women. The combination of Benzyl Penicillin and Gentamicin was given to 11(18.3%) patients, while combination of Vancomycin and Gentamicin and Vancomycin alone was also given to 3(5%) and 6(10%) patients respectively. Overall, 53(88.3%) isolates were Gram-positive and 7(11.7%) were Gram-negative. Among Gram-positive isolates, 39(65%) were Methicillin-sensitive Staphylococcus aureus, 2(3.3%) were Methicillin-resistant Staphylococcus aureus and 12(20%) were Streptococcus species. Among the Gram-negative group, 5(8.4%) isolates were of Escherichia coli, 2(3.3%) were of Pseudomonas aeruginosa. In vitro antimicrobial susceptibility of Gram-positive revealed 100% susceptibility to Vancomycin. Pseudomonas aeruginosa showed 100% in vitro susceptibility to Ciprofloxacin, Ceftazidime, Piperacillin+Tazobactam and Tigecycline, while Escherichia coli showed 60% susceptibility to Amikacin and Co-Amoxiclav. CONCLUSION: The frequency of Gram-positive organisms causing endocarditis was high. Vancomycin in Gram-positive cases revealed better in vitro efficacy, while in Gram-negative cases, Ciprofloxacin, Ceftazidime, Piperacillin+Tazobactam, Tigecycline Amikacin and Co-Amoxiclav were more effective than other antibiotics.

Antibiotic therapy in pyogenic meningitis in paediatric patients.

OBJECTIVE: To isolate and identify the causative pathogen, antibiotic sensitivity testing and success rate of empirical antibiotic therapy in pyogenic meningitis. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: The Children's Hospital and Institute of Child Health, Lahore, Pakistan, from March to July 2012. METHODOLOGY: The study was performed on 72 culture positive meningitis cases in children less than 15 years of age. This therapy was evaluated by monitoring the patient's clinical picture for 14 - 21 days. The collected data was analyzed by Chi-square test. RESULTS: Seventeen different bacteria were isolated. The most commonly occurring bacteria were coagulase negative Staphylococci (25%), E. coli (12.5%), Klebsiella pneumoniae (8.3%), Streptococcus pneumoniae (8.3%) and Pseudomonas aeruginosa (8.3%). All the bacteria were sensitive to vancomycin (96.7%), meropenem (76.7%), amikacin (75%), ciprofloxacin (65.3%), chloramphenicol (46.5%), ceftazidime (44.2%), cefepime (41.9%), co-amoxiclav (38.0%), oxacillin (34.8%), cefotaxime (21.4%), penicillin (20.7%), ceftriaxone (18.6%), cefuroxime (14%) and ampicillin (6.9%). The combination of sulbactam and cefoperazone showed antimicrobial sensitivity of 81.4%. The success rate of empirical antibiotic therapy was 91.7%. CONCLUSION: It was found that Gram negative bacteria were the major cause of pyogenic meningitis. Mostly there were resistant strains against all commonly used antibiotics except vancomycin. All empirical antibiotic therapies were found to be most successful.

In vitro toxic action potential of anti tuberculosis drugs and their combinations.

Tuberculosis (TB) is one of the leading infectious causes of death due to single infectious agent after HIV/AIDS. Rifampicin (RIF), Isoniazid (INH), Ethambutol (EMB), Pyrazinamide (PZA) and/or their combinations are extensively prescribed to treat TB. Despite several therapeutic implications, these drugs also produce several toxic effects at cellular level. MTT assay and Ames test were adopted in this study for the determination of cytotoxic and mutagenic potential of these anti-TB drugs. Among all tested drugs, cytotoxic potential of RIF was strongest with highly significant decline (p<0.001) in cell numbers at the concentration of 250µg/ml with LC50 at 325µg/ml, while significant decline (p<0.01) in cell count was observed in INH treated group at the concentration 500µg/ml with LC50 at 1000µg/ml. Moreover, combination RIPE demonstrated significant reduction (p<0.01) in cell number at the concentration of 25-500-500-500µg/ml with LC50 at 60-1200-1200-1200µg/ml. It is apparent from the data that almost all drugs represented identical mutagenic pattern i.e., more significant results were achieved in TA100 with metabolic activation (+S9). RIF proved to be highly mutagenic of all tested drugs with significant mutagenicity (p<0.01) at 0.0525µg/plate against TA98 strain with S9. The combination RIPE exhibited highly significant mutagenic activity (p<0.01) at concentration 0.125-3-3-3µg/plate without S9, while addition of S9 resulted in similar activity at lower doses, i.e., 0.0525-1-1-1µg/plate. It was concluded from the data that all anti-TB drugs possess significant cytotoxic and mutagenic potential, especially in combination, making TB patient more vulnerable to cytotoxic and mutagenic effects of anti-TB drugs, which could produce further health complications in TB patients.