Cognitive therapy for depression in tuberculosis treatment: protocol for multicentre pragmatic parallel arm randomised control trial with an internal pilot.

INTRODUCTION AND OBJECTIVES: There is an unmet need to develop high-quality evidence addressing tuberculosis (TB)-related mental health comorbidity, particularly in the context of lower-middle-income countries. This study aims to examine the effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) versus enhanced treatment as usual (ETAU) in improving depressive symptoms in people with TB and comorbid depression, enhancing adherence with anti-TB treatment (ATT) and its implementation in the real-world setting of Pakistan. METHODS: We will conduct a pragmatic parallel arm randomised control trial with an internal pilot. A brief psychological intervention based on CBT has been developed using a combination of qualitative and ethnographic studies. The inbuilt pilot trial will have a sample size of 80, while we plan to recruit 560 (280 per arm) participants in the definitive trial. Participants who started on ATT within 1 month of diagnosis for pulmonary and extrapulmonary TB or multidrug resistant TB (MDR-TB) and meeting the criteria for depression on Patient Health Questionnaire-9 (PHQ-9) will be randomised with 1:1 allocation to receive six sessions of CBT (delivered by TB healthcare workers) or ETAU. Data on the feasibility outcomes of the pilot will be considered to proceed with the definitive trial. Participants will be assessed (by a blinded assessor) for the following main trial primary outcomes: (1) severity of depression using PHQ-9 scale (interviewer-administered questionnaire) at baseline, weeks 8, 24 and 32 postrandomisation and (2) ATT at baseline and week 24 at the end of ATT therapy. ETHICS AND DISSEMINATION: Ethical approval has been obtained from Keele University Research Ethics Committee (ref: 2023-0599-792), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/CT/000990) and National Bioethics Committee Pakistan (ref: No.4-87/NBC-998/23/587). The results of this study will be reported in peer-reviewed journals and academic conferences and disseminated to stakeholders and policymakers. TRIAL REGISTRATION NUMBER: ISRCTN10761003.

Healthcare interactions prior to first hospital admission with alcohol-related liver disease.

BACKGROUND AND AIMS: To examine the healthcare contacts of patients in the year before an index admission to hospital with alcohol-related liver disease (ArLD) to identify where opportunities for earlier identification of alcohol use disorders (AUD) and ArLD and intervention may occur. METHODS: A retrospective cohort study using the regional database encompassing NHS organisations across North West London (344 general practitioner [GP] practices, 4 acute hospital trusts and 2 mental health and community health trusts). Patients who had an index admission with ArLD were identified through healthcare coding and compared with a control cohort. Healthcare contacts, blood tests and AUD testing in the year preceding admission were measured. RESULTS: The ArLD cohort had 1494 participants with an index hospital admission with ArLD. The control cohort included 4462 participants. In the year preceding an index admission with ArLD, 91% of participants had at least one contact with primary care with an average of 2.97 (SD 2.45) contacts; 80% (n = 1199/1494) attended ED, 68% attended an outpatient clinic, and 42% (n = 628/1494) had at least one inpatient admission. Only 9% of the ArLD (137/1494) had formal testing for AUD. Abnormal bilirubin and platelets were more common in the ArLD than the control cohort 25% (138/560) and 28% (231/837), respectively, v 1% (12/1228) and 1% (20/1784). CONCLUSIONS: Prior to an index admission with ArLD patients have numerous interactions with all healthcare settings, indicating missed opportunities for early identification and treatment.

Classification of aerosols using particle linear depolarization ratio (PLDR) over seven urban locations of Asia.

Active lidar remote sensing has been used to obtain detailed and quantitative information about the properties of aerosols. We have analyzed the spatio-temporal classification of aerosols using the parameters of particle linear depolarization ratio and single scattering albedo from Aerosol Robotic Network (AERONET) over seven megacities of Asia namely; Lahore, Karachi, Kanpur, Pune, Beijing, Osaka, and Bandung. We find that pollution aerosols dominate during the winter season in all the megacities. The concentrations, however, vary concerning the locations, i.e., 70-80% pollution aerosols are present over Lahore, 40-50% over Karachi, 90-95% over Kanpur and Pune, 60-70% and over Beijing and Osaka. Pure Dust (PD), Pollution Dominated Mixture (PDM), and Dust Dominated Mixture (DDM) are found to be dominant during spring and summer seasons.This proposes that dust over Asia normally exists as a mixture with pollution aerosols instead of pure form. We also find that black carbon (BC) dominated pollution aerosols.

Assessment of variability in PM2.5 and its impact on human health in a West African country.

PM2.5 has become a global challenge threatening human health, climate, and the environment. PM2.5 is ranked as the most common cause of premature mortality and morbidity. Therefore, the current study endeavors to probe the spatiodynamic characteristics of PM2.5 in the Republic of Niger and its impacts on human health from 1998 to 2019. Based on remotely sensed satellite datasets, the study found that the concentration of PM2.5 continued to rise in Niger from 68.85 µg/m3 in 1998 to 70.47 µg/m3 in 2019. During the study period, the annual average PM2.5 concentration is far above the WHO guidelines and the interim target-1 (35 µg/m3). The overall annual growth rate of PM2.5 concentration in Niger is 0.02 µg/m3/year. The health risk (HR) due to PM2.5 exposure is also escalated in Niger, particularly, in Southern Niger. The extent of the extremely high-risk areas corresponding to 1 × 104-9.4 × 105 µg.persons/m3 is increased from 0.9% (2000) to 2.8% (2019). Niamey, southern Dakoro, Mayahi, Tessaoua, Mirriah, Magaria, Matameye, Aguié, Madarounfa, Groumdji, Madaoua, Bouza, Keita, eastern Tahoua, eastern Illéla, Bkomnni, southern Dogon-Doutchi, Gaya, eastern Boboye, central Kollo, and western Tillabéry are experienced high HR due to long-term exposure to PM2.5. These findings indicate that PM2.5 causes a serious health risk across Niger. There is an immediate need to carry out its regional control. Therefore, policymakers and the Nigerien government should make conscious efforts to identify the priority target areas with radically innovative appropriate mitigation interventions.

Association and progression of multi-morbidity with Chronic Kidney Disease stage 3a secondary to Type 2 Diabetes Mellitus, grouped by albuminuria status in the multi-ethnic population of Northwest London: A real-world study.

INTRODUCTION: The prevalence of Diabetic Kidney Disease (DKD) secondary to Type 2 Diabetes Mellitus (T2DM) is rising worldwide. However, real-world data linking glomerular function and albuminuria to the degree of multi-morbidity is lacking. We thus utilised the Discover dataset, to determine this association. METHOD: Patients with T2DM diagnosed prior to 1st January 2015 with no available biochemical evidence of CKD were included. Patients subsequently diagnosed and coded for CKD3a in 2015, were grouped by the degree of albuminuria. Baseline and 5-year co-morbidity was determined, as were prescribing practices with regards to prognostically beneficial medication. RESULTS: We identified 56,261 patients with T2DM, of which 1082 had CKD stage 3a diagnosed in 2015 (224-CKD3aA1,154-CKD3aA2,93-CKD3aA1; 611 patients with CKD3a but no uACR available in 2015 were excluded from follow up). No statistically significant difference was observed in the degree of co-morbidities at baseline. A significant difference in the degree of hypertension, retinopathy, ischaemic heart disease and vascular disease from baseline compared to study end point was observed for all 3 study groups. Comparing co-morbidities developed at study end point, highlighted a statistical difference between CKD3aA1 Vs CKD3aA3 for retinopathy alone and for hypertension and heart failure between CKD3aA2 Vs CKD3aA3. 40.8% of patients with CKD3aA2 or A3 were prescribed Renin Angiotensin Aldosterone inhibitors (RAASi) therapy between June-December 2021. Survival analysis showed 15% of patients with CKD3aA3 developed CKD stage 5 within 5 years of diagnosis. DISCUSSION: CKD3a secondary to DKD is associated with significant multimorbidity at baseline and 5 years post diagnosis, with CKD3aA3 most strongly associated with CKD progression to CKD 5, heart failure, hypertension and retinopathy compared to CKD3aA1 or CKD3aA2 at 5 years post diagnosis. The lack of uACR testing upon diagnosis and poor prescribing of RAASi, in those with CKD3aA2/A3, raises significant cause for concern. CONCLUSION: DKD is associated with significant multimorbidity. Significant work is needed to be done to ensure patients undergo testing for uACR, to allow for future risk stratification and ability to be started on prognostically beneficial medication.

Effectiveness of locally produced ready to use supplementary food on hemoglobin, anthropometrics, and plasma micronutrients concentrations of 6 to 23 months age children: a non-randomized community-based trial from Pakistan.

Background: Micronutrient deficiencies including vitamin A, vitamin D, and zinc are highly prevalent in children below 5 years of age in low and -middle-income countries. We aimed to evaluate the effectiveness of ready-to-use Lipid-based Nutrient Supplement-Medium Quantity (LNS-MQ) local name "Wawa-mum" on plasma micronutrient status, hemoglobin concentration and anthropometric measurements. Methods: A community-based non-randomized trial was conducted in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019. A total of 110 children aged 6 to 23 months old were recruited and allocated to the intervention and control arm of the study. A total of 57 children in the intervention arm received a daily ration of 50 g of Wawa-mum, for one year. To assess the impact of the intervention on primary outcome measures, i.e., serum vitamin A, D concentration, plasma zinc, and hemoglobin concentration. Blood samples were collected at baseline and after one year following the intervention. The vitamins concentration in serum were assessed using Enzyme-Linked Immunosorbent Assay (ELISA) and plasma zinc by atomic absorption spectrometry. The hemoglobin concentration was measured by an automated hematology analyzer. A 24-h dietary recall interview was used to assess the nutrient intake adequacy. Multivariate Linear regression models were used to analyze the outcomes while controlling for potential confounders. Results: In the intervention arm, children had on average 6.2 µg/dL (95% CI 3.0-9.3, value of p<0.001) increase in the serum vitamin A concentration, 8.1 ng/mL (95% CI 1.3-14.9, value of p 0.02) increase in serum vitamin D concentration and 49.0 µg/dL (95% CI 33.5-64.5, value of p<0.001) increase in the plasma zinc concentration, and 2.7 g/dL (95% CI 2.0-3.3, value of p<0.001) increase in hemoglobin concentration while adjusted for covariates. An addition, length-for-age z-score (LAZ), weight-for-length z-score (WLZ), weight-for-age z-score (WAZ), and prevalence of undernutrition including stunting, wasting, and underweight were calculated as a secondary outcome to investigate the impact of micronutrients on growth parameters, that has been improved significantly after receiving the Wawa-mum. Conclusion: Wawa-mum (LNS-MQ) is an effective intervention to improve the micronutrient status, hemoglobin concentration, and growth parameters in 6 to 23 months children, which can be scaled up in the existing health system to address the alarming rates of under nutrition in Pakistan and other developing countries. Clinical trial registration: https://doi.org/10.1186/ISRCTN94319790, ISRCTN94319790.

Role of Primary Care Physicians in management of Schizophrenia in Low and Middle Income Countries (LMIC): A systematic review.

Many people with Schizophrenia lack the resources and access to mental health services especially in low and middle income countries. Integration of mental health into primary care services can be a cost effective way of reducing the disability associated with Schizophrenia. Our aim was to review the studies conducted on role of Primary care physicians in management of Schizophrenia in low and middle income countries. PRISMA guidelines were followed and we registered the study protocol at PROSPERO. Four Electronic Databases (Medline, Psycinfo, CINAHL and Embase) were searched in May 2022. Relevant articles after search were 504 of which 61 full text were examined. A total of 20 studies were included in the final review comprising of observational, experimental and qualitative studies. Most studies reported on abilities of Primary care physicians including their knowledge, perceptions, skills and competencies in identifying and management of Schizophrenia and related Psychosis. Findings suggest that there is considerable amount of stigma, lack of awareness and social support about people diagnosed with Schizophrenia. Significant improvement was observed in diagnosis and management of schizophrenia by Primary care physicians who received appropriate training by experts in the field. This review suggests that appropriate training of General practitioners in diagnosing and treating schizophrenia can help in reduction of huge Treatment Gap in Schizophrenia. They can also be utilised in delivering psycho social interventions to improve overall quality of patient care.

Analysis of aerosol optical depth and relation to covariates during pre-monsoon season (2002-2019) over Pakistan using ARIMAX model and cross-wavelet analysis.

The pre-monsoon season heavily influences the precipitation amount in Pakistan. When hydrometeorological parameters interact with aerosols from multiple sources, a radiative climatic response is observed. In this study, aerosol optical depth (AOD) space-time dynamics were analyzed in relation to meteorological factors and surface parameters during the pre-monsoon season in the years 2002-2019 over Pakistan. Level-3 (L3) monthly datasets from Moderate Resolution Imaging Spectroradiometer (MODIS) and Multi-Angle Imaging Spectroradiometer (MISR) were used. Tropical Rainfall Measuring Mission (TRMM) derived monthly precipitation, Atmospheric Infrared Sounder (AIRS) derived air temperature, after moist relative humidity (RH) from Modern-Era Retrospective analysis for Research and Applications, Version-2 (MERRA-2), near-surface wind speed, and soil moisture data derived from Global Land Data Assimilation System (GLDAS) were also used on a monthly time scale. For AOD trend analysis, Mann-Kendall (MK) trend test was applied. Moreover, Autoregressive Integrated Moving Average with Explanatory variable (ARIMAX) technique was applied to observe the actual and predicted AOD trend, as well as test the multicollinearity of AOD with covariates. The periodicities of AOD were analyzed using continuous wavelet transformation (CWT) and the cross relationships of AOD with prevailing covariates on a time-frequency scale were analyzed by wavelet coherence analysis. A high variation of aerosols was observed in the spatiotemporal domain. The MK test showed a decreasing trend in AOD which was most significant in Baluchistan and Punjab, and the overall trend differs between MODIS and MISR datasets. ARIMAX model shows the correlation of AOD with varying meteorological and soil parameters. Wavelet analysis provides the abundance of periodicities in the 2-8 months periodic cycles. The coherency nature of the AOD time series along with other covariates manifests leading and lagging effects in the periodicities. Through this, a notable difference was concluded in space-time patterns between MODIS and MISR datasets. These findings may prove useful for short-term and long-term studies including oscillating features of AOD and covariates.

Long-Term Impact of Multiple Micronutrient Supplementation on Micronutrient Status, Hemoglobin Level, and Growth in Children 24 to 59 Months of Age: A Non-Randomized Community-Based Trial from Pakistan.

Cost-effective interventions are needed to address undernutrition, particularly micronutrient deficiencies, which are common in children under the age of five in low- and middle-income countries. A community-based, non-randomized clinical trial was undertaken in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019, to evaluate the effect of locally produced micronutrient powder (local name: Vita-Mixe) on plasma micronutrient status, hemoglobin level, and anthropometric outcomes. Children aged 24-48 months old were recruited and allocated to the intervention and control arm of the study. The enrolled children in the intervention arm received one micronutrient powder (MNP) sachet for consumption on alternate days for 12 months. To assess the impact of the intervention on plasma levels of zinc, vitamin D, vitamin A, and hemoglobin level, blood samples were taken at baseline and after one year following the intervention. The analysis was conducted using Enzyme-Linked Immunosorbent Assay (ELISA), atomic absorption spectrometry, and an automated hematology analyzer. For the impact on growth parameters, the anthropometric assessment was performed using WHO standard guidelines. A 24 h dietary recall interview was used to assess the nutrient intake adequacy. Results showed that in the intervention arm, children had on average a 7.52 ng/mL (95% CI 5.11-9.92, p-value < 0.001) increase in the plasma level of vitamin A, 4.80 ng/mL (95% CI 1.63-7.95, p-value < 0.002) increase in vitamin D levels and 33.85 µg/dL (95% CI 24.40-43.30, p-value < 0.001) increase in the plasma zinc level, as well as a 2.0g/dL (95% CI 1.64-2.40, p-value < 0.001) increase in hemoglobin level. Statistically significant improvement was observed in the weight-for-height z-score (WHZ) (from -1.0 ± 0.88 to -0.40 ± 1.01, p < 0.001) and weight-for-age z-score (WAZ) (from -1.40 ± 0.50 to -1.05 ± 0.49, p < 0.001) in the intervention group compared to the control group. No statistically significant change was observed in the height-for-age z-score (HAZ) in the intervention group (p = 0.93). In conclusion, micronutrient powder supplementation is a cost-effective intervention to improve the micronutrient status, hemoglobin level, and growth parameters in under-five children, which can be scaled up in the existing health system to address the alarming rates of undernutrition in Pakistan and other developing countries.

Long term spatiotemporal trends and health risk assessment of remotely sensed PM2.5 concentrations in Nigeria.

PM2.5 is an important indicator reflecting air quality variations. Currently, environmental pollution related issues have become more severe that significantly threaten human health. The current study is an attempt to analyze the spatio-dynamic characteristics of PM2.5 in Nigeria based on the directional distribution and trend clustering analysis from 2001 to 2019. The results indicated that PM2.5 concentration increased in most of the Nigerian states, particularly in mid-northern and southern states. The lowest PM2.5 concentration in Nigeria is even beyond the interim target-1 (35 µg/m3) of the WHO. During the study period, the average PM2.5 concentration increased at a growth rate of 0.2 µg/m3/yr from 69 µg/m3 to 81 µg/m3. The growth rate varied from region to region. Kano, Jigawa, Katsina, Bauchi, Yobe, and Zamfara experienced the fastest growth rate of 0.9 µg/m3/yr with 77.9 µg/m3 mean concentration. The median center of the national average PM2.5 moved toward the north indicating the highest PM2.5 concentration in northern states. The Saharan desert dust is the dominant source of PM2.5 in northern areas. Moreover, agricultural practices and deforestation activities along with low rainfall increase desertification and air pollution in these regions. Health risks increased in most of the mid-northern and southern states. The extent of ultra-high health risk (UHR) areas corresponding to the 8×104-7.3×106 µg⋅person/m3 increased from 1.5% to 2.8%. Mainly Kano, Lagos, Oyo, Edo, Osun, Ekiti, southeastern Kwara, Kogi, Enugu, Anambra, Northeastern Imo, Abia, River, Delta, northeastern Bayelsa, Akwa Ibom, Ebonyi, Abuja, Northern Kaduna, Katsina, Jigawa, central Sokoto, northeastern Zamfara, central Borno, central Adamawa, and northwestern Plateau are under UHR areas.

Defining the role of renewable energy, economic growth, globalization, energy consumption, and population growth on PM2.5 concentration: evidence from South Asian countries.

Rapid industrialization and economic development in South Asia (SA) caused serious air pollution-related issues. Air pollutants, particularly fine particulate matter (PM2.5), have negative effects on health, instigating widespread concern. The current study is an attempt to analyze the impact of non-renewable energy (NRE), globalization (GLO), GDP, renewable energy (RE), and population (POP) on PM2.5 concentration in SA from 1998 to 2020. In doing so, this study incorporated advanced and robust econometric techniques, i.e., Pesaran (Economet Rev 34(6-10), 1089-1117, 2015), to check the cross-sectional dependency, and the unit root presence checked through Cross-sectional Im, Pesaran, and Shin (CIPS) and Cross-sectionally Augmented Dickey-Fuller (CADF) unit root tests. Moreover, the long and short-run association among the selected variables was analyzed through Westerlund and Edgerton (Econ Lett 97(3), 185-190, 2007), cointegration test, and cross-sectional augmented ARDL (CS-ARDL). The empirical results indicate that the panel was cross-sectionally correlated, stationary at the first difference, and co-integrated in the long run. Moreover, the CS-ARDL model indicates a positive association between GDP and PM2.5 concentration. Similarly, NRE and POP contribute significantly to increasing the PM2.5 concentration in SA. However, RE and GLO play an important role to decrease the PM2.5 concentration in SA.

Investigating the long-term trends in aerosol optical depth and its association with meteorological parameters and enhanced vegetation index over Turkey.

Aerosol optical depth (AOD) provides useful information on particulate matter pollution at both regional and global levels. In this study, the long-term datasets of aerosols, meteorological parameters, and enhanced vegetation index (EVI) were used from September 2002 to December 2021 over Turkey. This study examined the spatiotemporal distribution of aerosols and their association with meteorological parameters (temperature (Temp), relative humidity (RH), wind speed (WS)), and EVI over Turkey from 2002 to 2021. Moreover, this study also performed a comparison of AOD retrieved from Aqua with other satellites (Terra, SeaWiFS, and MISR) and ground-based (AERONET) products. The higher mean seasonal AOD (> 0.3) was observed over Southeastern Anatolia Region due to the dust transport from the Saharan Desert and Arabian Peninsula. Moreover, AOD was positively correlated with Temp and WS in the east of Turkey, while negative correlations were observed in the coastal regions. The correlation between AOD and RH was also observed negative in most parts of Turkey. Furthermore, in the coastal region, the correlation between AOD and EVI was found to be positive, whereas a negative correlation was seen over less vegetative areas. The multi-seasonal AOD averages were calculated as 0.187, 0.183, 0.138, and 0.104 for the spring, summer, autumn, and winter seasons, respectively. The most important result of this study is the regional differences in AOD over Turkey. For new studies, AOD should be observed separately for coastal areas and the eastern part of Turkey.

Economic policy uncertainty and CO2 emissions: a comparative analysis of developed and developing nations.

Energy consumption is essential for economic growth; however, its consumption also increases CO2 emissions, which contributes to climate change and environmental degradation. However, both environmental sustainability and sustainable development can be achieved by clean energy (CE) consumption since it consists of noncarbohydrates energy sources that seldom or do not cause CO2 emissions. Therefore, the current study considers economic policy uncertainty (EPU) to study the impacts of CE on CO2 emissions that control economic growth (GDP) and urbanization in both developed and developing nations. The findings from ARDL show that EPU significantly increases CO2 emissions in both the long and short run for both developing and developed nations. While CE and urbanization contribute to improving environmental quality. Economic growth increases CO2 emissions. The results could have a few significant practical impacts on economic policies across which policymakers could try to reduce policy uncertainty by participating in and organizing international treaties and summits. Additionally, international organizations could organize programs to reduce EPU. The role of political stability can be effective in reducing EPU in these countries. Moreover, these nations should introduce environmentally friendly innovation and clean energy technologies and give tax releases on the import and use of CE products while increasing R&D budgets.

Spatial and temporal variations in PM2.5 and associated health risk assessment in Saudi Arabia using remote sensing.

Air pollutants, especially ambient particulate matter (PM2.5), detrimentally impact human health and cause premature deaths. The dynamic characteristics and associated health risks of PM2.5 are analyzed based on the standard deviational ellipse (SDE) and trend analysis in Saudi Arabia (SAU) from 1998 to 2018 by utilizing recently updated satellite-derived PM2.5 concentrations (V4.GL.03). The outcomes show that the national average PM2.5 concentration increased from 28 µg/m3 to 45 µg/m3 with a growth rate of 2.3 µg/m3/year. The center of median PM2.5 concentrations moved to the southeast over the years studied due to the presence of vast sandy deserts, sand dunes, a busy port, and coastal and industrial areas in this region. The areas of SAU that experienced PM2.5 concentrations above 35 µg/m3 increased from 20% to 70%. The rapid-fast growth (RFG) class acquired from the unsupervised classification has the fastest growth rate of 2.5 µg/m3/yr, occurring in southeastern SAU, namely Ash-Sharqiyah, Ar-Riyad, and Najran. It covered ∼27% of the total area of SAU over the study period. Whereas, the slow growth (SG) class with a less than 0.2 µg/m3/yr growth rate covered 12% of the total area of SAU, distributed in northwestern regions. The extent of extremely-high risk areas corresponding to greater than 1 × 103 µg·person/m3 increased from 4% to 11%, particularly in Makkah, Central Al-Madinah, and western Asir, Jizan, mid-eastern Najran, Al-Quassim, and mid-eastern Ar-Riyad and Ash Sharqiyah.

Experiences of Newly Diagnosed Oral Cancer Patients during the First Wave of the COVID-19 Pandemic: A Qualitative Study from Pakistan.

The COVID-19 pandemic has resulted in the scaling back or postponement of non-emergency hospital services, including care of cancer patients. The present qualitative study explored the experiences of newly diagnosed oral cancer patients during the first wave of the COVID-19 pandemic in Pakistan. Patients who attended the Department of Maxillofacial Surgery, Khyber College of Dentistry in July 2020 were selected using a maximum variation purposive sampling method. Seventeen semi-structured interviews were conducted in Pashto, the local language of Khyber Pakhtunkhwa. All interviews were audiotaped, transcribed verbatim, and translated into English. Thematic content analysis yielded eight major themes: pain and generalised physical weakness, shock at diagnosis, psychological distress of the COVID-19 pandemic, faith and religion, double hit loss of employment, social isolation, social support from caregivers, and lack of support from health care professionals. In conclusion, the COVID-19 pandemic has a clear impact on the life experiences of newly diagnosed oral cancer patients. Distress due to delay in accessing health care and lack of support from health care providers are a matter of great concern. Appropriate interventions should be introduced to ensure psychological and social support strategies are in place for patients during interruptions of health care services.

Exploring the role of Microbiome in Susceptibility, Treatment Response and Outcome among Tuberculosis Patients from Pakistan: study protocol for a prospective cohort study (Micro-STOP).

INTRODUCTION: Tuberculosis (TB) caused by Mycobacterium tuberculosis is a common infectious disease associated with significant morbidity and mortality, especially in low-income and middle-income countries. Successful treatment of the disease requires prolonged intake (6-8 months) of multiple antibiotics with potentially detrimental consequences on the composition and functional potential of the human microbiome. The protocol described in the current study aims to identify microbiome (oral and gut) signatures associated with TB pathogenesis, treatment response and outcome in humans. METHODS AND ANALYSIS: Four hundred and fifty, newly diagnosed patients with TB from three district levels (Peshawar, Mardan and Swat) TB diagnosis and treatment centres, will be recruited in this non-interventional, prospective cohort study and will be followed and monitored until treatment completion. Demographic and dietary intake data, anthropometric measurement and blood, stool and salivary rinse samples will be collected at baseline, day 15, month-2 and end of the treatment. Additionally, we will recruit age (±3 years) and sex-matched healthy controls (n=30). Blood sampling will allow monitoring of the immune response during the treatment, while salivary rinse and faecal samples will allow monitoring of dynamic changes in oral and gut microbiome diversity. Within this prospective cohort study, a nested case-control study design will be conducted to assess perturbations in oral and gut microbiome diversity (microbial dysbiosis) and immune response and compare between the patients groups (treatment success vs failure). ETHICS AND DISSEMINATION: The study has received ethics approval from the Ethic Board of Khyber Medical University Peshawar, and administrative approval from Provincial TB Control Programme of Khyber Pakhtunkhwa, Pakistan. The study results will be presented in national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04985994.

Can Financial Institutional Deepening and Renewable Energy Consumption Lower CO2 Emissions in G-10 Countries: Fresh Evidence from Advanced Methodologies.

To tackle the challenges associated with global warming and climate change, several countries set their targets to lower carbon emissions in accordance with COP21 (Paris Conference). Even though studies highlighted the different aspects that contribute to environmental degradation, there still exists the scarcity of adequate research that emphasizes the environmental implications of financial institutional deepening, renewable energy consumption (REC), and technology innovations. Therefore, this study investigated the significance of financial institutional deepening, REC, gross domestic product (GDP), imports, exports, and technology innovations to achieve sustainability in G-10 countries, namely The Netherlands, Germany, France, Switzerland, United Kingdom, Sweden, Japan, Belgium, Canada, and Italy from 1990 to 2020. The results obtained from cross-sectionally augmented autoregressive distributed lag (CS-ARDL) and the dynamic common correlated effects mean group (DCCEMG) models reveal that financial institutional deepening and imports positively impact CO2 emissions (CO2e) both in the long and short run. A 1% increase in financial institutional deepening and import will increase CO2e by 0.5403% and 0.2942% in the short run and 0.2980% and 0.1479% in the long run levels, respectively. Contrary to this, REC, GDP, exports, and technology innovations improve environmental quality in these countries. The Dumitrescu & Hurlin causality test shows bidirectional causality between imports and CO2e, GDP and CO2e, exports and CO2e, and financial institutional deepening and CO2e, compared to unidirectional causality from technology innovations to CO2e and from REC to CO2e. Apart from this, the outcomes suggest that policymakers in G-10 countries have to consider their financial markets and firms to revise their current environmental policies.

Response of enhanced vegetation index changes to latent/sensible heat flux and precipitation over Pakistan using remote sensing.

For a sustainable development and ecological integrity, it is of worth importance to monitor land use/ land cover (LULC) changes and related land-atmosphere fluxes. To serve this purpose, we have used moderate resolution imaging spectroradiometer (MODIS) retrieved-enhanced vegetation index (EVI), MERRA-2 re-analysis surface heat fluxes (latent heat flux, sensible heat flux and specific humidity), TRMM rainfall data, and OMI retrieved aerosol index (AI) over Pakistan during 2000 to 2021. High EVI (0.66) is observed in May 2021 as compared to May 2000 over Muzaffarabad, Srinagar, north and northwest of Khyber Pakhtunkhwa, east of Punjab and along the Indus River in Sindh. The highest increase in vegetative area is observed in Baluchistan (~ 366%), followed by Manavadar (~ 60%), Khyber Pakhtunkhwa (~ 41%), Sindh (~ 37%), and Punjab (~ 20%) whereas Gilgit-Baltistan and Jammu and Kashmir show reduction in vegetative area by 21% and 11% respectively. The coefficient of determination (R2) is found to be highest between rainfall and latent heat flux (R2 = 0.59) followed by rainfall and specific humidity (R2 = 0.35), and rainfall and sensible heat flux (R2 = 0.06). The latent heat flux shows increasing trend at the rate of 0.003 Wm-2 winter-1, 0.0065 Wm-2 pre-monsoon-1 and 0.0272 Wm-2 post-monsoon-1 during 1980-2021 whereas sensible heat flux shows decreasing trend at the rate of 0.00056 Wm-2 winter-1, 0.00249 Wm-2 pre-monsoon-1 and 0.0037 Wm-2 post-monsoon-1 during 1980-2021. Specific humidity depicts increasing trend at the rate of 0.0002 Wm-2 winter-1, 0.0038 Wm-2 pre-monsoon-1 and decreasing trend at the rate of 0.0080 Wm-2 post-monsoon-1 during 1980-2021. The interannual variations in AI show highest AI of 2.28 in 2021 with maximum positive percentage anomaly of 28.06% during 2007.

Socio-Economic Drivers of Renewable Energy: Empirical Evidence from BRICS.

There is a need to implement efficient strategies to mitigate the challenges of climate change and income inequalities in developing countries. Several studies have been conducted to address the relationship among different econometric and environmental indicators of renewable energy (RE) but overlooked the relationship between RE and income inequalities. This study investigates the influence of the distribution of income on the RE in Brazil, Russia, China, and South Africa (BRICS) between 1988 and 2017. The econometric (economic growth and trade), environmental, and institutional parameters are also integrated into the model. The outcomes reveal that reduced inequality in income distribution increases the consumption of RE. In contrast, CO2 emissions have a positive correlation with RE. The governments should implement environmentally friendly policies and increase the consumption of renewable energy in the future with regards to reducing environmental pollution. Furthermore, findings from the study indicate a positive effect on the reduction of corruption in renewable energy. This shows that institutional quality can affect the uptake of renewable energy. The study further identified that growth in a country's economy decreases RE consumption, suggesting that these countries prefer fossil fuels to gain economic growth. The Granger causality results show that a bidirectional causality exists between income inequality and RE consumption. Bidirectional causality is observed between income distribution and CO2 emissions. The results from this study are important for policymakers to achieve sustainable development because fair income distribution and environmental quality are considered as two key factors for sustainable development. Strong institutions and control on corruption can bring sound social and economic gains. Therefore, fair distribution of income and strong institutional policies can increase RE consumption to achieve a clean environment.