COVID-19 vaccine hesitancy and attitudes in Pakistan: a cross-sectional phone survey of major urban cities.

BACKGROUND: COVID-19 mass vaccination is the only hopeful savior to curb the pandemic. Vaccine distribution to achieve herd immunity is hindered by hesitance and negative attitude of the public against COVID-19 vaccination. This study aims to evaluate the vaccine hesitancy and attitudes in major cities in Pakistan as well as their determinants. METHODS: A cross-sectional telephonic survey was conducted in June 2021 in major cities of Pakistan including Karachi, Lahore, Islamabad, Peshawar, and Gilgit, from unvaccinated urban population aged 18 years or older. Random Digit Dialing through multi-stage stratified random sampling was used to ensure representation of each target city and socio-economic classes. Questionnaire collected information on socio-demographics, COVID-19-related experiences, risk perception of infection, and receptivity of COVID-19 vaccination. Multivariate logistic regression analyses were performed to identify key determinants of vaccine hesitancy and acceptance. RESULTS: The prevalence of vaccinated population in this survey was 15%. Of the 2270 respondents, 65% respondents were willing to vaccinate, while only 19% were registered for vaccination. Factors significantly associated with vaccine willingness were older age (aOR: 6.48, 95% CI: 1.94-21.58), tertiary education (aOR: 2.02, 95% CI: 1.36, 3.01), being employed (aOR: 1.34, 95% CI: 1.01, 1.78), perceived risk of COVID-19 (aOR: 4.38, 95% CI: 2.70, 7.12), and higher compliance with standard operating procedures (aOR: 1.72, 95% CI: 1.26, 2.35). The most common vaccine hesitancy reasons were 'no need' (n = 284, 36%) and concerns with 'vaccine safety and side effects' (n = 251, 31%), while most reported vaccine motivation reasons were 'health safety' (n = 1029, 70%) and 'to end the pandemic' (n = 357, 24%). CONCLUSIONS: Although our study found 35% hesitancy rate of COVID-19 vaccine, there were noticeable demographic differences that suggest tailored communication strategy to address concerns held by most hesitant subpopulation. Use of mobile vaccination facilities particularly for less mobile and disadvantaged, and implementation and evaluation of social mobilization strategy should be considered to increase overall COVID-19 vaccination acceptance and coverage.

Cancer incidence in Khyber Pakhtunkhwa, Pakistan, 2020.

BACKGROUND: To present the population-based cancer statistics for Khyber Pakhtunkhwa (KP), Pakistan, an incidence study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan, in 2023. METHODS: Records from various centres on new cancers diagnosed among residents of KP between January and December 2020 were gathered. Both active and passive methods of data collection were applied, and the information was saved in a central repository at SKMCH&RC. The incidence rates were computed by age group and sex and presented per 100,000 population. RESULTS: Among children (0-14 years), the Age-Standardised Incidence Rate (ASIR) was 4.0 in girls and 6.1 in boys, and haematologic malignancies were more prevalent; in adolescents (15-19 years), the ASIR was 7.7 in females, 9.4 in males, and bone tumours, haematologic malignancies, and neurological cancers were prominent; in adult females (> / = 20 years), the ASIR was 84.9, and cancers of the breast, digestive system, and reproductive organs were predominant; and adult males, the ASIR was 73.0, and cancers of the gastrointestinal tract, lip/oral cavity/pharynx, prostate, and Non-Hodgkin Lymphoma (NHL) were common. CONCLUSIONS: It is crucial to investigate the aetiology of these diseases at the community level because dietary elements, infectious diseases, and tobacco use all appear to be significant contributors. Prospective studies could play a key role in highlighting the factors linked to these diseases. Therefore, cancer registration must continue in conjunction with the exploration of risk factors.

Raising the contraceptive prevalence rate to 50% by 2025 in Pakistan: an analysis of number of users and service delivery channels.

BACKGROUND: Pakistan is the fifth most populous country in the world, with a population that is growing at 2.4% annually. Despite considerable political will, including a national commitment that was endorsed by the president to raise the contraceptive prevalence rate (CPR) to 50% by 2025, it has stagnated at around 30-35%. Much of the dialogue on raising CPR is hypothetical and revolves around percentage point change rather than an actual number of women that must be served. METHODS: The Demographic and Health Survey 2017-18 (DHS 2017-18) provides information about the channels through which users receive family planning (FP) services and disaggregates this information at the provincial level. Proportions of users from each of these channels were multiplied by the Pakistan Census-2017 populations to arrive at the number of users. These users were compared with the total FP users and the number of women that had used any FP service in the past 12 months. Linear estimations of population were applied to calculate population numbers in 2025. RESULTS: The national target of 50% CPR by 2025 translates to a population of 20.02 million users. Currently, 11.26 million married women of reproductive age (MWRA) use any method, 8.22 million use a modern method and 4.94 million received this service in the past 12 months. Of these, 2.7 million did so from social marketing outlets, 0.76 million from public sector outreach through lady health workers (LHWs), 0.55 million from private sector and 0.88 million from public sector facilities. However, arriving at the CPR target means expanding annual service delivery from 4.94 to 13.7 million users. Since social marketing and LHW outreach may have become saturated, only public and private health facilities are the likely channels for such an expansion. CONCLUSIONS: We demonstrate triangulation of the survey data with the census data as a simple policy analysis tool that can help decision-makers estimate the quantum of services they must provide. Such an analysis also allows an understanding of the utilization patterns of each of these channels. In Pakistan's context, underutilization of funds and existing facilities suggests that increased funding or more providers will likely not be helpful. The policy changes that will likely be most effective include adding outreach to support existing public and private sector facilities while ensuring that procurement of commodities is prioritized.

A Scoping Review Of The Literature Of Research Ethics Committees And Ethics Review Framework In Pakistan: What We Know And What We Still Need To Learn.

OBJECTIVE: To map literature on research ethics committees, institutional review boards and ethics review framework in Pakistan to identify key insights during public health emergencies and normal times. Method: The systematic scoping review was conducted in April 2022, and comprised literature search on PubMed, World Health Organisation Global Index Medicus and Summons databases for articles published between January 2005 and February 2022. Information extracted included authors' names, year of publication, title, study methodology, and key insights under the heads of challenges and solutions. Due to data heterogeneity, key themes were identified and analysed. RESULTS: Of the 2,190 studies initially identified, 21(0.95%) were subjected to full-text review, and, from among them, 9(45%) were analysed in detail. There were 4 key insights identified: research ethics committees and institutional review boards in Pakistan remain unregulated as they are currently not registered or accredited by a competent national-level authority; most members of such committees are not formally trained to implement the mandate; internal and external pressures hinder independent decision-making of such committees; and other issues hindering the functionality and performance of research ethics committees and institutional review boards. CONCLUSIONS: Despite existing publications calling for urgent policy and regulatory reforms, there is a dearth of literature and minimal policy actions underlying the fact that ethics review remains a neglected area in Pakistan.

Connecting SiO4 in Silicate and Silicate Chain Networks to Compute Kulli Temperature Indices.

A topological index is a numerical parameter that is derived mathematically from a graph structure. In chemical graph theory, these indices are used to quantify the chemical properties of chemical compounds. We compute the first and second temperature, hyper temperature indices, the sum connectivity temperature index, the product connectivity temperature index, the reciprocal product connectivity temperature index and the F temperature index of a molecular graph silicate network and silicate chain network. Furthermore, a QSPR study of the key topological indices is provided, and it is demonstrated that these topological indices are substantially linked with the physicochemical features of COVID-19 medicines. This theoretical method to find the temperature indices may help chemists and others in the pharmaceutical industry forecast the properties of silicate networks and silicate chain networks before trying.

Some Novel Results Involving Prototypical Computation of Zagreb Polynomials and Indices for SiO4 Embedded in a Chain of Silicates.

A topological index as a graph parameter was obtained mathematically from the graph's topological structure. These indices are useful for measuring the various chemical characteristics of chemical compounds in the chemical graph theory. The number of atoms that surround an atom in the molecular structure of a chemical compound determines its valency. A significant number of valency-based molecular invariants have been proposed, which connect various physicochemical aspects of chemical compounds, such as vapour pressure, stability, elastic energy, and numerous others. Molecules are linked with numerical values in a molecular network, and topological indices are a term for these values. In theoretical chemistry, topological indices are frequently used to simulate the physicochemical characteristics of chemical molecules. Zagreb indices are commonly employed by mathematicians to determine the strain energy, melting point, boiling temperature, distortion, and stability of a chemical compound. The purpose of this study is to look at valency-based molecular invariants for SiO4 embedded in a silicate chain under various conditions. To obtain the outcomes, the approach of atom-bond partitioning according to atom valences was applied by using the application of spectral graph theory, and we obtained different tables of atom-bond partitions of SiO4. We obtained exact values of valency-based molecular invariants, notably the first Zagreb, the second Zagreb, the hyper-Zagreb, the modified Zagreb, the enhanced Zagreb, and the redefined Zagreb (first, second, and third). We also provide a graphical depiction of the results that explains the reliance of topological indices on the specified polynomial structure parameters.

A Paradigmatic Approach to Find the Valency-Based K-Banhatti and Redefined Zagreb Entropy for Niobium Oxide and a Metal-Organic Framework.

Entropy is a thermodynamic function in chemistry that reflects the randomness and disorder of molecules in a particular system or process based on the number of alternative configurations accessible to them. Distance-based entropy is used to solve a variety of difficulties in biology, chemical graph theory, organic and inorganic chemistry, and other fields. In this article, the characterization of the crystal structure of niobium oxide and a metal-organic framework is investigated. We also use the information function to compute entropies by building these structures with degree-based indices including the K-Banhatti indices, the first redefined Zagreb index, the second redefined Zagreb index, the third redefined Zagreb index, and the atom-bond sum connectivity index.

The emergence of an unassigned complex recombinant form in a Pakistani HIV-infected individual.

In Pakistan, the HIV situation has gone from an outbreak to a concentrated epidemic, and the virus has now crossed into the low-risk population. In addition, several new HIV outbreaks have occurred in different parts of the country. HIV-1 subtype A has been the major epidemic subtype in Pakistan; however, as the epidemic has grown, the emergence of several new subtypes and recombinant forms has been observed. Here, we present the first case and genetic analysis of an unassigned, complex recombinant form in a Pakistani HIV-infected individual with virological failure. Genetic analysis of the sequence indicated that this recombinant form is multi-drug resistant, harboring drug resistance mutations against more than one class of antiretroviral drugs.

A quantitative and qualitative analysis of the COVID-19 pandemic model.

Global efforts around the world are focused on to discuss several health care strategies for minimizing the impact of the new coronavirus (COVID-19) on the community. As it is clear that this virus becomes a public health threat and spreading easily among individuals. Mathematical models with computational simulations are effective tools that help global efforts to estimate key transmission parameters and further improvements for controlling this disease. This is an infectious disease and can be modeled as a system of non-linear differential equations with reaction rates. This work reviews and develops some suggested models for the COVID-19 that can address important questions about global health care and suggest important notes. Then, we suggest an updated model that includes a system of differential equations with transmission parameters. Some key computational simulations and sensitivity analysis are investigated. Also, the local sensitivities for each model state concerning the model parameters are computed using three different techniques: non-normalizations, half normalizations, and full normalizations. Results based on the computational simulations show that the model dynamics are significantly changed for different key model parameters. Interestingly, we identify that transition rates between asymptomatic infected with both reported and unreported symptomatic infected individuals are very sensitive parameters concerning model variables in spreading this disease. This helps international efforts to reduce the number of infected individuals from the disease and to prevent the propagation of new coronavirus more widely on the community. Another novelty of this paper is the identification of the critical model parameters, which makes it easy to be used by biologists with less knowledge of mathematical modeling and also facilitates the improvement of the model for future development theoretically and practically.

Microbiology and clinical characteristics of acute cholangitis with their impact on mortality; a retrospective cross sectional study.

OBJECTIVE: To evaluate microbiological and clinical characteristics of acute cholangitis along with their impact on mortality, and to compare the role of early versus late biliary drainage in the management of cholangitis. METHODS: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital Research Centre, Lahore, Pakistan, and comprised records of all patients presenting with acute cholangitis from June, 2012, to June, 2017. The risk factors, presence of bacteremia, resistance pattern of microbial pathogens and severity were assessed according to Tokyo guidelines in addition to associated mortality and recurrence at 3 months. Data was analysed using SPSS 20. RESULTS: Of the 230 patients, 137(59.6%) were male. The overall mean age was 56±13 years. The most common isolated organism was Escherichia coli 54(70.1%). Clinical severity (p=0.001), late biliary drainage (p=0.001) and use of multiple stents (p=0.03) were associated with increased mortality. However, in multivariable analysis, only high body mass index (p=0.01) and Tokyo severity grades II (p=0.04) and III (p=0.001) were significant factors associated with mortality. CONCLUSIONS: Early identification of risk factors, administration of appropriate antibiotics and establishing early biliary drainage were found to be the key management steps to reduce cholangitis-related mortality.

Characteristics of intercalary fragment in posterior malleolus fractures.

BACKGROUND: The purpose of the study is to investigatethe prevalence of posterior malleolus intercalary fragment (ICF) in adult ankle fractures; to analyze the morphological characteristics of ICF; and its mechanism. METHODS: Retrospectively, 247 cases of posterior malleolus fractures (PMF) were included in 369 cases of adult ankle fractures. The prevalence of ICF, relationship between type of ankle fracture, posterior malleolar fracture and the ICF was studied. RESULTS: Among 369 cases, the ICF was found in 43% of the PMF and 29% of the hospitalized unstable ankle fractures. Position of ICF is posterolateral in 68 (64%), mid posterior in 20 (19%) and posteromedial in 18 (17%) cases. The prevalence of ICF was 70% in Bartonícek classification type III fractures, which was significantly higher than type I, II and IV. CONCLUSIONS: The highest incidence occurs in Bartonícek III type fracture. The study helps in further understanding and treatment of the PMF. LEVEL OF EVIDENCE: Level IV, case series.

Diagnostic dilemma of granulomatous inflammation in cancer patients.

OBJECTIVE: To determine the frequency of granulomatous inflammation on histopathological findings amongst cancer patients and correlating them with tuberculosis. METHODS: The retrospective review was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised medical records of cancer patients with a histopathological finding of granulomatous inflammation between January 2010 and December 2015. Data was reviewed, including clinical history, availability of acid fast bacilli stain on tissue and mycobacterium tuberculosis culture results. Data related to treatment, duration and outcomes was also reviewed and was analysed using SPSS 19. RESULTS: Out of 28690 cancer patients during the study period, 17345(60.4%) had undergone biopsy for different reasons, and of those, 78 (0.45%) had granulomatous inflammation and formed the study sample. Among them, 40(51.3%) patients had caseous granulomatous inflammation while 38 (48.7%) had non-caseous granulomas. Acid fast bacillus tissue stain was performed on 77(98.7%) patients, of whom only 9 (11.5%) specimens showed acid fast bacilli. Mycobacterium tuberculosis culture was performed on 53(68%) specimens and among them 13(16.7%) grew mycobacterium tuberculosis. Anti-tuberculosis treatment was offered to 38 (48.7%) patients, including those with positive AFB stain and MTB culture results. Of them, 32(41%) patients completed the treatment while 4(5.1%) defaulted and 2(2.6%) died. Symptomatic and radiological improvement was observed in 16(20.5%) patients. CONCLUSIONS: Granulomatous inflammation was infrequently encountered in cancer patients. Mycobacterium tuberculosis cultures assisted in definitive decision-making but granulomatous inflammation could not be anticipated when the specimens were initially processed except when visible caseation was encountered. Processing specimens for mycobacterium tuberculosis cultures when caseation was encountered may be a reasonable strategy to adopt.

Hepatosplenic mucormycosis post autologous stem cell transplant.

Mucormycosis is a life threatening fungal infection and remains an important cause of morbidity and mortality in immunocompromised patients after hematopoietic stem cell transplant. We report here a case of hepatosplenic mucormycosis in a patient after autologous stem cell transplant. A young man with anaplastic large cell lymphoma underwent autologous hematopoietic stem cell transplant after achieving complete remission with standard chemotherapy and consolidative radiotherapy. He was found to have incidental hepatosplenic hypodensities on follow up imaging, that were proved to be mucormycosis on histopathology after getting CT-guided biopsy of splenic lesions. He was treated with intravenous amphotericin-B followed by complete radiological resolution of hepatosplenic lesions. Although these infections are often life threatening but limited disease may have better outcome if diagnosed and treated early and aggressively.

Risk factors and clinical outcomes for vancomycin-resistant enterococcus bacteraemia in hospitalised cancer patients in Pakistan: A case-control study.

OBJECTIVE: To compare the risk factors and outcomes of vancomycin-resistant enterococcus with vancomycin-sensitive enterococcus bacteraemia among hospitalised cancer patients. METHODS: The retrospective, case-control study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of cancer patients whose blood culture grew either vancomycin-sensitive or vancomycin-resistant enterococcus from January 2012 to December 2014. Multivariable logistic regression analyses were used to determine the factors associated with the development of vancomycin-resistant enterococcus bacteraemia and 12-week mortality. Stata 11 was used for data analysis. RESULTS: Of the 138 cases, 111(80%) were selected, of which 46(41.44%) were of vancomycin-resistant and 65(58.55%) were of vancomycin-sensitive enterococcus. Length of hospital stay prior to bacteraemia (adjusted odds ratio 1.18; 95% confidence interval 1.08-1.28) and use of vancomycin 30 days before the onset of bacteraemia (adjusted odds ratio 9.4; 95% confidence interval 1.70-52.19) were significant risk factors for the development of vancomycin-resistant enterococcus bacteraemia. The overall 12-week mortality rate was 29(63%) for patients with vancomycin-resistant bacteraemia and 28(43.1%) for vancomycin-sensitive enterococcus bacteraemia patients. Risk factors for mortality included the presence of shock at the time of the onset of bacteraemia (adjusted odds ratio 32.91; 95% confidence interval 3.02-358.81). CONCLUSIONS: The length of hospital stay and prior exposure to vancomycin were significant risk factors for the occurrence of vancomycin-resistant enterococcus bacteraemia.

Clinical features and outcomes of Candidaemia in cancer patients: Results from Pakistan.

OBJECTIVE: To evaluate clinical risk factors and outcomes among cancer patients with candidaemia at a large cancer treatment centre. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data related to all cancer patients with a positive blood culture for candida species between January 1995 and December 2013. RESULTS: A total of 311 patients were identified and there were 16 positive candida cultures among every 1000 (1.6%) cultures positive for any microorganism. Patients with haematological malignancies (adjusted odds ratio:2.23), those in shock (adjusted odds ratio: 9.48) were significantly more likely to die during the index hospitalisation, while patients with candida albicans isolated from the blood culture (adjusted odds ratio: 0.47) and those who received antifungal agent based on the sensitivity report of the fungal culture (adjusted odds ratio:0.32) were significantly less likely to die. Receipt of antifungal agents on an empirical basis before a positive culture was not significantly associated with mortality (p>0.05). CONCLUSIONS: No statistically significant risk factor for candidemia was identified, but haematological malignancies, shock and candidaemia due to non-albicans species were predictors of mortality during index hospitalisation.

Shigella infections: A two year experience in cancer patients.

OBJECTIVE: To identify clinical and microbiological characteristics of Shigella infections among cancer patients. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised medical records from December 2011 to November 2013 which were reviewed to identify persons with laboratory-confirmed Shigella infections. Demographic information, clinical history, seasonal variation, microbiological details, treatment given, and outcomes in term of symptoms resolution and mortality at two weeks were noted. RESULTS: Shigella infection was diagnosed in 45 cancer patients. The mean age of the patients was 36.02±19.30 years (range: 1-64 years), with 35(78%) patients being >18 years of age. Overall, 16(35.5%) patients had presented during winter months and 40(89%) presented as emergencies. Diarrhoea was present in 44(98%) patients and among them 20(45%) had dysentery whereas 28(64%) had fever and 21(47%) had abdominal pain. Of the total 45 cases, 41(91%) had isolates from stool. Besides, 39(87%) Shigella isolates were further speciated and Shigella flexneri was the most commonly isolated serotype in 25(64.1%). Overall, 42(93%) strains were sensitive to cefixime and ceftriaxone. Mean duration of symptoms resolution was 3.92±1.51 days (range: 1-10 days). No mortality was noted at 2 weeks. CONCLUSIONS: Shigella flexneri was the most common serotype isolated. Majority of the isolates were sensitive to 3rd generation cephalosporins (cefixime/ceftriaxone).

Bacteraemia caused by Escherichia coli in cancer patients at a specialist center in Pakistan.

OBJECTIVE: To analyse the antimicrobial susceptibility patterns of Escherichia coli bacteraemia among cancer patients, and to assess the risk factors and outcomes of multidrug-resistant Escherichia coli bacteraemia. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, and comprised medical records of patients with Escherichia coli bacteraemia presenting between December 2012 and November 2013. Multivariable logistic regression analyses were used to determine the factors associated with the development and 30-day mortality of multidrug-resistant Escherichia coli bacteraemia. RESULTS: Out of 1603 episodes of bacteraemia, 227(35.6%) were caused by E.coli, of which 98(43.2%) were multidrug-resistant. In multivariable analysis, age less than 18 years (adjusted odds ratio 3.92; 95% confidence interval 1.43-10.68), presence of central venous catheter (adjusted odds ratio 2.12; 95% confidence interval 1.04-4.33) and exposure to piperacillin/tazobactam within 90 days prior to infection (adjusted odds ratio 2.37; 95% confidence interval 1.15-4.86) were identified as independent risk factors for acquisition of multidrug-resistant Escherichia coli bacteraemia. The overall 30 day mortality rate was 35.2% (80/227). Risk factors for mortality were intensive care unit admission (adjusted odds ratio 3.95; 95% confidence interval 1.79-8.71) and profound neutropenia (adjusted odds ratio 4.03; 95% confidence interval 1.55-10.49). CONCLUSIONS: Bloodstream infections with multidrug-resistant Escherichia coli were common in cancer patients. However it was not a predictor of mortality.

Simultaneous quantitation of Ofloxacin, Fexofenadine HCl and Diclofenac Potassium in affixed dose combinative formulation by HPLC-UV method.

A high-pressure liquid chromatography (HPLC-UV) based simple and specific method for simultaneous quantitative determination of Ofloxacin, Fexofenadine HCl and Diclofenac Potassium has been developed and validated according to ICH guidelines. Chromatographic separation of the three drugs was carried out on 4.6 x 250 mm x 5 µ Licrospher RP Select B Column, using mobile phase constituted of methanol and phosphate buffer pH 3.5 (650: 350), pH adjusted to 3.5 ± 0.05 with dilute ortho-phosphoric acid and delivered at a flow rate of 1 ml/min. The eluents were detected at UV wavelength of 220 nm and the retention times for Ofloxacin, Fexofenadine HCl and Diclofenac Potassium were 2.5 minutes, 4 minutes and 11.5 minutes, respectively. This method is suitable and specific for the three drugs and was found to be linear (R² > 0.996), accurate, specific, reproducible and robust over a concentration range of 0.05 to 0.15 mg/ml for Ofloxacin, 0.015 to 0.045 mg/ml for Fexofenadine HCl and 0.0125 to 0.0375 mg/ml for Diclofenac Potassium. The proposed method is simple and convenient, hence easily utilized for the characterization and quantitation of the three drugs in a single formulation for combination therapy of rheumatoid arthritis, sepsis, infection with fever and flu.