Assessment of caregiver burden of patients receiving dialysis treatment in Rawalpindi.

OBJECTIVE: To determine the burden on the caregivers of patients receiving dialysis treatment. METHODS: This cross-sectional study was carried out in four different dialysis centres of Rawalpindi, Pakistan, from June 1 to December1, 2015, and comprised attendants of patients receiving dialysis. The data was collected from the attendants of patients receiving dialysis, and caregiver burden was measured using the Zarit Burden Interview questionnaire. SPSS 22 was used for data analysis. RESULTS: Of the 164 subjects, 97(59%) were females. The majority of caregivers reported stress for caring (2.28±1.31), patients asking for more help than needed (2.14±1.13), health problems (1.03±1.11), financial constraints (1.70±1.15) and little time for self-care (2.15±1.21). Besides, 107(65%) caregivers perceived the burden of their patients as mild to moderate. A positive correlation was found between the duration of a person on dialysis, daily hours of care-giving and the total burden score of his/her caregiver (p<0.05 each). CONCLUSIONS: Care-giving can create enormous burdens on caregivers, affecting their physical and psychological health.

Augmentation of oral submucous fibrosis by NSAIDs in the presence of risk factors.

Various Risk factors initiate Submucous fibrosis which may be augmented by NSAIDs. A number of animal studies on their mechanism indirectly support it especially regarding alterations in prostaglandin synthesis. This study has been designed to find association of these drugs with Oral Submucous fibrosis in the presence of risk factors. Newly diagnosed patients of Oral Sub mucous fibrosis were recruited for this study who attended Dental Department of Karachi Medical and Dental College from July 1 till Dec 31, 2013.A structured interview and medical record of each patient was used to determine the demographic profile, any addiction, previous and present illnesses and drug (s) used. Through examination of Oral cavity was carried out to access the severity of disease as per modified Khanna & Andrade Classification (1995). Statistical Analysis was done by SPSS 15. Total 102 patients were recruited from dental OPD as per criteria of inclusion. Among these patients 36 (49.31%) were using NSAIDs in which Acetaminophen (30.55%), Acetylsalicylic acid (25.00%) and Diclophenac (19.44%) were 1st, 2nd and 3rd most common drugs. Data shows that 14 patients (28.88%) had mild and 22(61.11%) had sever fibrosis which was significantly high (P<0.05). Mild fibrosis was seen in 05 (45.46%) and Sever fibrosis in 06 (54.54%) out of total 11 patients who were using NSAIDSs since less than or equal to 6 months. Similarly mild fibrosis was seen in 09 (36.00%) and Sever fibrosis in 16 (64.00%) out of total 25 patients who were on NSAIDs since more than 6 months. No statistical significant difference (P>0.05) in severity of fibrosis is seen in patients who were using NSAIDs since less than or equal to 6 months but statistical significant difference (P<0.05) in severity of fibrosis is seen in patients who on these drugs since more than 6 months. Addiction burden was calculated by Average Duration x Average Frequency, which was 92.72 for Pan, 88.88 for Supari and 61.30 for Miscellaneous. No statistically significant difference (P>0.05) was seen in addiction burden of various substances in these patients. An association of NSAIDs with Oral Sub mucous fibrosis exists. The pathology is augmented if these drugs are used in the presence of risk factors. Therefore these drugs should not be prescribed to these patients until a clear benefit is not targeted.

Phylogeography and evolutionary history of reassortant H9N2 viruses with potential human health implications.

Avian influenza viruses of the H9N2 subtype have seriously affected the poultry industry of the Far and Middle East since the mid-1990s and are considered one of the most likely candidates to cause a new influenza pandemic in humans. To understand the genesis and epidemiology of these viruses, we investigated the spatial and evolutionary dynamics of complete genome sequences of H9N2 viruses circulating in nine Middle Eastern and Central Asian countries from 1998 to 2010. We identified four distinct and cocirculating groups (A, B, C, and D), each of which has undergone widespread inter- and intrasubtype reassortments, leading to the generation of viruses with unknown biological properties. Our analysis also suggested that eastern Asia served as the major source for H9N2 gene segments in the Middle East and Central Asia and that in this geographic region within-country evolution played a more important role in shaping viral genetic diversity than migration between countries. The genetic variability identified among the H9N2 viruses was associated with specific amino acid substitutions that are believed to result in increased transmissibility in mammals, as well as resistance to antiviral drugs. Our study highlights the need to constantly monitor the evolution of H9N2 viruses in poultry to better understand the potential risk to human health posed by these viruses.

Isolation and identification of highly pathogenic avian influenza virus subtype H5N1 in peafowl (Pavo cristatus).

An outbreak of highly pathogenic avian influenza (HPAI) virus subtype H5N1 was first diagnosed in a "backyard" flock of peafowl (Pavo cristatus) raised on palace premises in the Kingdom of Saudi Arabia in December 3, 2007. The flock consisted of 40 peafowl, and their ages ranged from 3 to 5 years old. Affected birds suffered from depression, anorexia, and white diarrhea. Four dead birds were submitted for HPAI diagnosis at the Central Veterinary Diagnostic Laboratory in Riyadh. Brain and liver tissues and tracheal and cloacal swabs were taken from the dead birds and processed for a real-time reverse transcriptase (RT)-PCR test and virus isolation in specific-pathogen-free embryonating chicken eggs. The H5N1 subtype of avian influenza virus was isolated from the four dead birds and identified by a real-time RT-PCR before and after egg inoculation. The virus isolates were characterized as HPAI H5N1 virus by sequencing analysis. Phylogenetic comparisons revealed that the H5N1 viruses isolated from peafowl belong to the genetic clade 2.2 according to the World Health Organization nomenclature. The peafowl H5N1 virus falls into 2.2.2 sublineage II and clusters with the H5N1 viruses isolated from poultry in Saudi Arabia in 2007-08.

Epidemic outbreaks, diagnostics, and control measures of the H5N1 highly pathogenic avian influenza in the Kingdom of Saudi Arabia, 2007-08.

The first outbreak of H5N1 highly pathogenic avian influenza (HPAI) in the Kingdom of Saudi Arabia (KSA) occurred in two "backyard" flocks of Houbara bustards and falcons in February 2007. Subsequent outbreaks were seen through the end of 2007 in "backyard" birds including native chickens, ostriches, turkeys, ducks, and peacocks. From November 2007 through January 2008, H5N1 HPAI outbreaks occurred in 19 commercial poultry premises, including two broiler breeder farms, one layer breeder farm, one ostrich farm, and 15 commercial layer farms, with approximately 4.75 million birds affected. Laboratory diagnosis of all H5N1-positive cases was conducted at the Central Veterinary Diagnostic Laboratory (CVDL) in Riyadh, Saudi Arabia. A combination of diagnostic tests was used to confirm the laboratory diagnosis. A rapid antigen-capture test and real-time reverse transcriptase-PCR (rtRT-PCR) assay on clinical and field specimens were conducted initially. Meanwhile, virus isolation in specific-pathogen-free embryonating chicken eggs was performed and was followed by hemagglutinin (HA) and hemagglutination inhibition tests, then rapid antigen-capture and rtRT-PCR tests on HA-positive allantoic fluid samples. In most HPAI cases, a complete laboratory diagnosis was made within 24-48 hr at the CVDL. Saudi Arabian government officials made immediate decisions to depopulate all H5N1-affected and nonaffected flocks within a 5-km radius area and applied quarantine zones to prevent the virus from spreading to other areas. Other control measures, such as closure of live bird markets and intensive surveillance tests on all poultry species within quarantine zones, were in place during the outbreaks. As a result, the HPAI outbreaks were quickly controlled, and no positive cases were detected after January 29, 2008. The KSA was declared free of HPAI on April 30, 2008, by the World Animal Health Organization.

Isolation and identification of highly pathogenic avian influenza H5N1 virus from Houbara bustards (Chlamydotis undulata macqueenii) and contact falcons.

Highly pathogenic influenza virus (HPAIV) H5N1 has caused mortality and morbidity in many species of domestic and wild bird. The Houbara bustard (Chlamydotis undulata macqueenii) is a solitary bird that inhabits semi-desert regions. It is known to be susceptible to avianpox, avian paramyxovirus type 1, and low-pathogenicity avian influenza H9N2. We report an outbreak of H5N1 HPAIV in Houbara bustards, which were introduced into the Kingdom of Saudi Arabia for falconry purposes. Ninety-three per cent mortality (38 out of 41 birds) in the infected Houbara bustard flock and about 62.5% mortality (10 out of 16 birds) in falcons that came in contact with these birds were observed. Pooled cloacal and tracheal swabs from Houbara bustards as well as visceral organ homogenates collected in Houbara bustards and falcons were tested by real-time reverse transcriptase-polymerase chain reaction, and virus isolation was attempted in specific pathogen free hens' eggs. The viruses isolated were characterized as HPAIV H5N1. Phylogenetic analysis of the haemagglutinating and Neuraminidase (NA) genes revealed that the viruses isolated from Houbara bustards and falcons were closely related to each other and to Kuwaiti H5N1 strains isolated in 2007. Interestingly, they were genetically distinguishable from the co-circulating A/H5N1 viruses in Kingdom of Saudi Arabia causing outbreaks in domestic birds. This case emphasizes the need for surveillance of this endangered species in its natural habitat.

Co-circulation of two sublineages of HPAI H5N1 virus in the Kingdom of Saudi Arabia with unique molecular signatures suggesting separate introductions into the commercial poultry and falconry sectors.

Since early 2007, the Kingdom of Saudi Arabia (KSA) has experienced several highly pathogenic avian influenza (HPAI) H5N1 outbreaks in the falconry and poultry sectors. The public health threat associated with peculiar husbandry systems, requiring close contact between humans and birds of prey, highlights the need of an improved understanding of the epidemiology and of the viral characteristics of H5N1 viruses circulating in the region. Here we report molecular and phylogenetic analyses of H5N1 viruses isolated in the KSA in 2007 in distinct compartments of avian husbandry. From the results of our investigation it appears that two separate introductions into the different sectors occurred. The identification of specific amino acid mutations, which are described as genetic signatures of human influenza A viruses or known to confer resistance to antiviral drugs, raises concerns for the possible human health implications of the KSA H5N1 viruses.