Safety and efficacy of Sinopharm vaccine (BBIBP-CorV) in elderly population of Faisalabad district of Pakistan.

INTRODUCTION: The first case of novel SARS-COV-2 (COVID-19) in Pakistan was detected on 26 February 2020. Pharmacological and non-pharmacological strategies have been tried to lessen the mortality and morbidity burden. Various vaccines have been approved. The Drug Regulatory Authority of Pakistan gave emergency approval for Sinopharm (BBIBP-CorV) COVID-19 vaccine in December 2021. The phase 3 trial of BBIBP-CorV included only 612 participants aged 60 years and above. The primary aim of this study was to assess the safety and efficacy of BBIBPP-CorV (Sinopharm) vaccine within the Pakistani adult population aged 60 or above. The study was carried out in the Faisalabad district of Pakistan. METHODS: A test negative case-control study design was used to assess safety and efficacy of BBIBP-CorV in individuals aged 60 and above against symptomatic infection, hospitalisations and mortality due to SARS-CoV-2 among vaccinated and unvaccinated individuals. ORs were calculated using logistic regression model at 95% CI. ORs were used to calculate the vaccine efficacy (VE) by using the following formula.VE= (1-OR) ×100. RESULTS: 3426 individuals with symptoms of COVID-19 were PCR tested between 5 May 2021 and 31 July 2021. The results showed that Sinopharm vaccine 14 days after the second dose was efficient in reducing the risk of symptomatic COVID-19 infection, hospitalisations and mortality by 94.3%, 60.5% and 98.6%, respectively, among vaccinated individuals with a significant p value of 0.001. CONCLUSION: Our study showed that BBIBP-CorV vaccine is highly effective in preventing infection, hospitalisations and mortality due to COVID-19.

Excessive Daytime Sleepiness and Sleep Quality and their Impact on Health-Related Quality of Life in People with Epilepsy: A study from Pakistan.

BACKGROUND: Epilepsy is one of the most common but manageable neurological disorder. The relation between epilepsy, sleep, and health-related quality of life (HRQoL) in culturally distinct environment of Pakistan remains unclear. The purpose of this study was to determine prevalence and predictors of excessive daytime sleepiness (EDS), poor sleep quality (SQ), and to analyze their association with HRQoL in people with epilepsy (PWE). METHODS: A study was conducted among PWE attending two tertiary care hospitals of Islamabad and Rawalpindi, Pakistan. The EDS, SQ, and HRQoL were evaluated by Urdu versions of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31). RESULTS: The study included 200 PWE and 51 healthy controls with mean (SD) ages of 33.1 ±â€¯13.9, 32.9 ±â€¯10.9, and a disease duration of 5.01 ±â€¯6.17, respectively. The majority of the respondents (n = 130, 65%) had poor seizure control, and most of these (n = 88, 68%) were on combination antiepileptic drug (AED) therapy. In comparison to controls, a higher number of PWE had EDS by ESS (score ≥ 11, 10% vs. 40%, p-value 0.00), and poor SQ by PSQI (score > 5, 9% vs. 71%, p-value 0.00). A multiple logistic regression analysis reveals that the factors significantly associated with EDS were: female gender; increasing age; seizure control; duration of epilepsy; and combination AED therapy. A second multiple binary logistic regression analysis suggests that factors significantly associated with poor SQ were: increasing age; female gender; poor seizure control; and combination therapy. The Hierarchical multivariate analysis suggests that poor seizure control, EDS, and poor SQ were significant predictors of low HRQoL. CONCLUSION: The findings suggest high prevalence of EDS and poor SQ in PWE in Pakistan. A significant negative association exists between sleep complaints and HRQoL. During routine clinical consultations, awareness about sleep hygiene practices must be provided to enhance HRQoL.

3DMesh-GAR: 3D Human Body Mesh-Based Method for Group Activity Recognition.

Group activity recognition is a prime research topic in video understanding and has many practical applications, such as crowd behavior monitoring, video surveillance, etc. To understand the multi-person/group action, the model should not only identify the individual person's action in the context but also describe their collective activity. A lot of previous works adopt skeleton-based approaches with graph convolutional networks for group activity recognition. However, these approaches are subject to limitation in scalability, robustness, and interoperability. In this paper, we propose 3DMesh-GAR, a novel approach to 3D human body Mesh-based Group Activity Recognition, which relies on a body center heatmap, camera map, and mesh parameter map instead of the complex and noisy 3D skeleton of each person of the input frames. We adopt a 3D mesh creation method, which is conceptually simple, single-stage, and bounding box free, and is able to handle highly occluded and multi-person scenes without any additional computational cost. We implement 3DMesh-GAR on a standard group activity dataset: the Collective Activity Dataset, and achieve state-of-the-art performance for group activity recognition.

Photonic generation of terahertz dual-chirp waveforms ranging from 364 to 392†GHz.

In this paper, we propose and experimentally demonstrate a photonic scheme based on frequency doubling and photo-mixing to generate dual-chirp signals in the terahertz (THz) band. A broadband dual-chirp THz signal with 28 GHz bandwidth, ranging from 364 GHz to 392 GHz, is successfully generated in the proof-of-concept experiment, resulting in a chirp rate of 0.028 GHz/ns for both up chirp and down chirp signals. THz dual-chirp signals featuring a large bandwidth are beneficial to enable high resolution and high accuracy by mitigating the range measurement error induced by the range-Doppler coupling effect. Therefore, the proposed system is expected to have a great potential for future THz radar applications.

Knowledge, attitude and perceptions about Crimean Congo Haemorrhagic Fever (CCHF) among occupationally high-risk healthcare professionals of Pakistan.

BACKGROUND: Crimean Congo Haemorrhagic Fever (CCHF), a tropically neglected infectious disease caused by Nairovirus, is endemic in low middle-income countries like Pakistan. Emergency health care professionals (HCPs) are at risk of contracting nosocomial transmission of CCHF. We, therefore, aim to analyze the knowledge, attitudes, and perceptions (KAP) of at-risk physicians, nurses, and pharmacists in Pakistan and the factors associated with good KAP. METHOD: A validated questionnaire (Cronbach's alpha 0.71) was used to collect data from HCPs in two CCHF endemic metropolitan cities of Pakistan by employing a cross-sectional study design. For data analysis percentages, chi-square test and Spearman correlation were applied by using SPSS version 22. RESULTS: Of the 478 participants, 56% (n = 268) were physicians, 37.4% (n = 179) were nurses, and 6.5% (n = 31) were pharmacists. The proportion of HCPs with good knowledge, attitude, and perception scores was 54.3%, 81, and 69%, respectively. Being a physician, having more work experience, having a higher age, working in tertiary care settings, were key factors for higher knowledge (p < 0.001). The correlation coefficient showed significant positive correlation between attitude- perception (r = 0.560, p < 0.001). CONCLUSION: We have observed average knowledge of HCPs. Therefore, we recommend time to time education campaigns and workshops in highly endemic CCHF regions to be launched by health ministries and HCPs, in particular nurses, encouraged to follow authentic academic sources of information to prevent nosocomial transmission.

Translation and cross-cultural adaptation of WHOQOL-HIV Bref among people living with HIV/AIDS in Pakistan.

BACKGROUND: Reliable Health-Related Quality of Life (HRQoL) assessment will be useful in identifying health issues and in identifying health care actions. Due to the lack of a psychometrically valid tool in Urdu, we aim to translate and examine the psychometric and cross-cultural adaptation of WHOQOL HIV Bref among people living with HIV/AIDS (PLWHA) in Pakistan. METHODS: The standard forward-backwards translation technique was used to convert English version of the WHOQOL HIV Bref into Urdu. After cognitive debriefing, final Urdu version of instrument was developed. Based on the principle of at least 5 subjects for each item, a sample of 182 patients was used using a universal random sampling technique from the Pakistan Institute of Medical Sciences, Islamabad. The Cronbach's alpha and intra-class correlation coefficients (ICC) were estimated to assess internal validity and reliability of the translated version. Exploratory factor analysis was carried out to determine the factor structure and independent associations between the instrument domains and CD-4T-cell count were assessed using multivariable linear regression RESULTS: High Cronbach alpha 0.93 was found for all WHOQOL HIV Bref facets. The test-retest reliability demonstrated a statistically significant ICC ranged from 0.88 to 0.98 (p < 0.001). In known group validity, lower CD-4 lymphocytes count was significantly related to poor scores for all six domains (p < 0.001). Similarly, symptomatic subjects had significantly lower scores compared to asymptomatic subjects on the physical, psychological, social relationship and independence domains (p < 0.05). Statistically significant positive correlation of all six domains of instrument with CD4 cells count (p < 0.001), exhibiting patients with higher CD-4 cells will have higher mean scores of all domains. Factor analysis revealed 5 domains, including physical health, psychological health, social relationship, environmental, and spiritual health. Multivariable linear regression analysis reported; only physical, psychological health and environment health domains were found significantly associated with higher CD-4 lymphocytes count (Beta = 0.121, p < 0.001, Beta = 0.103, p = 0.002, and Beta = 0.032, p = 0.032). CONCLUSION: Findings suggested that the Urdu version of WHOQOL HIV Bref is a psychometrically valid and culturally well-adapted HRQoL measurement tool for PLWHA in Pakistan.

Health-related quality of life and its predictors among adults living with HIV/AIDS and receiving antiretroviral therapy in Pakistan.

BACKGROUND: Health-related quality of life (HRQoL) is considered to be the fourth 90 of UNAIDS 90-90-90 target to monitor the effects of combination antiretroviral therapy (ART). ART has significantly increased the life expectancy of people living with HIV/AIDS (PLWHA). However, the impact of chronic infection on HRQoL remains unclear, while factors influencing the HRQoL may vary from one country to another. The current study aimed to assess HRQoL and its associated factors among PLWHA receiving ART in Pakistan. METHODS: A cross-sectional descriptive study was conducted among PLWHA attending an ART centre of a tertiary care hospital in Islamabad, Pakistan. HRQoL was assessed using a validated Urdu version of EuroQol 5 dimensions 3 level (EQ-5D-3L) and its Visual Analogue Scale (EQ-VAS). RESULTS: Of the 602 patients included in the analyses, 59.5% (n = 358) reported no impairment in self-care, while 63.1% (n = 380) were extremely anxious/depressed. The overall mean EQ-5D utility score and visual analogue scale (EQ-VAS) score were 0.388 (SD: 0.41) and 66.20 (SD: 17.22), respectively. Multivariate linear regression analysis revealed that the factors significantly associated with HRQoL were: female gender; age  > 50 years; having primary and secondary education;  > 1 year since HIV diagnosis; HIV serostatus AIDS-converted; higher CD 4 T lymphocytes count; detectable viral load; and increased time to ART. CONCLUSIONS: The current findings have shown that PLWHA in Pakistan adherent to ART had a good overall HRQoL, though with significantly higher depression. Some of the factors identified are amenable to institution-based interventions while mitigating depression to enhance the HRQoL of PLWHA in Pakistan. The HRQoL determined in this study could be useful for future economic evaluation studies for ART and in designing future interventions.

Population preferences and attitudes towards COVID-19 vaccination: a cross-sectional study from Pakistan.

BACKGROUND: While vaccine development is itself a challenge; ensuring optimal vaccine uptake at population level can present an even more significant challenge. Therefore, this study aimed to assess the Pakistani population's attitude and preferences towards the Coronavirus disease 2019 (COVID-19) vaccine. METHOD: A cross-sectional study was carried out through an online self-administered questionnaire from 27 September 2020 to 11 October 2020. A total of 883 people responded to the survey. The questionnaire included the participants' socio-demographic variables, attitudes, beliefs towards the COVID-19 vaccine and acceptance and rejection of vaccination, and reasons for them. Logistic regression analysis was used to analyze the predictors for vaccine acceptance and willingness to pay for the vaccine. RESULTS: A majority (70.8%) of respondents will accept the COVID-19vaccine if available, and 66.8% showed a positive attitude towards vaccination. Monthly family income, education level, self-diagnosis of COVID-19 or a friend, family member, or colleague are significant factors influencing the acceptance of COVID-19 vaccination. The dogma of being naturally immune to COVID-19 was a key reason for the refusal of the vaccine. Less than half (48%) of those who refuse will vaccinate themselves if government officials have made it compulsory. A third (33.9%) of participants were willing to pay up to (7 USD) 1000 Pkr (Pakistani Rupees) for the vaccine. CONCLUSION: The population's positive attitude should be improved by increasing awareness and eradicating false myths about vaccines through large-scale campaigns.

The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review.

BACKGROUND: The pharmacist's role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists' clinical roles in improving Pakistani patients' therapeutic, safety, humanistic, and economic outcomes. METHODS: We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed. RESULTS: The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions. CONCLUSIONS: The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients' health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.

Case report: adult onset diabetes with partial pancreatic agenesis and congenital heart disease due to a de novo GATA6 mutation.

BACKGROUND: Mutations in GATA6 are the most frequent cause of pancreatic agenesis. Most cases present with neonatal diabetes mellitus. CASE PRESENTATION: The case was a female born after an uncomplicated pregnancy and delivery in a non-consanguineous family (3.59 kg, 70th percentile). Severe cardiac malformations were diagnosed at two and a half months old. No hyperglycaemic episodes were recorded in the neonatal period. Diabetes was diagnosed at 21 years due to the detection of incidental glycosuria. She had a low but detectable C-peptide level at diagnosis. Anti-GAD and Islet-cell antibodies were negative and she failed oral hypoglycaemic therapy and was started on insulin. Abdominal MRI revealed the absence of most of the neck, body, and tail of pancreas with normal pancreas elastase levels. Criteria for type 1 or type 2 diabetes were not fulfilled, therefore a next generation sequencing (NGS) panel was performed. A novel heterozygous pathogenic GATA6 mutation (p.Tyr235Ter) was identified. The GATA6 variant was not detected in her parents, implying that the mutation had arisen de novo in the proband. CONCLUSION: Rarely GATA6 mutations can cause adult onset diabetes. This report highlights the importance of screening the GATA6 gene in patients with adult-onset diabetes, congenital cardiac defects and pancreatic agenesis with no first-degree family history of diabetes. It also emphasizes the importance of genetic counselling in these patients as future offspring will be at risk of inheriting the variant and developing GATA6 anomalies.

Potentially inappropriate medications use and its association with health-related quality of life among elderly cardiac patients.

BACKGROUND: Previous studies identified alarming use of potentially inappropriate medications (PIMs) in Pakistani population but its effect on health-related quality of life (HRQoL) is still largely unknown. OBJECTIVE: This study aimed to determine the association between PIMs use and HRQoL among elderly cardiac outpatients. METHOD: A descriptive, non-experimental, cross-sectional study was carried out from June 2018 to September 2018 in two outpatient departments of tertiary-care hospitals in the Punjab Province of Pakistan. The population under study were patients aged ≥ 65 years with at least one cardiovascular condition taking at ≥ 1 prescribed medication. Patients with PIMs were identified by using Beers criteria. HRQoL was assessed using EuroQoL-5 dimension (EQ-5D) and EuroQoL-visual analogue scale (EQ-VAS). The association of PIMs with HRQoL was analyzed using χ2 tests, independent sample t-test, and one-way ANOVA tests. Multiple linear regression analysis was used to determine how HRQoL varied by PIMs use after adjusting for patient-level covariates. RESULTS: Of 386 elderly cardiac patients, 260 (67.4%) patients were receiving at least one PIM. Mean EQ-5D scores were significantly lower among patients with PIMs (0.51) compared to patients without PIMs (0.65) (P < 0.001). In multiple linear regression analysis, increasing numbers of PIMs were significantly associated with lower EQ-5D scores [ß = - 0.040 (- 0.075, - 0.005), P < 0.001] and VAS scores [ß = - 1.686 (- 2.916, - 0.456), P < 0.05]. CONCLUSION: The present study concluded that exposure to PIM was significantly associated with lower HRQoL. This indicates that guidelines recommendations should be followed to improve patient's quality of life.

Predicting the multiwavelength fiber Brillouin cavity based on the finite element method.

A simulation-based method to predict the multiwavelengths in a fiber Brillouin cavity is proposed. The coupled steady-state equation is solved by describing the multiwavelength in a clockwise or counterclockwise direction of the fiber Brillouin cavity. By applying the guessed constants solution as the boundary condition at the output, the partial differential equation is solved with the initial guess value to find the approximate solution. The algorithm is based on the finite element method, and it has proven to be somewhat fast and accurate. Furthermore, a quantitative study is performed on the basis of the proposed algorithm. This work presents a practical option to gain experimental instructions to describe the multiwavelength fiber Brillouin cavity, for which we believe no efficient algorithm currently exists.

Emerging pharmacy services; Recommendations for emergency care of COVID-19 pandemic in low and middle-income countries.

The ongoing outbreak of coronavirus diseases (COVID-19) has been declared as Pandemic by the World Health Organization and now become a global health emergency. Low and Middle income-countries lack standard pharmacy services in terms of staff, education, training, pharmaceutical care, research, and practice. The literature aimed to provide emerging pharmacy services and recommend it to be implemented in low and middle-income countries. Currently, pharmacies were easily accessible sites by the community, a trained staff under the guidance of pharmacist can be helpful for the management of visiting customers. In the surge of disease, pharmacists proved themselves as a frontline defense for the community by significant contribution in identifying, reporting, and managing COVID-19 patients through pharmaceutical care services at the community level, hospital/clinical level, and through Tele-pharmaceutical services.

Devastating urban flooding and dengue outbreak during the COVID-19 pandemic in Pakistan.

Pakistan has recently been overwhelmed by extreme torrential rains, with its most populous city of Karachi experiencing its worst floods in almost a century. Poor flood control and water disposal facilities have led to an immense risk of another dengue outbreak, with multiple cases being reported recently. The enormous accumulation of stagnant water in urban areas is a major source of mosquito breeding and transmission. Historical data has shown the correlation between the number of dengue cases and average rainfall in the region. The monsoon rains have pounded at a time where health authorities are battling to contain the Coronavirus (COVID-19) pandemic. There is a need to implement centralized dengue control strategies to undertake large scale water drainage, sanitation, and disinfection drives in disaster-stricken areas alongside public health awareness programs to combat the after-effects of this natural calamity.

Feasibility analysis of opto-electronic THz Earth-satellite links in the low- and mid-latitude regions.

Terahertz (THz) communication is considered as a promising technology for the Earth-space application due to its high potential of supporting large data capacity. However, THz wave suffers extreme attenuation from absorption of water vapor (WV) molecules in the propagation path. In this work, we present a theoretical model and analyze the capacities of both inter-satellite and geostationary satellite-to-Earth station (GEO-ES) opto-electronic links operating in the 100-500 GHz band within low- and mid-latitude regions. In our work, THz frequency windows in the 140, 220, 340, and 410 GHz bands with relatively low atmospheric loss are selectively used, targeting a data capacity of 10 Gbps per gigahertz. Our analysis indicates that, in the low-latitude regions, due to high water vapor density (WVD), transmitting and receiving antennas with extremely high gains are required. On the contrary, the mid-latitude regions require less power due to comparatively lower WVD. Moreover, due to seasonal variation in the mid-latitude regions, the requirement of link power budget is tens of decibels less in winter as compared to summer. The results suggest that the establishment of GEO-ES THz links in low- and mid-latitude regions is more realistic in the sub-THz bands, such as 140 and 220 GHz, while the potential of using higher carrier frequencies above 300 GHz for inter-satellite THz links, due to the absence of WV-induced absorption, is supported.

Association study of Apolipoprotein A5 gene (APOA5 gene) variant with the metabolic syndrome in local Pakistani population.

OBJECTIVE: To explore the association of rs662799 variants of Apolipoprotein A5 gene with metabolic syndrome in Pakistani population. METHODS: The case-control study was conducted at Pakistan Institute of Medical Sciences, Islamabad, Pakistan from 2014 to2016, and comprised subjects enrolled from the out-patient clinics. Groups were formed on the basis of preliminary screening for risk factors like obesity, insulin resistance, hypertension, dyslipidemia and fasting blood glucose levels. Met S was diagnosed based on the international diabetes federation criteria. Blood samples were collected for biochemical testing and deoxyribonucleic acid extraction. Genotyping of rs662799 was performed a the Genome Research Centre of the University of Hong Kong using Sequenom Mass ARRAY, iPLEX Gold technology. Data was analysed using SPSS 16and Plink software. RESULTS: :There were 712 subjects in two groups of 356(50%) each. The overall mean age was 41.59}7.18 years. There was a significant association of risk allele C of rs662799 with metabolic syndrome (p=0.002). The risk showed strong association with dyslipidaemia (p=0.03) and obesity (p=0.01) which are risk phenotypes of metabolic syndrome in age- and gender-adjusted model. CONCLUSIONS: The association of risk allele C of genetic variant rs662799 of Apolipoprotein A5 gene with dyslipidaemia and obesity may lead to the development of metabolic syndrome in the Pakistan adult population.

Medication Adherence and Its Association with Health Literacy and Performance in Activities of Daily Livings among Elderly Hypertensive Patients in Islamabad, Pakistan.

Background and Objective: Medication non-adherence is a preventable reason for treatment failure, poor blood pressure control among hypertensive patients and the geriatric population owing to poor physical activity is more vulnerable strata. The objective of this study is to investigate medication adherence and its associated factors among Pakistani geriatric hypertensive patients. Methods: A cross-sectional survey-based study was conducted at the out-patient department of the cardiac center from May 2018 to August 2018. A universal sampling technique was used to approach patients and 262 eligible consented patients were interviewed to collect information about socio-demographics, health, and disease-related characteristics using a structured questionnaire. The Morisky Levine Green test was used for the assessment of medication adherence. The Barthel index and single item literacy screener (SILS) was used to measure performance in activities of daily living and health literacy respectively. Chi-square tests and multivariate binary logistic regression analysis were performed to find factors by using SPSS version 20. Results: Of the total 262 participants, about 38.9% (n = 102) were scored 4 and considered adherent while 61.1% (n = 160) were considered as non-adherent. In logistic regression analysis, self-reported moderate (OR = 3.538, p = 0.009) and good subjective health (OR = 4.249, p = 0.008), adequate health literacy (OR = 3.369, p < 0.001) and independence in performing activities of daily living (OR = 2.968, p = 0.002) were found to be independent predictors of medication adherence among older hypertensive patients. Conclusion: Medication adherence among the older hypertensive population in Pakistan is alarmingly low. This clearly requires patient-centered interventions to overcome barriers and educating them about the importance of adherence.

Knowledge, perception and attitude about Crimean Congo Hemorrhagic Fever (CCHF) among medical and pharmacy students of Pakistan.

BACKGROUND: Crimean Congo Hemorrhagic (CCHF) is a deadly tick born disease caused by a virus of genus Nairovirus and is endemic in the Middle East, Asia, Africa, and Eastern areas of Europe. Pakistan is a CCHF endemic country with a constant threat of sporadic outbreaks. Health care workers are more prone to CCHF, hence, it is a prerequisite for members of the healthcare team to stay abreast with current knowledge and display positive attitude and perception. This study assessed the medical and pharmacy students' preparedness level in terms of CCHF control and management. METHODS: A total of 900 consenting students were selected randomly, who completed a predesigned and validated questionnaire which assessed the participant's general knowledge, emergency preparedness control and management of CCHF. Data were analyzed by SPSS (IBM SPSS version 21). For data analysis percentages, P-value, t-test, the independent sample mean, Whitney U test, Kruskal-Wallis test, Logistic regression, and Spearman correlation were utilized. RESULTS: Among 900 study respondents, 68% were females and 32% were males, out of which physicians (MBBS) students were 48.4%, and pharmacists students were 51.6%. Majority of the respondents 39.9% were from age group of 22-25 years. Overall 43% healthcare students demonstrated good knowledge about disease causes, transmission, and treatment options. Additionally, 81% of the study participants showed positive attitude, whereas, 69% students demonstrated positive perceptions. The correlation coefficient showed positive correlation between attitude- perception (r = 0.268, p value = 0.000), knowledge- attitude (r = 0.234, p value = 0.000) and knowledge- perception (r = 0.257, p value = 0.000). CONCLUSIONS: Knowledge gaps were observed which is alarming. These gaps were multifactorial and mainly due to lack of knowledge, poor motivation, and old syllabus which needs to be addressed. The study results show that it is crucial to evaluate current curriculum and also showing a dire need of awareness seminars, conferences workshops to highlight and educate about the current endemic disease to future health care professionals.

Screening of cardiometabolic risks clustering in young Pakistani adults classified by anthropometric traits.

OBJECTIVE: To estimate frequencies of metabolic risk phenotypes and their associations in body mass index and waist circumference-based obesity categories. METHODS: The cross-sectional study was conducted at Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan, from August 2014 to March 2016. Anthropometric and clinical data of young adults was collected. All subjects were categorised into body mass index, waist circumference-based obesity categories and common metabolic risk phenotypes (hypertension, hyperglycaemia, dyslipidaemia) frequencies and their associations were estimated in age and gender adjusted models. Data was analysed using SPSS 21. RESULTS: Of the 2,000 participants, 800(40%) were females and 1,200(60%) were males. There were 500(25%) participants in each group, i.e. underweight, normal weight, overweight and obese. The overall mean age was 23.68±4.33 years (range: 16-30 years). All clinical parameters were significantly raised in general and abdominally obese class (p<0.05). Based on body mass index and waist circumference, the frequency of general obesity was 324(16.2%) and abdominal obesity was 994(49.7%). Co-morbid metabolic risk phenotypes were as follows: hypertension 1,098(54.9%) and 924(46.2%); hyperglycaemia 1,116(55.8%) and 550(27.5%); dyslipidaemia 300(15%) and 194(9.7%), respectively. The strongest associations of body mass index and waist circumference alone catergorised obesity were found with hyperglycaemia, (Odds ratio: 7.23, 6.49) followed by dyslipidemia (Odds ratio: 5.60, 5.67) and hypertension (Odds ratio: 3.28, 3.02). . CONCLUSIONS: Body mass index and waist circumference were found to be powerful, discriminating predictors of co-morbidities linked with general and abdominal obesity.

Identification of Metabolic risk phenotypes predisposing to Non-Alcoholic Fatty Liver Disease in a Pakistani Cohort.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) has emerged in the last two decades with worldwide prevalence of 25.24%. Due to its increasing frequency in Pakistan, it was aimed to identify disease predisposing metabolic risks and their association with NAFLD. METHODS: Anthropometric and biochemical investigations were collected from 1366 subjects with minor metabolic disturbances. Comparative analyses were performed to compute frequencies of common metabolic risk phenotypes while their associations with NAFLD were explored using regression analyses. The prevalence of NAFLD was also estimated in total, age, and gender-based population cohorts. RESULTS: Among metabolic risk phenotypes obesity, hyperglycemia, hypertension, and dyslipidemia significantly associated (p<0.001) with NAFLD risk irrespective of age, gender, and BMI. Prevalence of NAFLD in total study cohort was 14.8%, 16.1% in males, 13.4% in females, 19.9% in ≥40 years and 8.7% in ≤40 years respectively. CONCLUSION: General Pakistani populations experiencing common metabolic disturbances are at high risk of NAFLD development, especially male gender and advanced age. Based on these parameters the stratified NAFLD population could be treated accordingly.