Assessing the knowledge, attitude, and practice measures against tuberculosis in patients in ambulatory department facilities in Pakistan: a cross-sectional analysis.

Tuberculosis (TB), at present, is the leading infectious etiology of death globally. In Pakistan, there are approximately 510,000 new cases annually, with more than 15,000 of them developing into drug-resistant TB, making the nation the fifth-leading country in TB prevalence in the world. Due to the ongoing COVID-19 pandemic, the focus has drifted away from TB screening, diagnostic and health awareness campaigns, and therapeutic measures endangering knowledge, attitude, and practices (KAP) towards TB in our population. We conducted a cross-sectional descriptive study in Pakistan to assess the KAP of Pakistani residents attending the adult outpatient departments of public hospitals for any health-related concerns. Our sample size was 856 participants, with a median age of 22 years. Occupation-wise, those who were employed had better knowledge of TB than those who were unemployed [odds ratio (OR): 1.011; 95% confidence interval (CI): 1.005-1.8005]. No differences were observed in TB knowledge between those adherents to common preventive practices versus those not adherent (OR: 0.875; 95% CI: 0.757-1.403). More than 90% of participants agreed that TB is dangerous for the community, and the majority opted against stigmatizing TB patients (79.1%). People who could read and write were 3.5 times more likely to have a good attitude towards TB compared to those who could not (OR: 3.596; 95% CI: 1.821-70.230; p=0.037). Similarly, employed subjects had better attitudes compared to unemployed ones (OR: 1.125; 95% CI: 0.498-1.852; p=0.024) and those with better knowledge of TB had a better attitude grade (OR: 1.749; 95% CI: 0.832-12.350; p=0.020). Age, occupation, and educational status were statistically significant among the two groups (p=0.038, p=0.023, p=0.000). Literate subjects had three times better practice towards TB than illiterate subjects (OR: 3.081; 95% CI: 1.869-4.164; p=0.000). Future education and awareness programs should target specific groups, such as the unemployed and illiterate, with practice-focused approaches. Our study outcomes can enable the concerned officials and authorities to take appropriate evidence-based steps to direct the efforts efficiently to curtail the burden of TB in Pakistan and to limit its progression, which could potentially lead our nation to become a multi drug-resistant TB endemic territory.

Bartter Syndrome: A Systematic Review of Case Reports and Case Series.

Background and Objectives: Bartter syndrome (BS) is a rare group of autosomal-recessive disorders that usually presents with hypokalemic metabolic alkalosis, occasionally with hyponatremia and hypochloremia. The clinical presentation of BS is heterogeneous, with a wide variety of genetic variants. The aim of this systematic review was to examine the available literature and provide an overview of the case reports and case series on BS. Materials and Methods: Case reports/series published from April 2012 to April 2022 were searched through Pubmed, JSTOR, Cochrane, ScienceDirect, and DOAJ. Subsequently, the information was extracted in order to characterize the clinical presentation, laboratory results, treatment options, and follow-up of the patients with BS. Results: Overall, 118 patients, 48 case reports, and 9 case series (n = 70) were identified. Out of these, the majority of patients were male (n = 68). A total of 21 patients were born from consanguineous marriages. Most cases were reported from Asia (73.72%) and Europe (15.25%). In total, 100 BS patients displayed the genetic variants, with most of these being reported as Type III (n = 59), followed by Type II (n = 19), Type I (n = 14), Type IV (n = 7), and only 1 as Type V. The most common symptoms included polyuria, polydipsia, vomiting, and dehydration. Some of the commonly used treatments were indomethacin, potassium chloride supplements, and spironolactone. The length of the follow-up time varied from 1 month to 14 years. Conclusions: Our systematic review was able to summarize the clinical characteristics, presentation, and treatment plans of BS patients. The findings from this review can be effectively applied in the diagnosis and patient management of individuals with BS, rendering it a valuable resource for nephrologists in their routine clinical practice.

Viral hepatitis amidst COVID-19 in Africa: Implications and recommendations.

Hepatitis, a significant cause of mortality worldwide, results in around 1.34 million deaths each year globally. Africa is not exempt from the plague of Hepatitis. Around 100 million estimated individuals are infected with Hepatitis B or C. Egypt has the highest prevalence of cases of Hepatitis followed by Cameroon and Burundi. The continent is severely affected by the onset of the COVID-19 pandemic, as the virus has added an additional burden on the already fragile continent. With the pandemic, it is presumable that Hepatitis like other viral diseases will pose a threat to collapsing healthcare system. Therefore, for Africa to become more resilient in the face of such menaces, including Hepatitis, further prevention policies are required to be implemented.

HIV epidemic amidst COVID-19 pandemic in India: a conundrum for the country's healthcare system.

India has the third-largest burden of human immunodeficiency virus (HIV) infection in the world. The coronavirus disease 2019 (COVID-19) pandemic has only exposed the cracks in the Indian healthcare infrastructure concerning HIV. The prevalence of HIV in India is more among the destitute or sections of society shrouded by years of social stigma such as prostitutes, truck drivers, transsexuals and intravenous drug users. National AIDS Control Organisation and The Joint United Nations Programme on HIV/AIDS (UNAIDS) organisation have many several efforts over the years to set up counselling and testing centres all over the country and spread awareness about HIV among the masses. COVID-19 pandemic has reversed years of progress made by the same. HIV patients are biologically more susceptible to COVID-19, and the lockdown has led to the loss of jobs, economic crises, shortage of drugs and necessities such as food and housing among this vulnerable population, which can result in lowered CD4-T cell counts in the coming months and make way for dangerous opportunistic infection outbreaks in this population increasing the overall HIV burden of India. This article explores how COVID-19 has impacted India's already existing HIV epidemic and tries to put forth recommendations based on the evidence found to be better prepared in treating the HIV-positive population in India in the face of another catastrophe like the COVID-19.

Addressing the humanitarian crisis in Afghanistan through $10 billion Afghani assets: what are the challenges and opportunities at hand?

BACKGROUND: The current humanitarian crisis in Afghanistan started after the US and international allies' withdrawal. This has put the country in a dire situation as the globalized infrastructure supporting Afghanistan came to halt. Moreover, 10 billion USD of Afghanistan's assets were frozen by the U.S and other international organizations after the Taliban takeover. This further exacerbated the humanitarian crisis and quickened the economic collapse in Afghanistan. These assets should be freed to support the people of Afghanistan. MAIN BODY: In order to address this situation, international oversight is needed to allow these funds to be returned and used by the Central Bank of Afghanistan without misappropriation by the Taliban. We suggest a number of short term interventions and long term considerations to improve the situation in Afghanistan with the $10 billion in frozen assets. In the short term, economic stability and the hunger crisis should be addressed by funding international organizations such as the World Food Program and national Afghani NGOs. In the long term funds should be used to build back the economy, build healthcare infrastructure, and support the development of women and children. CONCLUSION: At this juncture, the world and international organizations have a moral and ethical responsibility to ensure the 10 billion in funds go to the owners, the people of Afghanistan. With oversight and fund distribution to the right partners, progress can be made by providing support in security, healthcare, education and food resources. This calls for action to deliver $10 billion of assets to the Afghan people in a transparent manner, avoiding further tension and disasters in the country.

Redressing COVID-19 vaccine inequity amidst booster doses: charting a bold path for global health solidarity, together.

BACKGROUND: With large swathes of the world's population-majority clustered in low- and middle-income countries-still yet to receive the minimum of two doses of the COVID-19 vaccine; The need to address the failures of international solidarity to equitably distribute COVID-19 vaccines is now more urgent than ever to help curb the pandemic and prevent future variants. However, many high-income countries have adopted a "me first" approach, proceeding to offer COVID-19 booster doses to their entire populations, including those at least risk of severe illness, whilst the rest of the world is left unvaccinated or partially vaccinated with one dose for even their most vulnerable communities. MAIN BODY: COVID-19 vaccine inequity places the health of the global population at risk and exacerbates socio-economic repercussions, especially in low- and middle-income countries. Initiatives launched to combat vaccine inequity such as the Fair Allocation Framework for the COVID-19 Vaccines (COVAX) have been unsuccessful as several governments, primarily from high-income countries, have scaled down their contributions to the initiative. Furthermore, COVAX has not seriously engaged with the Access to COVID-19 Tools (ACT) Health Systems Connector, as was originally intended, leading to crucial health systems components critical to vaccine delivery to be overlooked. Several strategies can be employed to help achieve the desired global immunization goals, such as Intellectual Property waivers, increased donations, and activation of new COVID-19 vaccine manufacturing hubs. In addition, continued advocacy for vaccine equity by all involved and affected stakeholders, as well as critical amendments to existing or upcoming legislation and funding mechanisms will help address the shortcomings of current inequitable vaccine distribution. CONCLUSIONS: Global solidarity and collective action through pandemic governance mechanisms are urgently needed to ensure vaccine equity. These interventions are vital to rapidly mitigate ongoing health and humanitarian crises and ultimately curb the pandemic, sooner rather than later.

COVID-19 vaccination strategies and policies in India: The need for further re-evaluation is a pressing priority.

India is one of the worst-hit nations by the COVID-19 pandemic and witnessed a devastating impact across cities in the country. Although behavioral measures like wearing a face mask, maintaining social distance, and hand hygiene helped to control the spread of the disease initially, but a long-term action by vaccinating the population is a promising solution. On 16 January 2021, India undertook the challenge to vaccinate 300 million people by August 2021 against COVID-19, the largest vaccination campaign globally. India has been lauded by several prominent organizations around the world for its efforts. But catering to India's massive population is not without its own set of complex challenges. As of 29 July 2021, a mere 9.82 million (approximately 7.03 percent of the total Indian population) people have been fully vaccinated against COVID-19 with the first and second dose, and only 352.5 million (roughly 25.28 percent of the total Indian population) have been partly vaccinated with the first dose. This shows, India's current COVID-19 vaccination policies and plans are still inadequate and not undisputedly equitable even after several amendments in the guidelines. However, even with the second wave abating slowly and steadily in India, there is a need to further re-strategize the current vaccination policy and plans in India against COVID-19 to help achieve long-term positive outcomes in the shortest feasible time frame hoping to evade a third wave.

Enhancing public trust in COVID-19 vaccination during ramadan 2022: A call for action.

Ramadan is the ninth month of the Islamic lunar calendar in which it is compulsory for Muslims to abstain from eating and drinking during the daytime. The COVID-19 pandemic posed additional challenges for Muslims as the crowded religious gatherings could give a new breath to the spread of the virus. Similar measures were adopted during Ramadan in 2021. The initiation of COVID-19 vaccination across the globe in combination with the need to maintain personal protective measures against COVID-19, result in new needs and challenges. At this juncture, Ramadan 2022 offers a growing opportunity to unite a global voice for solidarity, equal distribution of COVID-19 vaccines, and tackling the challenge of vaccine hesitancy.

Improving access to maternal care in Africa through telemedicine and digital health.

Access to maternal health care is limited for women in Africa, while it remains a crucial determinant of maternal mortality and morbidity. The utilization of telemedicine and digital health can help remove barriers to access through economical and geographical convenience. In addition, feasible frameworks operating on themes such as technology, user acceptance, short-term and long-term funding, organizational factors, and political and legislative aspects can help overcome implementation challenges that persist in Africa and permit maximal utilization of telehealth to enhance maternal outcomes.

Unraveling the Jeopardy: Child health in Afghanistan.

A humanitarian crisis started in Afghanistan after the United States and international Allies withdrew in August 2021, causing numerous challenges and have especially impacted children. Children in Afghanistan have been affected by a long history of suffering from violence, war, and poverty. The US withdraw and COVID-19 pandemic have caused an economic crisis causing high rates of child malnutrition and prevented them from receiving healthcare and education. In the long run, the impacts of the current situation will significantly affect the child growth, education, and psychological health. There is a need for international organizations to intervene now to ensure children do not further suffer and have the option for a bright future. In turn, ensuring a brighter future for Afghanistan.

Viral infections amidst COVID-19 in Africa: Implications and recommendations.

Viral infections have been on the rise for the past decades. The impact of the viruses worsened amidst the pandemic burdening the already overwhelmed health care system in African countries. This article sheds light on how the coronavirus together with the already existing viral infections, some of which re-emerged, impacted the continent. The strategies in place such as immunization, education, will have to be strengthened in all African countries to reduce the burden. Furthermore, governments can further collaborate with other countries in creating guidelines to reduce co-infection of the diseases.

Resurgence of tuberculosis amid COVID-19 in Peru: Associated risk factors and recommendations.

Peru is one of the countries with the highest incidence of tuberculosis and multidrug-resistant tuberculosis in the world. Although public health measures adopted in the country have improved the care, diagnosis and management of patients with tuberculosis, there are still failures in the control of the disease in the country, especially of multidrug-resistant tuberculosis and among the prison population or people living with HIV. The COVID-19 pandemic has added a great burden to the Peruvian public health system, negatively impacting tuberculosis-focused health programs due to the diversion of resources to control the pandemic. Consequently, combat measures, epidemiological surveillance of tuberculosis cases were affected, and data point to an increase in the number of cases, especially of multidrug-resistant tuberculosis, and to the underdiagnosis of the disease. To deal with this problem and avoid a future catastrophe for the country's health system, multidisciplinary measures involving the population, health professionals and government bodies are needed. It is essential that education, diagnosis, contact screening and treatment programs are prioritised and given greater financial support. Furthermore, it is necessary to raise awareness in the population about the need for isolation and maintenance of treatment, especially among the most vulnerable populations.

Tongue ulcer in a patient with COVID-19: a case presentation.

BACKGROUND: The emergence of COVID-19 has devastated many parts of the world. From asymptomatic to symptomatic, the virus causes a wide spectrum of presentations. COVID-19 patients may present with oral manifestations. In Afghanistan, where COVID-19 has severely strained the health care system, much of the population lacks proper oral hygiene. This makes the oral cavity a perfect site for SARS-CoV-2 to manifest clinical signs. CASE PRESENTATION: A 62-year-old male was evaluated in the Dentistry Teaching Clinic of Kabul University of Medical Sciences for a painful erosive lesion on dorsal surface of his tongue. He also complained of fever, cough, and taste alteration. He was referred to Afghan Japan Hospital for COVID-19 testing and tested positive. He was followed on for the treatment of SARS-CoV2. After 2 weeks, the patient tested negative and returned to the dentistry clinic for follow-up. Although there were no other signs of COVID-19, the painful erosive lesion on his tongue persisted. Oral evaluation were performed and the patient was advised to practice good hygiene. After 10 days, we observed an asymptomatic geographic tongue without fever and myalgias and the lesion of dorsal surface of tongue improved from severe condition to moderate. CONCLUSION: In conclusion, patients with suspected or confirmed SARS-CoV-2 should be screened for symptoms and physical findings in the oral mucosa To prevent such an outcome, awareness programs need to be implemented for the diagnosis and management of clinical symptoms among patients.

Rethinking 'Bacha Bazi', a culture of child sexual abuse in Afghanistan.

The global pandemic appears to be a never ending challenge. With the authorities' reach shrinking, we can assume that Bacha Bazi is celebrated more than before. Perpetrators not only harass individuals but also put public health in peril by organizing gathering and parties. With both individual and public health and rights at stake, this pandemic could also be a chance to contain Bacha Bazi practices. It may be early to say this and we definitely need to collect more information before we reach any conclusion, but most importantly, we, from healthcare workers and youth workers to policymakers, need to take action. Awareness is the spark of our mobilization. As citizens we can be more critical towards traditions involving any kind of abuse. As healthcare workers, we can be alert when treating boys, adolescents and young adults. We can probably spot a hidden case of abuse and refer the victim accordingly. As citizens we can support policymakers who are committed to take action against harassment of this, and any other, kind and this can also be a crucial chance to address the shadows haunting our societies once and for all.