High Pretreatment Level of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio and Other Factors Associated with Delayed Sputum Conversion in Patients with Pulmonary Tuberculosis.

Introduction: Patients with delayed intensive phase sputum conversion have a higher risk of multidrug resistant-tuberculosis (MDR-TB) and poorer treatment outcomes. Both, host (immune response and comorbidity) and pathogen factors play important roles in determining sputum conversion after treatment initiation. Impaired host immune response, especially the cellular components, as defined by the increased pre-treatment level of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and other additional factors, were associated with severe active TB. Purpose: To evaluate whether impaired immune responses (high pre-treatment level of NLR and MLR) and other factors associate with delayed sputum conversion at the end of the intensive phase treatment. Patients and Methods: This was a case-control study from 2016 to 2020, which retrospectively analyzed the pre-treatment level of NLR, MLR and other factors among patients with new cases of pulmonary tuberculosis (PTB). Results: A total of 62 patients (31 cases and 31 control). The cut-off value of high pretreatment level of NLR and MLR was 5.065 and 0.585, respectively. Bivariate analysis showed that pretreatment NLR ≥5.065 (OR 8.23, CI 95% 2.48-27.32, p < 0.001), MLR ≥0.585 (OR 10.18, 95% CI 3.13-33.18, p < 0.001) and BMI <18.5 (OR 2.91, 95% CI 1.03-8.20, p = 0.041) were associated with an increased risk of delayed sputum conversion. Multivariate analysis, however, showed that pretreatment NLR ≥5.065 was not significantly associated with delayed sputum conversion (AOR 3.370, 95% CI 0.71-15.91, p value 0.125). A high pretreatment of MLR (AOR 30.802, 95% CI 3.22-287.55, p value 0.003) and lower BMI (AOR 10.942, 95% CI 1.121-98.563, p value 0.033) were significantly associated with an increased risk of delayed intensive phase sputum conversion. Conclusion: High MLR pretreatment and a low BMI were significantly associated with an increased risk of delayed sputum conversion at the end of the PTB intensive phase treatment. High NLR pretreatment, smoking, diabetes, and HIV were not associated with sputum conversion.

The Effect of Fear of COVID-19 on Green Purchase Behavior in Pakistan: A Multi-Group Analysis Between Infected and Non-infected.

The coronavirus disease 2019 (COVID-19) pandemic and its effects on an individual's life have altered the consumer behavior. In the context of purchase and consumption, a shift from conventional to green purchase has been noticed. Although the factors underlying this shift were relatively unexplored, the study aimed to identify the factors that influenced a significant role in the green purchases during the outbreak and the relationship of these factors with green purchase behavior (GPB). Subsequently, this study investigates and interprets the role of fear of COVID-19 (FCV), psychological distress (PD), and mortality salience (MS) in predicting consumer's GPB. This research adopted a quantitative methodology using data collected from 432 respondents in various cities across Pakistan. Smart-PLS 3 was used to evaluate the measurement model, structural model, and multi-group analysis (MGA). Despite having the negative psychological and physical impact of the pandemic, a significant proportion of customers have switched to healthier and sustainable products. This research revealed that the FCV, PD, and MS plays a substantial role in adopting GPB. All the direct relationships were positive and significant. In addition, MS and PD partially mediate the effect of FCV on GPB. Furthermore, the MGA revealed that the infected respondents were interested in purchasing green products than uninfected respondents due to their FCV; conversely, the PD and MS were higher in uninfected individuals than infected ones. However, there is a vast literature on GPB, but little has investigated the cumulative impact of FCV, PD, and MS on GPB.

Mutational and biochemical findings in adults with persistent hypophosphatasemia.

A majority of adults with persistently low serum alkaline phosphatase values carry a pathogenic or likely pathogenic variant in the ALPL gene and also have elevated alkaline phosphatase substrate values in serum and urine. These adults may fall within the spectrum of the adult form of hypophosphatasia. INTRODUCTION: The primary objective of this study was to determine what proportion of adults with persistently low serum alkaline phosphatase values (hypophosphatasemia) harbor mutations in the ALPL gene or have elevated alkaline phosphatase (ALP) substrates. Some adults with persistent hypophosphatasemia share clinical and radiographic features with the adult form of hypophosphatasia (HPP). In HPP, ALPL mutations result in persistent hypophosphatasemia and ALP substrate accumulation in plasma (pyridoxal-5-phosphate (PLP)) and urine (phosphoethanolamine (PEA)). METHODS: Biochemical analyses, including serum ALP activity, bone-specific ALP, plasma PLP, and urine PEA, were performed in adults with persistent hypophosphatasemia. Mutational analyses were performed using PCR and Sanger sequencing methods. Gene variants were classified as pathogenic (P), likely pathogenic (LP), variants of uncertain significance (VUS), likely benign (LB), and benign (B). P and LP variants were further grouped as "Positive ALPL variants" and LB and B grouped as "Negative ALPL variants." RESULTS: Fifty subjects completed all mutational and biochemical analyses. Sixteen percent carried only Negative ALPL variants. Of the remaining 42 subjects, 67% were heterozygous for a P variant, 19% for an LP variant, and 14% for a VUS. Biochemical results were highly inter-correlated and consistent with the expected inverse relationship between ALP and its substrates. Subjects harboring Positive ALPL variants showed lower ALP and BSAP and higher PLP and PEA values compared with subjects harboring only Negative ALPL variants. Approximately half of all subjects harboring Positive ALPL variants or ALPL VUS showed elevations in plasma PLP, and three quarters showed elevations in urine PEA. CONCLUSION: Adults with persistent hypophosphatasemia frequently harbor ALPL mutations and have elevated ALP substrates. These adults may fall within the spectrum of the adult form of hypophosphatasia. Clinicians should take note of persistent hypophosphatasemia in their patients and be cautious in prescribing bisphosphonates when present.

Utilizing education infrastructure for primary health care.

PIP: Sahar Matha Secondary School and Ghoretar Health Post serve approximately 30,000 people living in scattered communities over the steep foothills of the Himalaya in East Nepal. A pilot health education and sanitation project was implemented with the objectives of giving the secondary school students the knowledge and skills necessary for building domestic pit latrines in their villages. It was hoped that the students could be motivated to create enough awareness of the need for domestic pit latrines so that latrines would continue to be built after the pilot phase of the project. At the end of the 4 week building period there were 150 completed domestic pit latrines and 45 pits or partially complete latrines. Seeing pit latrine in Ghoretar at the school and health post had not been enough to motivate people to build their own domestic pit latrine. It seemed that people could understand the convenience of privacy in an area where there was no jungle cover, but did not appreciate the hygiene reasons for using pit latrines. It is now planned to extend the project into the 19 schools which feed the 2ndarty school, with the 2ndary school boy and girl scouts taking the health messages to the primary schools. Particular attention will be given to the teaching of modes disease transmission. So that the villagers can use their latrines hygienically.^ieng