Knowledge, attitudes, and practices against the growing threat of COVID-19 among medical students of Pakistan.

BACKGROUND: On account of the COVID-19 pandemic, many changes have been implicated in university medical students. We are cognizant that pandemic can be controlled with dedicated contributions from all involved in the healthcare profession. Therefore, it is important to know the pandemic and application of knowledge by the medical students to formulate a further line of management in Pakistan. OBJECTIVE: We aimed toinvestigate the knowledge, attitudes, and practices (KAP) regarding COVID-19 and its impact on medical students of Pakistan. METHODS: A cross-sectional survey was conducted in June 2020 by a validated self-administered questionnaire. The survey instrument was tailored from a published questionnaire comprised of questions on demographics (6), knowledge (14), attitudes (4), and practices (6). RESULTS: Of the 1474 medical students in the study, 576(39.1%) were males, and 898(60.1%) were females. Two-thirds of the participants 1057(71.7%) had adequate knowledge, and almost all the students had positive attitudes (1363(92.5%), and good practices 1406(95.4%) to COVID-19. Two-thirds of the medical students 1023(69%) believed that the COVID-19 outbreak had affected their social, mental, and psychological well-being. One-quarter of the medical students 391(26%) become more religious, 597(40%) realized the importance of life, and 1140(77%) became careless because of the pandemic. The female medical students were 2.545 times (p < .001) and 4.414 times (p < .001) more likely to have positive attitudes and good practices toward COVID-19 as compared to males. CONCLUSION: Medical students, especially females and senior year scholars, were well-versed with desired levels of knowledge, attitudes, and preventive measures toward COVID-19. Most of them recognized COVID 19, is shaping their social, mental, and psychological well-being and encroaching on the healthcare system and economy. The information acquired by the KAP study may help to devise effective preventive strategies for future events.

Molecular Pathogenesis of Chewable Tobacco.

In Pakistan, extensive use of several precarious chewable tobacco formulations has made oral cancer the second leading malignancy. Selection of literature was done by a survey of studies published from 1990 to 2017 mainly, from PUBMED and few from other search engines, on naswar, gutka, areca nut and betel quid, which included published reviews, original articles and other data sources on chewable tobacco, its epidemiology, pathological implications, and psychological effects. These studies have revealed that the chemicals in these formulations bind and mutate DNA of oral mucosa through down regulating cellular repair pathways and upregulating genetic networks associated with pathogenesis. Areca nut, having aercoline (the major alkaloid) causes carcinogenicity, mutagenicity, and genotoxicity of oral mucosa through increased production of growth factors and corticotrophin-releasing hormone, and genetic alteration in expression of CASP8, APAF-1, BAX, BAD, and upregulation of caspas-3. Gutka addiction leads to precancerous lesions resulting in characteristic facial abnormalities, following trismus. Naswar, in addition to oral cancer, causes adverse cardiovascular events by reducing glutathione per oxidase (GPx) and super-oxide dismutase (SOD), serum levels of HDL, whereas, increasing the ratio of cholesterol, LDL, triglycerides and LDL-C/HDL-C. Betel quid (Paan), causes psychoactivity affecting central and autonomic nervous systems leading to dependence with decreased cognition, euphoria, sweating, salivation, palpitation, heightened alertness and zest to work. Metabolically, cardio-acceleration, cortical desynchronisation of EEG, elevated plasma noradrenaline and adrenaline were found. This review highlights the corrosive effects of various most popular chewable tobacco formulations; and damage done by their cocktail of carcinogenic substances and added ingredients, leading to oropharangeal cancer.