A novel test and treat program for hepatitis C virus infection utilizing HCV core antigen testing, among police and general population, Islamabad, Pakistan, 2022.

Hepatitis C virus core antigen (HCVcAg) testing can simplify and decrease costs of HCV infection confirmation compared to molecular testing (nucleic acid testing). We piloted HCVcAg testing for the confirmation of active infection. The study was conducted during June through December 2022 among the police and the general population of Islamabad, Pakistan age 18 years and older. Initial screening for HCV antibody was conducted using a rapid diagnostic test (RDT) for all consenting participants. Those who tested positive had venous blood samples tested for HCVcAg, platelets and aspartate aminotransferase (AST). Persons with HCVcAg values ≥3 fmol/L were defined as viremic, and they were offered treatment with direct acting antiviral (DAA) medications, sofosbuvir and daclatasvir. Aspartate aminotransferase to platelet ratio index (APRI) was calculated for each HCV infected person, and those with an APRI score <1.5 received treatment for 12 weeks, while those with APRI ≥ to 1.5 received 24 weeks of treatment. A total of 15,628 persons were screened for anti-HCV using RDT and 643 (4.1%) tested positive. HCVcAg values of ≥3 fmol/L was found in 399/643 (62.1%), and all were offered and accepted treatment. Of those treated, 273/399 (68.4%) returned for a follow-up SVR and HCVcAg was not detected in 261/273, a 95.6% cure rate. The pilot study demonstrated the effectiveness of reaching and treating an urban population using RDT for screening and HCVcAg for confirmation of infection and test of cure.

Measures used by medical students to reduce test anxiety.

OBJECTIVE: To determine test anxiety in medical students and to assess the measures used by them to reduce it. METHODS: The cross-sectional study was conducted in August 2009 at the Dow University of Health Sciences, Karachi, and involved 388 medical students who were voluntary participants. The 10-item Westside Test Anxiety Scale, was used to measure anxiety and the pre-designed questionnaire asked the students about the frequent measures used by them to overcome anxiety during exams and their past Grade Point Average. All data was coded and analysed using SPSS version 16 with a prior set alpha level of 0.05. RESULTS: Of the 450 students who were initially considered for the study, 388 fulfilled the inclusion criteria. Among them, 101 (25.3%) were male students with a mean anxiety level of 2.55 +/- 1.27, and 287 (71.8%) were females with a mean anxiety level of 3.07 +/- 1.43 (p<0.05). Prayers and self-motivation (28.3%), sleep and relaxation (11%), television and music (10%), calling friends (8.5%) and revision (6.7%) were the frequent measures used by the medical students to overcome exam anxiety. Students in their fourth and final years of studies showed a higher level of anxiety compared to those in the 2nd and 3rd years. CONCLUSION: The study indicated high levels of exam anxiety among the medical students, showing that there is a need for anxiety-reduction programmes in medical colleges.

General practitioner's knowledge regarding the diagnosis and drug therapy for acute myocardial infarction.

OBJECTIVE: To assess the general practitioners (GP) knowledge regarding the diagnosis and initial drug therapy for acute myocardial infarction (AMI). METHODS: A questionnaire-based survey was conducted in randomly selected GPs of Karachi. Doctors working in community as GPs who were registered medical practitioners having a Bachelor of Medicine & Bachelor of Surgery degree were included in the study. Doctors working at tertiary care facilities or having a post graduate degree or post graduate training in a specialty other than family medicine were excluded from the study. RESULTS: A total of 186 GPs participated in our study. GPs who studied research journals were 2.33 times more likely to investigate serum cardiac troponins levels for the diagnosis of AMI compared to those who did not study research journals (P = 0.02). Twenty six percent of the GPs said that they would refer a patient with suspected AMI without treatment, while 76% said that they would consider some treatment prior to referral. Fifty eight percent of the GPs identified ST segment elevation myocardial infarction (STEMI) of < 12 hours duration as an indication of thrombolysis while 28% identified posterior wall AMI as a thrombolytic indication. CONCLUSION: GPs, although adequately aware of the presenting features of AMI, were lacking in knowledge regarding the means for confirmation of diagnosis, initial drug therapy and were less likely to carry management steps in their practice.