Narcissism, perfectionism, and self-promoting behavior on social networking sites among university students in Pakistan / Narcisismo, perfeccionismo y comportamiento de autopromoción en sitios de redes sociales entre estudiantes universitarios en Pakistán

Existe un debate considerable en la literatura sobre cómo el narcisismo predice diversos comportamientos asociados con la utilidad de los sitios de redes sociales, pero los investigadores han prestado menos atención a explorar los mediadores potenciales de esta relación. Con base en la literatura existente, anticipamos que el narcisismo predice comportamientos de autopromoción en los sitios de redes sociales. El estudio actual también investigó el papel mediador del perfeccionismo multidimensional entre el narcisismo y el comportamiento de autopromoción. Se recopiló un total de 605 cuestionarios completos de estudiantes de universidades de Rawalpindi e Islamabad, Pakistán, mediante un muestreo conveniente. El estudio utilizó el Inventario de Personalidad Narcisista (Ames et al., 2006), un cuestionario de desarrollo propio sobre comportamiento de autopromoción en sitios de redes sociales y la Escala de Perfeccionismo Multidimensional (Hewitt et al., 1991). Los hallazgos indicaron que las mujeres en comparación con los hombres y las solteras en comparación con las casadas obtuvieron puntuaciones más altas en narcisismo. Los niveles educativos más altos se asociaron con tasas más altas de narcisismo. Los resultados también sugieren que el narcisismo se correlaciona con el perfeccionismo orientado a uno mismo y, más significativamente, con el narcisismo orientado a los demás. El perfeccionismo orientado a uno mismo y a los demás medió significativamente la relación entre el narcisismo y el comportamiento de autopromoción en los sitios de redes sociales.(AU)

There is considerable debate in the literature about how narcis-sism predicts various behaviors associated with the utility of social net-working sites, but researchers have paid less attention to exploring the po-tential mediators of this relationship.Based on the existing literature, we anticipated that narcissism predicts self-promoting behaviors on social networking sites. The current study also investigated the mediating role of multidimensional perfectionismbetween narcissism and self-promoting behavior. A total of 605 complete questionnaires weregathered fromstu-dents from universities from Rawalpindi and Islamabad, Pakistan using convenient sampling. The study used Narcissistic Personality Inventory (Ames et al., 2006), self-developed Self-promoting Behavior on social net-working sites questionnaire, and the Multidimensional Perfectionism Scale (Hewitt et al., 1991). Findings indicated that females as compared to males and single as comparedto married individuals scored higher on narcissism. Higher educational levels were associated with higher rates of narcissism. The results also suggestthat narcissism correlated with self-oriented per-fectionism, and more significantlywith others-oriented narcissism. Self-oriented and others-oriented perfectionism significantly mediated the rela-tionship between narcissism and self-promoting behavior on social net-working sites.(AU)

Phytochemical-mediated regulation of aflatoxigenic fungi contamination in a shifting climate and environment.

Mycotoxin contamination poses a significant problem in developing countries, particularly in northern Pakistan's fluctuating climate. This study aimed to assess aflatoxin contamination in medicinal and condiment plants in Upper Dir (dry-temperate) and Upper Swat (moist-temperate) districts. Plant samples were collected and screened for mycotoxins (Aflatoxin-B1 and Aflatoxin-B-2). Results showed high levels of AFB-1 (11,505.42 ± 188.82) as compared to AFB-2 (846 ± 241.56). The maximum contamination of AFB-1 in Coriandrum sativum (1154.5 ± 13.43 ng to 3328 ± 9.9 ng) followed by F. vulgare (883 ± 9.89 ng to 2483 ± 8.4 ng), T. ammi (815 ± 11.31 ng to 2316 ± 7.1 ng), and C. longa (935.5 ± 2.12 ng to 2009 ± 4.2 ng) while the minimum was reported in C. cyminum (671 ± 9.91 ng to 1995 ± 5.7 ng). Antifungal tests indicated potential resistance in certain plant species (C. cyminum) while A. flavus as the most toxins contributing species due to high resistance below 80% (54.2 ± 0.55 to 79.5 ± 2.02). HPLC analysis revealed hydroxyl benzoic acid (5136 amu) as the dominant average phytochemical followed by phloroglucinol (4144.31 amu) with individual contribution of 8542.08 amu and 12,181.5 amu from C. cyaminum. The comparison of average phytochemicals revealed the maximum concentration in C. cyminum (2885.95) followed by C. longa (1892.73). The findings revealed a statistically significant and robust negative correlation (y = - 2.7239 × + 5141.9; r = - 0.8136; p < 0.05) between average mycotoxins and phytochemical concentrations. Temperature positively correlated with aflatoxin levels (p < 0.01), while humidity had a weaker correlation. Elevation showed a negative correlation (p < 0.05), while geographical factors (latitude and longitude) had mixed correlations (p < 0.05). Specific regions exhibited increasing aflatoxin trends due to climatic and geographic factors.

M2 Genotype of Varicella zoster virus associated with Severe Herpes zoster in Pakistan.

This case report is of herpes zoster which is caused by Varicella zoster virus (VZV). The patient was presented with acute renal failure associated with intravenous acyclovir administration for its management. A 50 years old man visited the hospital with rashes on his back. The serum sample was positive for anti-VZV IgM via Enzyme Linked Immunosorbent Assay (ELISA), and vesicular swab for VZV via polymerase chain reaction (PCR). Phylogenetic analysis identified it as M2-genotype. Patient was treated with intravenous acyclovir administration, which led to acute renal failure. Later with shift to oral acyclovir, renal functions were restored. Elderly patients with reactivation of VZV in Pakistan are at risk to contract herpes zoster. Acyclovir is drug of choice via intravenous route was found to be nephrotoxic, however oral acyclovir was safe and effective. This is first report on pathogenic VZV genotype from Pakistan and is presented to highlight that the herpes zoster cases of elderly patients' treatment option need to be revisited.

Strength in silence: the journey of mothers raising children with hydrocephalus.

BACKGROUND: Raising a child with hydrocephalus can be very challenging, especially in low- and middle-income countries. In Pakistan, mothers being the primary caregivers for their hydrocephalic children are under tremendous stress. METHODS: This study explores the challenges faced by Pakistani mothers raising children with hydrocephalus, employing a qualitative methodology through focus group discussions comprising ten mothers of hydrocephalic babies at Tertiary Care Hospital in Pakistan. RESULTS: The findings highlight three main themes: emotional toll, social isolation, and financial strain. Mothers experience significant emotional stress due to societal stigma and a lack of support, particularly from their husbands and family. Social isolation is prevalent, as mothers fear sharing their burdens and face physical confinement due to their children's needs. Financial strain is another major issue, with high medical costs adding to their economic difficulties. CONCLUSION: The study emphasizes improved access to specialized care, awareness campaigns to reduce stigma, financial assistance, and stronger community support networks to support these mothers better. Addressing these unmet needs is crucial for empowering Pakistani mothers in their caregiving roles and improving the quality of life for their children with hydrocephalus.

Incidence of cutaneous Leishmaniasis in humans during the COVID-19 pandemic in Baluchistan Province, Pakistan.

INTRODUCTION: Cutaneous leishmaniasis (CL) is one of the neglected tropical diseases that affects impoverished communities throughout the world. In Pakistan CL is an endemic disease. AIMS AND OBJECTIVES: This study aimed to determine the incidence of CL infection in the Baluchistan province of Pakistan from January 2020 to March 2022 during the COVID-19 pandemic. METHODOLOGY: A total of 1047 clinically suspected cases of CL from Bolan Medical College Hospital, Quetta, were followed up in the study. The data regarding the epidemiological characterstics, pathological information, and treatment of patients was collected. RESULTS: Out of 1047 probable cases of CL, 594 (56.73%) cases were found to be positive for CL. Females had the highest infection rate, with the majority of reported cases being in the 0-9-year age group. Most CL cases were reported in April in the year 2020, with a few cases reported in June. But in the year 2021, the highest number of cases were reported in December. The number of overall cases has gradually increased in the year 2022, most likely because of the reduction in COVID-19 pandemic restrictions. The p value for the positive as compared to suspected cases in the years 2020, 2021, and 2022 was calculated as 0.8925, 0.8763, and 0.8535 respectively. CONCLUSIONS: Further epidemiological studies and health education campaigns are recommended to increase public awareness. It is strongly advised that local, provincial, and national health authorities establish and maintain effective leishmaniasis surveillance systems to promptly identify disease outbreaks and implement timely control measures.

IMPACT OF BURNS ON ANXIETY, DEPRESSION AND SELFESTEEM AMONG PATIENTS WITH BURN INJURIES: A CROSS-SECTIONAL STUDY.

Burns are a major public health issue. Psychiatric issues require special attention. According to research, lowering stigma and anxiety and raising self-esteem are efficient ways to encourage the social reintegration of burn patients. The current study was aimed at investigating the association between burn patients' anxiety, depression, low self-esteem levels and the total body surface area (TBSA) affected by burn injuries. This single-center, cross-sectional study was conducted from January to June 2022. A sample size of 200 burn patients was calculated. Any patient with a prior psychiatric diagnosis was disqualified from the trial except for nicotine dependency. The patients were evaluated for anxiety, depression and self-esteem using specific scales. The data were tabulated and statistically analyzed using SPSS 25.0. There was male predominance as 55% (n=110) of participants were males. The age range was 18-70 years, and the average age of participants was 36.4±8.6 years. About 68.50% of participants were married, 29.50% were unmarried and 2% were divorced/widowed. Men tended to experience anxiety symptoms more frequently. More than half (58.0%) suffered from burns involving 20-39% of total body surface area (TBSA). No significant relationship was found between TBSA and anxiety, depression or self-esteem. Psychiatric issues are highly prevalent in burn victims. More research is necessary to determine the extent and determinants of psychological issues in burn patients.

Les brûlures sont un problème de santé publique majeur et leurs conséquences psychiatriques ne doivent pas être négligées. La prise en compte de la baisse thymique, de l'anxiété et de la perte de confiance en soi promeuvent la réintégration sociale de ces patients. Cette étude a cherché une corrélation entre la surface brûlée et les conséquences psychologiques et/ou psychiatriques. Cette étude monocentrique cas- témoin a été conduite entre janvier et juin 2022, permettant de recruter l'effectif calculé de 200 brûlés, exempts de pathologie psychiatrique préalable (hors addiction au tabac). Anxiété, dépression et estime de soi ont été mesurées au moyen d'échelles spécifiques puis analysées avec SSPS 25.0. Cent dix (55%) des patients étaient de sexe masculin. L'âge moyen était de 36,4 +/- 8,6 ans (18-70). Environ 68,5% des patients étaient mariés, 29,5% célibataires et 2% séparés ou veufs. Les hommes tendaient à présenter plus souvent des symptômes anxieux. Plus de la moitié (58%) avaient une atteinte sur 20 à 39% de SCT, cependant il n'a pas été trouvé de corrélation entre la SCT et les variables étudiées. Les séquelles psychiatriques étant très fréquentes après une brûlure, il est nécessaire d'en déterminer la gravité et les facteurs déclenchants.

Structured Reporting of Superficial Soft Tissue Masses on Ultrasonography: A Closed-Loop Clinical Audit From a Tertiary Care Hospital in Pakistan.

Background Among all the modalities of diagnostic radiology, ultrasonography is considered the least invasive one. However, this benefit usually comes at the cost of its subjective evaluation since it is purely a dynamic diagnostic modality. Thus, instead of ultrasonography, most clinicians usually rely on the report written by the radiologist. Objective The objective of this study is to evaluate the clinical practices of ultrasound reporting of superficial soft tissue masses. Materials and methods A closed-loop retrospective and prospective study was conducted at the Department of Radiology and Medical Imaging, Jinnah Hospital, Lahore between December 2023 and March 2024. In the pre-intervention phase, a randomly collected sample of 100 ultrasound reports documenting superficial soft tissue masses were included in the study and judged against standard criteria set by the Royal College of Radiologists (RCR). The intervention phase included regular presentations, identification of problems, and designing of preformed reporting forms. Post-intervention assessments were based on the judgment of 100 ultrasound reports in each cycle twice. Intervention and post-intervention assessments were done twice to correct the ongoing practices. Results During the pre-intervention phase, the ultrasound reports issued by the department of study showed only 41.5% compliance with the RCR structured reporting guidelines. However, after the first and second post-intervention phases, this percentage increased up to 98.3%. Overall, we observed a compliance difference of 56.5% between the pre-intervention and second post-intervention phases. Conclusion Integration of methods, such as briefing the residents on RCR guidelines, displaying parameters, and making structured report templates available, can greatly increase adherence to RCR guidelines for structured ultrasonography reporting. It also greatly enhances the comprehensiveness and reliability of ultrasonography reports for clinicians. Clinical audits should be routinely practiced in the settings of radiology.

Prevalence and Risk Factors of Pressure Ulcers in Bedbound Diabetic vs. Non-diabetic Patients in a Lower-Middle-Income Country.

Introduction Pressure ulcers, also known as bedsores, are a significant concern for bedridden individuals, presenting both physical and socioeconomic challenges. Factors such as prolonged immobility, chronic medical conditions, and poor nutrition contribute to their development. Despite extensive research in some regions, studies comparing diabetic and non-diabetic populations remain limited, particularly in low-income settings. This study aimed to investigate the risk factors and frequency of pressure ulcers among bedridden patients, addressing this gap in understanding and guiding targeted interventions. Materials and methods A cross-sectional study was conducted across four government hospitals in Peshawar, Pakistan. A total of 388 bedridden patients with pressure ulcers were included, and data were collected through a questionnaire. The questionnaire covered demographics, comorbidities, duration of bedbound status, BMI, and caregivers' awareness of pressure ulcer care. Data analysis was performed using SPSS version 22.0 (Armonk, NY: IBM Corp.), with qualitative data presented as frequencies and percentages and quantitative data as mean and standard deviation. Chi-square tests were utilized for significance, with p<0.05 considered significant. Results Of the 388 patients analyzed, 230 (59.3%) were diabetic, highlighting the prevalence of diabetes among pressure ulcer cases. The majority of diabetic patients with ulcers were over 41 years old, and 293 (75.5%) had comorbidities. Surgical intervention was the primary cause of ulcers in 213 (54.8%) cases, followed by stroke in 77 (19.8%) cases. Notably, 252 (65%) of caregivers exhibited inadequate knowledge regarding ulcer care. Stage II ulcers were prevalent in both diabetic and non-diabetic cohorts. Conclusions Pressure ulcers are poorly controlled complications observed in bedridden individuals, highlighting a critical need for comprehensive preventive measures and caregiver education to alleviate the burden of pressure ulcers, especially in diabetic patients. Factors such as prolonged immobility, surgical interventions, and insufficient caregiver knowledge contribute to the development of pressure ulcers. Understanding these complexities is essential for implementing effective care approaches and mitigating the impact of pressure ulcers.

Review of the Phonological System of Contemporary Urdu Spoken in Pakistan.

PURPOSE: Urdu is the lingua franca and national language of Pakistan, and is the 10th most-spoken language worldwide with over 230 million speakers. The Urdu phonological system has been examined over the past decades. However, the system has been evolving. This paper aimed to review the available studies investigating various aspects of the Urdu phonological system and to reveal the variations noted among these studies. METHOD: Twenty-one studies examining the phonological system of Urdu were located. The studies were reviewed in terms of consonants, geminates, consonant clusters, vowels, diphthongs, syllable structure, phonotactic constraints, and stress. RESULT: The findings indicated that 38 consonants, 23 vowels, and 15 diphthongs are used in contemporary Urdu. Most consonants exist as geminates word medially. There are six syllable structures. The consonant clusters are constrained to the coda position only, and short vowels cannot exist in the word-final position. Like other syllable-timed languages, stress is not prominent in Urdu. CONCLUSION: Based on this review, a contemporary Urdu phonemic and syllable structure inventory has been proposed. This will serve as a reference for use in further acquisition research and clinical practice.

External Quality Assessment Program for SARS-COV-2 Molecular Detection in Pakistan.

INTRODUCTION: Amid coronavirus disease 2019 (COVID-19) pandemic, accurate detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical for diagnosis management and breaking down transmission chains. We designed a national external quality assessment panel (EQAP) for SARS-CoV-2 molecular detection comprising working laboratories nationwide. METHODS: A molecular diagnostic EQA panel that consists of five samples for SARS CoV-2 testing was distributed to 141 public and private sector laboratories across country. These samples contain different concentrations of SARS-CoV-2 to evaluate the sensitivity of commercial kits available. RESULTS: Sensitivity among public and private sector laboratories was variable, particularly lower SARS-CoV-2 concentrations significantly increased the risk of false-negative tests, whereas Ct values of accurately tested SARS-CoV-2 specimens increased as concentration decreased. These findings highlighted that performance of used commercial kits was not significantly correlated to various extraction or PCR methods. CONCLUSION: This study highlights the need for a national external quality assessment panel (EQAP) in the country to improve the quality of the healthcare system while ensuring the accuracy and reliability of results. Furthermore, EQAPs can help laboratories meet accreditation and regulatory requirements. However, continued participation in EQAP is recommended for quality enhancement of laboratories.

Decomposing Socioeconomic Effects on the Consumption of Calories and Macronutrients in Pakistan Between 2006 and 2016.

Background: This study examines the impact of socioeconomic factors on calorie intake and macronutrient composition at the household level in Pakistan from 2006 to 2016, using data from the Household Integrated Income and Consumption Survey (HIICS). By applying a copula-based decomposition method, it identifies key drivers such as urbanization, household size, paternal education, income, and cultivation, highlighting their roles in dietary changes and implications for public health. The findings are crucial for understanding nutritional shifts and addressing non-communicable diseases. Objectives: This study was conducted to assess the socioeconomic changes in total calorie intake per capita and calories obtained from macronutrients (fat, protein, and carbohydrates) at the household level in Pakistan. Methods: : Cross-sectional data were taken from 2 national-level surveys published by the Pakistan Bureau of Statistics: the Household Integrated Economic Survey 2006 (14,948 households) and the Household Integrated Income and Consumption Survey 2016 (7842 households). Participants were from all 4 provinces of Pakistan. A copula-based decomposition method was applied to decompose the 10-y change in the distribution (mean, median, and quartiles) of the total calorie intake per capita and calories obtained from macronutrients. Results: The estimated results of decomposition revealed that total calorie intake per capita has increased on average and in the considered quartiles. The calories obtained from fat and carbohydrates have increased, whereas calories from protein have decreased, according to the distribution of the mean and quartile. The composition effect was negative for all outcome variables, and the main drivers of the composition effect were urbanization, household size, paternal education, income, and cultivation for all outcome variables. Conclusions: Household size and income are the most important covariates in an increase of total calories per capita and consumption of macronutrients, but urbanization, paternal education, and cultivation contribute negatively to the composition effect. Such findings are very important to inform researchers about nutritional change at the national level because the correlation between dietary change and risk factors for noncommunicable diseases such as heart disease and obesity is very strong.

Assessing the environmental impacts of clean energy investment in Pakistan using a dynamic autoregressive distributed lag model.

In this study, the authors projected the impacts of clean energy investment on environmental degradation by applying a novel and dynamic Autoregressive Distributed Lag (DARDL) model for Pakistan from 1990 to 2022. Most researchers have used ecological footprint or CO2 emissions indicators to look at how clean energy investment affects environmental degradation, which primarily represents contamination induced by humans' consumption patterns and does not consider the impact of the supply side. Against this background, the study scrutinized the dynamic interaction between clean energy investment and environmental sustainability using the load capacity factor (LCF) as an ecological indicator in Pakistan, including economic growth, population density, trade openness, urbanization, and industrialization in the analysis. The long-run estimates from DARDL indicate that a 1 percent upsurge in clean energy investment mitigates environmental degradation by approximately 0.42 percent on average, controlling for other factors. Further, the study also revealed that a 1 percent increase in clean energy investment diminishes dirty energy consumption by approximately 0.45 percent. The validity of the findings is confirmed using alternate methods, i.e., KRLS. The study recommends that Pakistan prioritize investment in clean energy projects to promote environmental sustainability and enforce environmental regulations to reduce the adverse externalities associated with dirty energy activities.

Identification and prevalence of ticks infesting small ruminants of Fort Munro region in South Punjab, Pakistan.

Fort Munro is a hill station in Southern Punjab the residents of whom are heavily dependent upon livestock for their living but ticks are a big treat for the livestock. The purpose of this study was to ascertain the tick infestation among the small ruminants of Fort Munro. Ticks (N = 273) were collected from 333 animals (165 goats and 168 sheep) during August and September 2022. Two tick genera Hyalomma and Rhipicephalus were identified. Rhipicephalus was most abundant tick genera (78.02%) followed by Hyalomma (21.98%).Tick distribution significantly varied with the host: Rhipicephalus ticks were more frequently infesting goats while Hyalomma were more common on sheep. For both hosts, tick infestation varied with the sampling sites and male animals were significantly more infested than females. Five tick species were infesting goats with the following relative abundance: Rhipicephalus (R.) senegalensis (39.20%) > R. sanguineus (36.8%) > R. appendiculatus (10.40%) > R. turanicus (8%) > R. guilhoni (5.6%). Rhipicephalus senegalensis (41.22%) was also the most common tick species infesting sheep followed by Hyalomma (H.) marginatum (29.73%), R. guilhoni (18.24%), H. dromedarii (5.41%) and H. impeltatum (5.41%). Male ticks very more abundantly on both goats and sheep than female. Distribution of Hyalomma species also varied between the sampling sites. In conclusion, we are reporting the infestation of 3 Hyalomma and 5 Rhipicephalus in small ruminants of Fort Munro. The data generated through this study will help in developing appropriate tick control in the study area and will add to the existing knowledge regarding tick species that are infesting the small ruminants of Pakistan.

Changing Cancer Trends in District Dir, Pakistan: Epidemiological Insights From a 10-Year Hospital-Based Study.

Background More alarming than the rise of cancer globally is its discreet changing profiles over the years. According to our knowledge, no new studies on cancer have taken place in Dir since 2004. Hence, we aimed to provide and analyze the cancer trends in district Dir, Malakand division, Khyber Pakhtunkhwa (KPK), regarding its prevalence and incidence, and compare it nationally and internationally. Methods A retrospective study was conducted by collecting data from 2647 clinically diagnosed cancer patients of all ages in district Dir, between the years 2008 and 2017, from the Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar. Statistical analysis was performed using SPSS version 20 and presented using different tables and figures. Results Out of the total patients, 52.7% were male and 47.3% were female. The most common types of cancers in both genders combined were breast (9.0%), acute lymphocytic leukemia (ALL) (6.0%), skin (5.7%), non-Hodgkin Lymphoma (NHL) (5.6%), and brain tumor (5.2%). The age-standardized incidence rate (ASIR) in males in 2017 was peaking in the age group 60-69 (2707.2) with the most prevalent cancer being NHL (7.7%). In females, ASIR was highest in the age group 30-39 (2500.8) with the majority having breast cancer (18.1%), and in children, ALL (30.9%) was most prevalent. Incidence was highest in 2014 with a staggering 15 cases/100,000 population. Cancer prevalence in females aged 50 and below was significantly higher (p<0.001) compared to males. Conclusion Our study highlights that cancer profiles in Dir in the past two decades have changed with certain results non-conforming to global and regional trends. A follow-up research should be carried out to further ascertain and analyze these diverging results in hopes of drawing a more concrete conclusion from these findings.

Experiences of identifying pre-school children with disabilities in resource limited settings - an account from Malawi, Pakistan and Uganda.

Although access to effective medical care for acutely sick children has improved globally, the number of children surviving but who may not be thriving due to disability, is increasing. This study aimed to understand the views of health professionals, educators and caregivers of pre-school children with disabilities in Malawi, Pakistan and Uganda regarding early identification, referral and support. Using applied thematic analysis, we identified themes relating to; limited 'demand' by caregivers for services; different local beliefs and community perceptions regarding the causes of childhood disability. Themes relating to 'supply' of services included inability to respond to community needs, and inadequate training among professionals for identification and referral. Stepwise, approaches provided to the families, community health worker and higher-level services could include training for community and primary care health workers on basic identification techniques and enhanced awareness for families and communities on the importance of early identification of children with disabilities.

Lack of collaboration between the community and health services may lead to entrenched pessimistic views of what can be done to support children with disabilities - generating a greater mistrust and low parental take-up of vital health services.If parents do not receive help at the community and clinic level, then, there is a need to move away from trying to provide a 'specific diagnosis' to working more on a level of assessing the child's functioning in terms of what their limitations are and how they can be addressed.Any identification and referral programme needs to consider the varying local beliefs, the stigma of having a child with a disability and feelings of blame, right from the start.A stepwise, incremental approaches, ranging from the provision of basic information, such as using brief materials highlighting 'red flag' milestones and conditions which are linked to guidance for support to families, community health workers, as well as higher levels of medical services, are likely to work best.

Treatment gap and barriers to access mental healthcare among women with postpartum depression symptoms in Pakistan.

Background and Objectives: Postpartum depression (PPD) is prevalent among women after childbirth, but accessing mental healthcare for PPD is challenging. This study aimed to assess the treatment gap and barriers to mental healthcare access for women with PPD symptoms living in Punjab, Pakistan. Methods: A multicenter cross-sectional study was conducted in five populous cities of Punjab from January to June 2023 by administering the questionnaire to the women using stratified random sampling. A total of 3,220 women in first 6 months postpartum were screened using the Edinburgh Postnatal Depression Scale. Of them, 1,503 women scored thirteen or above, indicating potential depressive disorder. Interviews were conducted to explore help-seeking behavior and barriers to accessing mental healthcare. Descriptive statistics along with nonparametric tests (e.g., Kruskal-Wallis, Mann-Whitney U) were used and group differences were examined. Scatter plot matrices with fitted lines were used to explore associations between variables. Classification and regression tree methods were used to classify the importance and contribution of different variables for the intensity of PPD. Results: Only 2% of women (n = 33) with high PPD symptoms sought mental healthcare, and merely 5% of women (n = 75) had been in contact with a health service since the onset of their symptoms. 92.80% of women with PPD symptoms did not seek any medical attention. The majority of women, 1,215 (81%), perceived the need for mental health treatment; however, 91.23% of them did not seek treatment from healthcare services. Women who recently gave birth to a female child had higher mean depression scores compared to those who gave birth to a male child. Age, education, and birth location of newborn were significantly associated (p  <  0.005) with mean barrier scores, mean social support scores, mean depression scores and treatment gap. The results of classification and regression decision tree model showed that instrumental barrier scores are the most important in predicting mean PPD scores. Conclusion: Women with PPD symptoms encountered considerable treatment gap and barriers to access mental health care. Integration of mental health services into obstetric care as well as PPD screening in public and private hospitals of Punjab, Pakistan is critically needed to overcome the treatment gap and barriers.

Nexus among the perceived infrastructural, social, economic, and environmental impact of CPEC: A case of Pakistan.

Despite its ambitious "economic sustainability" objectives, the China-Pakistan Economic Corridor (CPEC) has been the subject of growing environmental anxiety. Considering the CPEC developments, it is clear that Pakistan is ready to fully embrace this new industrial chapter and take advantage of its major benefits to solve social, energy, infrastructure, and economic problems. However, it should also seriously commit to undertaking proper environmental impact assessments and upgrading system resilience. Data was collected from 400 respondents from Pakistan, and structural equation modeling was applied with the help of AMOS. Factor analysis and structural equation modeling techniques were used to estimate the results and test the study's hypothesis. The results indicate a strong socio-economic impact across perceived economic, infrastructure, social, and total impacts, but they identify a negative association between infrastructure innovation and environmental sustainability. Moreover, results revealed that infrastructure supports social and economic growth, but it might have a substantial negative impact on biodiversity. According to findings, Pakistan may be more vulnerable to climate change due to three potential environmental issues: coal-fired power plants, CO2 concentration along the CPEC route, and increased traffic on the Karakorum Highway. Furthermore, future international trade will be significantly impacted by the corridor. It may, however, also accelerate the destruction of the ecosystem over time due to the industrial revolution.

Navigating Pakistan's immunization landscape: Progress and pitfalls.

Objectives: This study aims to assess the impact of the 2022 floods in Pakistan on the incidence of vaccine-preventable diseases (VPDs) in flood-affected regions, specifically focusing on areas with traditionally low vaccination coverage. Design: Weekly incidence data of VPDs from September to November 2021 and 2022 were collected and analyzed for the provinces of Sindh, Khyber Pakhtunkhwa, and Baluchistan. The study compared year-on-year changes in disease incidence to evaluate the effect of the floods on disease burden. Results: The analysis revealed significant increases in the incidence of various VPDs in the flood-affected regions compared to the previous year. Diseases such as pertussis showed a 171% increase, while mumps exhibited nearly a 1000% increase in reported cases. Other diseases including polio, diphtheria, neonatal tetanus, measles, chickenpox, and rubella also experienced substantial rises in case numbers. Concurrently, cases of lower respiratory tract illnesses and diarrheal diseases in children under five years old surged notably. Conclusions: The findings underscored the failure of relief and healthcare efforts in managing vaccine-preventable diseases in flood-affected areas of Pakistan. The study highlights an urgent need for targeted intervention strategies, including enhanced immunization drives and healthcare infrastructure improvements in vulnerable regions. The post-flood scenario presents a critical opportunity to address existing challenges in vaccination coverage and to mitigate future disease outbreaks through comprehensive public health initiatives.

Efficacy of Remdesivir on Clinical Outcomes in COVID-19 Patients: A Study in a Tertiary Care Hospital in Pakistan.

Background: As of October 3, 2023, the global COVID-19 case tally exceeded 696 million, with almost 7 million fatalities. Remdesivir, approved for treatment of COVID-19 by regulatory bodies, has seen varying recommendations by the World Health Organization over time. Despite certain studies questioning its efficacy, others highlight potential benefits. The objective of this study was to gauge the impact of remdesivir on clinical outcomes in a Pakistani tertiary care hospital. Methods: An analytical cross-sectional study was conducted on 108 COVID-19 patients at Mayo Hospital Lahore between September 2020 and August 2021. Of these, 52 received remdesivir. The study employed a structured proforma for data collection, with analyses conducted using SPSS version 26, considering a p-value of less than 0.05 as statistically significant. Results: Demographic distribution between remdesivir-treated and untreated groups was similar. Significant improvement was observed in the remdesivir cohort in terms of oxygen saturation (58%), ferritin levels (58.2%), chest X-ray results (67.8%), and discharge rates (66.7%) when compared to the untreated group. Stratification based on disease severity showed that remdesivir was particularly beneficial for moderate illness cases in several parameters. Conclusion: This study suggests that remdesivir can be associated with improved outcomes, especially in patients with moderate COVID-19 severity. The data emphasizes the importance of the disease stage when considering therapeutic interventions and calls for more region-specific research to guide health responses amid diverse epidemiological landscapes.

Presentation, management, and early outcomes of young acute coronary syndrome patients- analysis of 23,560 South Asian patients from 2012 to 2021.

BACKGROUND: There is dearth of literature addressing early outcomes of acute coronary syndrome (ACS) among young patients, particularly South Asians descent who are predisposed to premature coronary artery disease (CAD). Therefore, we compared presentation, management, and early outcomes of young vs. old ACS patients and explored predictors of in-hospital mortality. METHODS: We extracted data of 23,560 ACS patients who presented at Tabba Heart Institute, Karachi, Pakistan, from July 2012-June 2020, from the Chest pain-MI-Registry™. We categorized data into young ≤ 45 and old ACS patients > 45 years. Chi-sq/Fischer exact tests were used to assess the difference between presentation, disease management, and in-hospital mortality between both groups. Logistic regression was used to determine odds ratio along with 95% confidence interval of factors associated with early mortality. RESULTS: The younger patients were 12.2% and women 23.5%. The prevalence of dyslipidemia (34.5% vs. 22.4%), diabetes (52.1% vs. 27.4%), and hypertension (68.3% vs. 42.9%) was higher in older patients. Family history of premature CAD (18.1% vs. 32.7%), smoking (40.0% vs. 22.9%), and smokeless tobacco use (6.5% vs. 8.4%) were lower in older patients compared to younger ones. Younger patients were more likely to present with STEMI (33.2% vs. 45%). The median symptom-to-door time was 125 min longer (p-value < 0.01) in the young patients compared to the older age group. In-hospital mortality (4.3% vs. 1.7%), cardiac arrest (1.9% vs. 0.7%), cardiogenic shock (1.9% vs. 0.9%), and heart failure (1% vs. 0.6%) were more common in older patients. After adjusting for other factors, younger age (AOR 0.6, 95% CI 1.5-3.7) had significantly lesser odds of in-hospital mortality. Other factors associated with early mortality included women, family history of premature CAD, STEMI, Killip class III and IV, coronary angiography, revascularization, CABG, and use of aspirin and beta blockers within the first 24 h. CONCLUSION: We found every tenth ACS patient was younger than 45 years of age despite a lesser number of comorbidities such as hypertension and diabetes. Overall, the in-hospital prognosis of young patients was more favorable than that of older patients. The study emphasizes the need for tailored primary prevention programs for ACS, considering the varying risks among different age groups.