Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar,Pakistan

Objective:To assess the profile of TB/multidrug-resistant TB(MDR-TB) among household contacts of MDR-TB patients.Methods:Close contacts of MDR-TB patients were traced in the cross-sectional study.Different clinical,radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB.Results:Between January 2012 and December 2012,a total of 200 index MDR-TB patients were initiated on MDR-TB treatment,out of which home visit and contacts screening were conducted for 154 index cases.Of 610 contacts who could be studied,41(17.4%) were diagnosed with MDR-TB and 10(4.2%) had TB.The most common symptoms observed were cough,chest pain and fever.Conclusions:The high incidence of MDR-TB among close contacts emphasize the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease.

Views of South Asian Physicians on Climate Related Health Effects: A Multinational Cross-Sectional Pilot Study

Background: South Asian populations are vulnerable to poor health outcomes associated with climate due to the region’s complex topography, poverty, lack of education, and population density. Physicians, being highly trusted members of society, can help mitigate climate change effects in their countries. Objectives: The present study assessed perceptions of physicians from four South Asian countries (Bangladesh, Bhutan, India, and Pakistan). We hypothesized that physicians from these countries will be aware and knowledgeable about health effects of climate change. Methods: We conducted a cross-sectional online survey of physicians between March and July 2022. Data of 201 physicians was analyzed using the Kruskal-Wallis test and Dunn’s post hoc method. Results: Physicians from four South Asian countries were attuned to the health risks associated with climate change. A majority of physicians (86.6%) believed that climate change would make health conditions in their countries more severe or frequent (Bangladesh 83.3%;Bhutan 70%;India 91% and Pakistan 90.8%). The most common health effect related to climate change was illnesses related to reduced outdoor air quality (54.3%). Common barriers to discuss climate change with patients from all four countries were physicians’ lack of knowledge (strongly agree, 13.8%;agree 47.7%) in how to approach the issue with patients, lack of time (strongly agree, 12%;agree, 48%) and their perception that patients were not interested in knowing about climate change (strongly agree, 8.6%;agree, 42.6%). More than half (56.2%) of the physicians reported no training (Bangladesh, 51.7%;Bhutan, 80%;India, 44.6%;Pakistan, 63.1%) and approximately 30% reported less than 20 hours of training (Bangladesh, 28.3%;Bhutan, 15.0%;India, 39.3%;Pakistan, 27.7%) in climate-change-related health effects. Conclusion: While additional large-scale research is needed to understand the trends observed in our pilot study, our findings identify the need to introduce interventions to improve physicians’ knowledge of the health impacts of climate crisis.

Effects of cumulative COVID-19 cases on mental health:Evidence from multi-country survey

BACKGROUND Depression and anxiety were both ranked among the top 25 leading causes of global burden of diseases in 2019 prior to the coronavirus disease 2019(COVID-19)pandemic.The pandemic affected,and in many cases threatened,the health and lives of millions of people across the globe and within the first year,global prevalence of anxiety and depression increased by 25%with the greatest influx in places highly affected by COVID-19.AIM To explore the psychological impact of the pandemic and resultant restrictions in different countries using an opportunistic sample and online questionnaire in different phases of the pandemic.METHODS A repeated,cross-sectional online international survey of adults,16 years and above,was carried out in 10 countries(United Kingdom,India,Canada,Bangladesh,Ukraine,Hong Kong,Pakistan,Egypt,Bahrain,Saudi Arabia).The online questionnaire was based on published approaches to understand the psychological impact of COVID-19 and the resultant restrictions.Five standardised measures were included to explore levels of depression[patient health questionnaire(PHQ-9)],anxiety[generalized anxiety disorder(GAD)assessment],impact of trauma[the impact of events scale-revised(IES-R)],loneliness(a brief loneliness scale),and social support(The Multidimensional Scale of Perceived Social support).RESULTS There were two rounds of the online survey in 10 countries with 42866 participants in Round 1 and 92260 in Round 2.The largest number of participants recruited from the United Kingdom(112985 overall).The majority of participants reported receiving no support from mental health services throughout the pandemic.This study found that the daily cumulative COVID-19 cases had a statistically significant effect on PHQ-9,GAD-7,and IES-R scores.These scores significantly increased in the second round of surveys with the ordinary least squares regression results with regression discontinuity design specification(to control lockdown effects)confirming these results.The study findings imply that participants’mental health worsened with high cumulative COVID-19 cases.CONCLUSION Whist we are still living through the impact of COVID-19,this paper focuses on its impact on mental health,discusses the possible consequences and future implications.This study revealed that daily cumulative COVID-19 cases have a significant impact on depression,anxiety,and trauma.Increasing cumulative cases influenced and impacted education,employment,socialization and finances,to name but a few.Building a database of global evidence will allow for future planning of pandemics,particularly the impact on mental health of populations considering the cultural differences.