The Coronavirus Anxiety Scale: Cross-national measurement invariance and convergent validity evidence

Coronavirus Anxiety Scale (CAS) is a widely used measure that captures somatic symptoms of coronavirus-related anxiety. In a large-scale collaboration spanning 60 countries (Ntotal = 21,513), we examined the CAS's measurement invariance and assessed the convergent validity of CAS scores in relation to the fear of COVID-19 (FCV-19S) and the satisfaction with life (SWLS-3) scales. We utilized both conventional exact invariance tests and alignment procedures, with results revealing that the single-factor model fit the data well in almost all countries. Partial scalar invariance was supported in a subset of 56 countries. To ensure the robustness of results, given the unbalanced samples, we employed resampling techniques both with and without replacement and found the results were more stable in larger samples. The alignment procedure demonstrated a high degree of measurement invariance with 9% of the parameters exhibiting noninvariance. We also conducted simulations of alignment using the parameters estimated in the current model. Findings demonstrated reliability of the means but indicated challenges in estimating the latent variances. Strong positive correlations between CAS and FCV-19S estimated with all three different approaches were found in most countries. Correlations of CAS and SWLS-3 were weak and negative but significantly differed from zero in several countries. Overall, the study provided support for the measurement invariance of the CAS and offered evidence of its convergent validity while also highlighting issues with variance estimation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing the multitargeted antidiabetic potential of three pomegranate peel-specific metabolites: An in silico and pharmacokinetics study

Diabetes is a chronic metabolic disorder that occurs due to impaired secretion of insulin, insulin resistance, or both. Recent studies show that the antidiabetic drugs used to control hyperglycemic levels are associated with undesirable adverse effects. Therefore, developing a safe and effective medicine with antidiabetic potential is needed. In this context, in silico studies are considered a rapid, effectual, and cost-effective method in drug discovery procedures. It is evident from the literature that plant-based natural components have shown promising outcomes in drug development to alleviate various diseases and hence have diversified the screening of potential antidiabetic agents. Purposely, in the present study, an in silico approach was performed on three Punica granatum peel metabolites (punicalin, punicalagin, and ellagic acid). All these three compounds were docked against nine protein targets involved in glucose metabolism (GFAT, PTP1β, PPAR-ᵞ, TKIR, RBP4, α-amylase, α-glucosidase, GCK, and AQP-2). These three pomegranate-specific compounds demonstrated significant interactions with GFAT, PTP1β, PPAR-ᵞ, TKIR, RBP4, α-amylase, α-glucosidase, GCK, and AQP-2 protein targets. Specifically, punicalin, punicalagin, and ellagic acid revealed significant binding scores (-9.2, -9.3, -8.1, -9.1, -8.5, -11.3, -9.2, -9.5, -10.1 kcal/mol; -10, -9.9, -8.5, -8.9, -10.4, -9.0, -10.2, -9.4, -9.0 kcal/mol; and -8.1, -8.0, -8.0, -6.8, -8.7, -7.8, -8.3, -8.1, -8.1 kcal/mol, respectively), with nine protein targets mentioned above. Hence, punicalin, punicalagin, and ellagic acid can be promising candidates in drug discovery to manage diabetes. Furthermore, in vivo and clinical trials must be conducted to validate the outcomes of the current study.

ViSHWaS: Violence Study of Healthcare Workers and Systems-a global survey

OBJECTIVE

To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education.

METHODS

The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ2 test was performed to determine the association between gender and different violence forms.

RESULTS

A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26-35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26-65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55-65 age group, which lost statistical significance.

CONCLUSION

This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.

Geostatistical analysis for spatial distribution of anemia (Hb level) among women of reproductive age and determinant factors

The study was designed to assess the geostatistical spatial distribution of anemia and determinant factors among the women of reproductive age group (RAG) in Gilgit district, Pakistan. The Hb levels for 15-25 RAG, 26-35 RAG, and 36-45 group showed 10.22 g/dL, 10.41 g/dL, and 9.90 g/dL levels, respectively, while the Hb level showed a nugget/sill ratio of 0.21 inferring strong for the 15-25 group, weak for the 26-36, and moderate for 36-45 spatial dependence. Furthermore, 15-25 RAG showed 8% severe and 33.34% sufficient cases and 26-35 showed 12% severe and 29.33% sufficient results in their Hb level, whereas 36-45 had 9.34% severe and 29.33% sufficient.

A report of Kabul internet users on self-medication with over-the-counter medicines

Self-medication (SM) with over-the-counter (OTC) medications is a prevalent issue in Afghanistan, largely due to poverty, illiteracy, and limited access to healthcare facilities. To better understand the problem, a cross-sectional online survey was conducted using a convenience sampling method based on the availability and accessibility of participants from various parts of the city. Descriptive analysis was used to determine frequency and percentage, and the chi-square test was used to identify any associations. The study found that of the 391 respondents, 75.2% were male, and 69.6% worked in non-health fields. Participants cited cost, convenience, and perceived effectiveness as the main reasons for choosing OTC medications. The study also found that 65.2% of participants had good knowledge of OTC medications, with 96.2% correctly recognizing that OTC medications require a prescription, and 93.6% understanding that long-term use of OTC drugs can have side effects. Educational level and occupation were significantly associated with good knowledge, while only educational level was associated with a good attitude towards OTC medications (p < 0.001). Despite having good knowledge of OTC drugs, participants reported a poor attitude towards their use. Overall, the study highlights the need for greater education and awareness about the appropriate use of OTC medications in Kabul, Afghanistan.

Basic life support knowledge among healthcare providers in Afghanistan: a cross-sectional study of current competencies and areas for improvement

Basic life support (BLS) is a type of emergency care provided by healthcare workers and public safety professionals to individuals experiencing cardiac arrest, respiratory distress, or other cardiopulmonary emergencies. Despite having a high burden of cardiovascular disease and trauma from conflict in Afghanistan, little is known about the level of BLS knowledge Afghani healthcare workers have. A cross-sectional study was conducted in Kabul, Afghanistan, to assess healthcare workers' training and knowledge of BLS. The study, which took place from March to June 2022 across multiple public and private hospitals, was approved by the institutional ethics committee of Ariana Medical Complex. The sample size was calculated using a nonprobability convenience sampling method, and the study population consisted of healthcare workers actively working in a health center who were willing to complete a questionnaire. The results of the study showed that most participants (71.3%) were in the 21-30-year-old age range, and a third (32.3%) were doctors. 95.3% of participants had poor knowledge of BLS, with a mean score of 4.47±1.58 out of 13. Additionally, it was evident from questionnaire responses that providers are not adequately performing BLS. These findings suggest that further work, including regular BLS courses, is necessary to improve the knowledge and practice of BLS by healthcare workers in Afghanistan.

Antioxidant activity and phytochemical analysis of fennel seeds and flaxseed

Natural herbs are now receiving more attention due to the growing demand for their antioxidant properties. This study compared flaxseed and fennel seeds for their nutritional composition, bioactive moieties, and antioxidant activity-the study comprised two different phases. According to methods, phase I analyzed flaxseed and fennel seeds for proximate composition, mineral profile, dietary fiber, and amino acid content. In phase II, seeds were extracted using three different solvents, i.e., ethanol 80%, acetone 80%, and distilled water, to probe the total phenolic and flavonoid content. Antioxidant activity was measured using DPPH and a FRAP in the final phase. Current study revealed that flaxseed had higher protein (17.33 ± 0.02%), fat content (36.76 ± 0.02%), potassium (763.66 ± 4.04 mg/100 g), iron (5.13 ± 0.03 mg/100 g), phosphorus (581.46 ± 4.07 mg/100 g), magnesium (406.60 ± 5.12 mg/100 g), and zinc (3.30 ± 0.49 mg/100 g), respectively. In fennel seed, high dietary fiber (53.2 ± 0.01 g/100 mg), calcium, manganese, and sodium (588.93 ± 7.77, 20.30 ± 0.95, and 57.34 ± 0.33 mg/100 g, respectively) were found. Acetone showed better extraction efficiency than acetone, ethanol, and distilled water. Moreover, acetone flaxseed extract showed higher total phenolic content (84.13 ± 7.73 mgGAE/g), flavonoid content (5.11 ± 1.50 mgQE/g), and FRAP (5031 ± 15.92 μMFe^2+/g) than fennel seed extract. This study showed that, among both herbs, flaxseed extract may have pharmacological potential in preventing illnesses and may be suggested for use in the food industry as a natural antioxidant.

Characterization of ultrasonically extracted flaxseed polysaccharide gum and assessing its lipid-lowering potential in a rat model

Flaxseed polysaccharide gum (FPG) was extracted through the ultrasound-assisted process using water as a solvent with a yield ranging from 8.05 ± 0.32% to 12.23 ± 0.45% by changing different extraction variables. The extracted FPG was analyzed for its functional groups and antioxidant potential. The maximum DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical scavenging activity (≈100%) of FPG was noted at concentrations beyond ≈10 mg·ml^-1. The maximum inhibition percentage through ABTS (2,2'-azino-bis 3-ethylbenzothiazoline-6-sulfonic acid) (72.4% ± 1.9%) was noted at 40 mg·ml^-1, which was observed to be less when compared to DPPH at the same concentration. The total antioxidant potential of the FPG solution at a concentration of 10 mg·ml^-1 was equivalent to 461 mg ascorbic acid, which tends to increase with concentration at a much lower scope. The in vivo trial suggested that the least weight gain was noted in experimental groups G₂ and Gh₂. A significant reduction in total cholesterol was noticed in G₁ (-14.14%) and G₂ (-17.72%) and in Gh₁ (-22.02%) and Gh₂ (-34.68%) after 60 days of the trial compared to the baseline values. The maximum reduction in total triglyceride was observed in Gh₂ (-25.06%) and Gh₁ (-22.01%) after 60 days of the trial. It was an increasing trend in high-density lipoprotein cholesterol (HDL-c) in different experimental groups G₂ (10.51%) than G₁ (5.35%) and Gh₂ (48.96%) and Gh₁ (31.11%), respectively, after 60 days of study interval. Reduction of -5.05% and - 9.45% was observed in G₁ and G₂, while similar results were observed in Gh₁ and Gh₂. Conclusively, results suggested a possible protective role of FPG against hyperlipidemia.

Self-reported adherence to preventive practices during the third wave of COVID-19 in Afghanistan

Objective:

The study objectives were aimed to highlight the areas where public awareness is needed to enhance preventive practices among the public. Hence, to avoid the spread of virus in public settings. In addition, the study has provided compelling data and evidence on the coronavirus disease-2019 trend for health policymakers to make strategic decisions.

Introduction:

The coronavirus disease-2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus type-2. The disease has spread across the globe. In Afghanistan, thousands of confirmed cases with hundreds of deaths have been reported. In addition, due to insufficient healthcare workforce, insecurity, fragile healthcare infrastructure, low coronavirus disease-2019 vaccination and low testing capacity, the true nature of the pandemic is unlcear.

Method:

An online survey of the general population in Afghanistan was conducted from April-May 2021. Convenience sampling technique was used to recruit the respondents. Social media platforms were used (WhatsApp, Twitter and Facebook Messenger) to disseminate the electronic survey instrument. Written informed consent was taken from the participants before the filling questionnaires. Data collection was guided through a self-administered questionnaire developed by the researchers according to the World Health Organization guidelines. The sample size was calculated using EPI software. The inclusion criteria were being 18 years or older and having access to the Internet to fill out the online questionnaire. IBM SPSS Statistics version 25.0 was used for analysis. Descriptive statistics (frequencies, percentages) and bi-variable (chi-square) analyses were done. A p value of <0.05 was considered significant at a 95% confidence interval.

Results:

From 1094 respondents, 78% were male. The majority of respondents were aged ⩽30 years and had an undergraduate education. Nearly 1 in 3 participants were healthcare workers, and 70% lived in households with five or more family members. Overall, 70% of the respondents reported good preventive practices. The majority of the participants reported covering their mouth and nose while coughing and sneezing and cleaning their hands regularly and using alcohol. Meanwhile, 80% of the participants wore a mask when going outside. Moreover, people with post-graduate education had a higher level of preventive practices than those with an undergraduate education.

The results of logistic regression revealed participants residence in Kabul, healthcare workers, family size less than 5, avoid meeting people outside, gender, and avoiding 3Cs, were the significant determinants of adhering to good preventive practices.

Conclusion:

Generally, the public in Afghanistan followed infection prevention rules. However, certain areas require further improvement, such as observing social distance and avoiding shaking hands when meeting others. Negligence of these prevention practices can lead to an increase in infection transmission among people. Public awareness should be continued to keep the people supportive of the government policies.

Risk Factors for Calcific Aortic Valve Disease in Afghan Population

Objective

Evidence from previous studies suggests that calcific aortic valve disease (CAVD) is not an unavoidable consequence of aging, and may be linked to explicit risk factors. However, little is known regarding the Afghan population in this context. The current study aimed to identify the clinical features of CAVD and determine independent risk factors for CAVD in the Afghan population.

Patients and Methods

A case-control study was conducted among 1072 Afghan participants (age >18 years) from January 2018 to December 2020. The study participants were divided into two groups based on echocardiographic findings: 536 individuals with CAVD and 536 age- and sex-matched controls. Data were collected using questionnaires from the medical records of all cases and controls. The independent predictors of CAVD were evaluated using multivariate logistic regression analysis.

Results

The mean age of study participants was 65.3 ± 13.5 years (range, 20–100 years). Of the 536 patients with CAVD, 77 (14.4%) had aortic valve stenosis, 415 (77.4%) had aortic valve calcification, and 44 (8.2%) had bicuspid aortic valve. Multivariate logistic regression analysis revealed that sedentary lifestyle (odds ratio [OR] = 2.517, p = 003), diabetes mellitus (DM) (OR = 1.902, p = 006), high body mass index (BMI ≥ 30 kg/m²) (OR = 1.776, p = 005), good socioeconomic status (OR = 1.724, p = 021), and hypertension (OR = 1.664, p ˂0.001) were independent risk factors for CAVD in the Afghan population.

Conclusion

It was observed that sedentary lifestyle, diabetes mellitus, high BMI (≥ 30 kg/m²), good socioeconomic status, and hypertension are independent risk factors for the development of CAVD compared to those with a normal aortic valve in the Afghan population.

Addressing the humanitarian crisis in Afghanistan through $10 billion Afghani assets: what are the challenges and opportunities at hand?

Background

The current humanitarian crisis in Afghanistan started after the US and international allies’ withdrawal. This has put the country in a dire situation as the globalized infrastructure supporting Afghanistan came to halt. Moreover, 10 billion USD of Afghanistan’s assets were frozen by the U.S and other international organizations after the Taliban takeover. This further exacerbated the humanitarian crisis and quickened the economic collapse in Afghanistan. These assets should be freed to support the people of Afghanistan.

Main body

In order to address this situation, international oversight is needed to allow these funds to be returned and used by the Central Bank of Afghanistan without misappropriation by the Taliban. We suggest a number of short term interventions and long term considerations to improve the situation in Afghanistan with the $10 billion in frozen assets. In the short term, economic stability and the hunger crisis should be addressed by funding international organizations such as the World Food Program and national Afghani NGOs. In the long term funds should be used to build back the economy, build healthcare infrastructure, and support the development of women and children.

Conclusion

At this juncture, the world and international organizations have a moral and ethical responsibility to ensure the 10 billion in funds go to the owners, the people of Afghanistan. With oversight and fund distribution to the right partners, progress can be made by providing support in security, healthcare, education and food resources. This calls for action to deliver $10 billion of assets to the Afghan people in a transparent manner, avoiding further tension and disasters in the country.

Knowledge, Attitude, and Practices Toward Tuberculosis Among Hospital Outpatients in Kabul, Afghanistan

Background

Tuberculosis (TB) is a high-burden respiratory infectious disease. There was a sharp decline in the number of confirmed TB cases during the pandemic; this is likely to be influenced by the COVID-19 pandemic response, with under-reporting due to resource diversion. There are typically 13,000 tuberculosis-associated deaths in Afghanistan annually, with significant problems posed by drug-resistant TB.

Method

A cross-sectional descriptive study was conducted in Afghanistan on Kabul residents who visited the adult outpatient departments of public hospitals for any health-related reason from 1st January to 20th March 2022. The study scored their knowledge, attitude, and practices (KAP) toward tuberculosis. The sample size was calculated using Epi-Info, and the minimum sample size was 385. The sampling method is chosen the non-probability convenient sampling for data gathering. Data were analyzed using SPSS version 28, and we used the Mann-Whitney test, Chi-square or fisher extract test, spearman correlations, and binary logistic regression model.

Results

Of 829 participants, 450 (54.3%) were males and 379 (45.7) females. The median age was 28 years, and 63.3% were married. Most participants were unemployed (75.5%), but 54% had a monthly income >3,000 Afghanis, indicating the reliance on family. By TB knowledge score, 727 (87.7%) participants had good knowledge, and 800 (96.5%) participants had a positive attitude toward treatment and control. Only 2 participants reported poor practices regarding prevention. Regarding the binary logistic regression, young age, being a male, belonging to the “1,000–3,000” Afghani monthly income category, and having a positive attitude were significant predictors of good TB knowledge (P-value = 0.009, 0.000, 0.003, and 0.009), respectively. A positive attitude was expected to have good knowledge 6.035 times more than a negative attitude (95% CI: 1.572–23.167).

Conclusion

The study findings highlighted that outpatients in Kabul had good knowledge, attitude, and practice toward TB. More studies are needed to highlight KAP in different Afghan populations, including in other parts of the country.

Impact of vitamin D on maternal and fetal health: A review

The role of vitamin D in improving maternal health and reducing the risk of developmental disorders in fetus has been an important domain of research since the past few years. Vitamin D, owing to its immunomodulatory, anti‐inflammatory, developmental roles, and regulating calcium homeostasis, is predicted to have a significant influence on maternal and fetal health status. Several observational studies and clinical trials, determining the impact of vitamin D on gestational diabetes, C‐section, postpartum depression, pre‐eclampsia, miscarriages, and preterm delivery, have been elaborated in this review. In addition, fetal birth defects including neurological development, reduced birth weight, respiratory infections, bone development, and altered anthropometrics have also been summarized with available evidences. Other important mechanisms related to the roles of vitamin D in the body are also explained. Furthermore, recent studies determining the effect of vitamin D at genetic level will also help in understanding and future design of research in the area of maternal and fetal health.

Facemask Usage Among Pedestrians in Most Crowded Urban Districts of Kabul, Afghanistan, During the Third COVID-19 Wave: An Observational Study

The COVID-19 has spread to everywhere since its emergence from Wuhan. In countries with a low vaccination rate, the use of facemasks is essential to limit the risk of COVID-19 transmission. We have conducted this study in June 2021 to estimate the prevalence of facemask usage, and investigate the use of different types of facemasks and their distribution among pedestrians in the most crowded urban districts of Kabul during the third COVID-19 wave in Afghanistan. Using a multistage sampling method, a total of 5,000 pedestrians were selected from five most crowded urban districts of the city. The data was gathered by an observational method. The percentage, mean, and standard deviation were used to describe the variables. The χ2 test analysis was used to assess the relationship between two categorical variables. Of the 5,000 observations, the most common age group was 10-39 years with high participation of male (87.2%). A total of 2,013 (40.3%) people used facemasks (95% CI). Females used facemasks significantly more than males (64.6% versus 36.7%, P < 0.001). Among the pedestrians who used a facemask, most of them (88.6%) wore their facemask correctly. In conclusion the prevalence of facemask use in Kabul was fairly low especially among elderly people (≥ 60 years). Hence, the observed rates probably cannot protect the community against the COVID-19. Therefore, it is important to emphasize the public health recommendations via educational programs and national campaigns to support the strict use of facemasks in public places.

Giant congenital melanocytic nevus in an Afghan child

We report an 8-year-old Afghan female with giant congenital melanocytic nevus (GCMN) which covered the entire back. The GCMN extended to anterolateral parts of the trunk surrounded by multiple satellite melanocytic nevi.

Public Perception and Preparedness to Fight Against the Third Wave of COVID-19 in Kabul, Afghanistan

The avalanche of Corona Virus 2019 (COVID-19) cases has placed an unprecedented load on Afghanistan’s government and public health authorities, putting the country in jeopardy. The primary goal of this research was to shed light on the country’s capital, Kabul, and to examine the existing preparedness and perceptions of its population in the midst of COVID-19’s third wave, which could result in decentralization and fragmentation of the already overburdened health-care system. An online, cross-sectional survey was conducted by the lecturers of the Kabul University of Medical Sciences between April 15, 2021 and April 25, 2021, to evaluate the preparedness of the Kabul citizens amidst the third wave of COVID-19. About 1736 citizens from Kabul participated in the survey. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. All categorical variables were reported using frequencies and percentages. The findings revealed that the most common source of COVID-19-related information was social media (74.8%). In addition, 34.4% of subjects had previously been infected with COVID-19. It was reassuring to see that 78.4% of residents said they knew more about COVID-19 than they did about prior COVID-19 waves. A majority (81.5%) expressed willingness to resist the third wave, but 89.4% said that the country’s government would be unable to develop an effective COVID-19 vaccine within the next 6 months. The findings of this present study indicates that citizens of Kabul are active in obtaining accurate information and disseminating it in the community. The citizens also reported sufficient COVID-19 related knowledge; however, they were more motivated to fight against the third wave of COVID-19. In regards to vaccination, they believed that the government could not vaccinate the public anytime soon. Hence, the enactment of non-pharmaceutical measures is important in the fight against the pandemic.

Availability of Personal Protective Equipment Among Health-care Workers in Jordan During the COVID-19 Pandemic: A Web-Based Survey

Propose

The inception of the COVID-19 has put health-care workers (HCWs) in a precarious situation across the world. In spite of the challenges in Jordan, the high awareness and preparedness of HCWs made it feasible for the country to control the contagious virus. The study aimed to provide a useful insight into availability of PPE among HCWs in Jordan, which could help the policy/decision-makers of public health to design better programs based on the information reported.

Methods

This cross-sectional online survey was conducted during July 2020 for the evaluation of the availability of personal protective equipment (PPE) among HCWs in Jordan.

Results

A total of 751 HCWs responded from different parts of the country, who were actively working at different hospitals in Jordan. The majority of the participants (94%) reported having sufficient knowledge about COVID-19 and more than two-thirds of participants (68%) reported that PPE were provided by the Jordanian Ministry of Health. The majority (91%) of participants reported availability of medical face masks, while only 26% reported having facial protective shields.

Conclusion

The study highlighted sufficient availability of PPE during the COVID-19 pandemic, which may have caused minimal infection rates among HCWs in Jordan.

The Third Wave of the COVID-19 Arrived in Afghanistan: A Severe Case with Skin Manifestation

The COVID-19 is an ongoing global pandemic that has put the world in a devastating situation. The virus is able to attack multiple body systems and cause a variety of clinical problems ranging from asymptomatic to critical cases. Although young individuals are more likely to suffer milder forms of the disease, critical cases also might happen. Recent literature has revealed that, along with other clinical symptoms, skin manifestations have also progressively grown. In Afghanistan where COVID-19 has entered into a third wave, many people do not take the initial mild symptoms seriously to prevent further spreading in the community. We report symptoms of skin rash, fatigue, muscle pain, dry cough and fever at the onset of the disease, followed by rapid lung damage in a 23-year-old young adult, who did not have any preexisting risk factors. This case highlights the importance of urgent skin assessment of the COVID-19 patient complaining of any skin symptoms.

Food Security, Conflict, and COVID-19: Perspective from Afghanistan

Afghanistan, a country challenged by war and conflicts, has been in a state of turmoil for several years. The prolonged suffering has brought many challenges to the country's inhabitants. Among these, food security is one important cause for concern. Food security occurs when people continuously have physical and economic access to adequate, safe, and nutritious food to meet their dietary requirements and food preferences for a functional and healthy life. Amid the pandemic, Afghanistan has witnessed a large increase in food shortages due to its dependence on neighboring countries. In light of current circumstances, food insecurity, coupled with political instability and the third wave of the COVID-19, have made it extremely hard for people to access daily provisions. Hence, people are left to navigate the COVID-19 pandemic with economic recession and poverty as the backdrop of the other health crises. To mitigate food security, international attempts are the required at this critical juncture. The aim of this article is to understand the causes leading to food insecurity and its implications in Afghanistan and to propose solutions that will improve the overall food security at the policy and implementation levels.

Role of stilbenes against insulin resistance: A review

Insulin resistance (IR) is a state characterized by the inability of tissues to utilize blood glucose particularly liver, muscle, and adipose tissues resulting in hyperglycemia and hyperinsulinemia. A close relationship exists between IR and the development of type 2 diabetes (T2D). Therefore, therapeutic approaches to treat IR also improve T2D simultaneously. Scientific evidence has highlighted the major role of inflammatory cytokines, reactive oxygen species (ROS), environmental & genetic factors, and auto-immune disorders in the pathophysiology of IR. Among therapeutic remedies, nutraceuticals like polyphenols are being used widely to ameliorate IR due to their safer nature compared to pharmaceutics. Stilbenes are considered important metabolically active polyphenols currently under the limelight of research to cope with IR. In this review, efforts are made to elucidate cellular and subcellular mechanisms influenced by stilbenes including modulating insulin signaling cascade, correcting glucose transport pathways, lowering postprandial glucose levels, and protecting β-cell damage and its effects on the hyperactive immune system and proinflammatory cytokines to attenuate IR. Furthermore, future directions to further the research in stilbenes as a strong candidate against IR are included so that concrete recommendation for their use in humans is made.

Infantile Hemangioma Treated with Oral Propranolol: Case Presentation

Infantile hemangiomas (IHs) are the most common vascular tumors in childhood. We report the use of propranolol to treat the growth phase of IHs. Propranolol was given to a 6-month-old infant who presented with a 4-cm sharply demarcated hemangioma on his left gluteal region. After relevant evaluation, propranolol was prescribed with a starting dose of 1 mg/kg/day, given in 3 divided doses. Vital signs were monitored during the first 6 hours of treatment. In the absence of side effects, treatment was continued at home with 2 mg/kg/day for six months, and the child was reevaluated after 7 days of treatment and then monthly. After one month, effects on color and growth were noted. Complete healing occurred in less than 6 months. Side effects and relapse were not reported. Propranolol administered orally at 2 mg/kg/day was successful, leading to near resolution of the patient’s hemangioma.

The Third Wave of the COVID-19 in Afghanistan: An Update on Challenges and Recommendations

The COVID-19 has spread to almost all countries since its emergence from Wuhan, China. Afghanistan has entered the third wave of the COVID-19 pandemic in May 2021. The county is bracing the third wave at a time when challenges like continuous conflict, illiteracy, poverty, inadequate healthcare personnel and service coverage, inadequate testing capacity, shortage of laboratory kits and reagents, lower public awareness and lower public trust on the government have brought it to its knees. All stakeholders including government, healthcare workers, civil societies, the public and the international community should combine their efforts to combat such a devastating situation. Although the inception of vaccination program against COVID-19 seems relieving, but it may take several months until a significant proportion of the people get vaccinated to reach the herd immunity. Thus, non-pharmaceutical intervention should be followed strictly. Moreover, awareness campaigns should also be continued to educate people and keep them supportive of the government plans and policies. Otherwise, the current wave may cause deadly consequences in such a complex situation.

Willingness to Vaccinate against COVID-19 among Healthcare Workers: An Online Survey in 10 Countries in the Eastern Mediterranean Region

BACKGROUND: Willingness of healthcare workers to be vaccinated is an important factor to be considered for a successful COVID-19 vaccination programme. This study aims to understand the willingness of health workers to receive a COVID-19 vaccine and its associated concerns across 10 countries in the Eastern Mediterranean Region (EMR). METHOD: A cross-sectional study was conducted in January 2021 among healthcare workers in EMR using an online survey. Data were analyzed using IBM SPSS software package version 20.0. RESULTS: A total of 2806 health workers (physicians, nurses and pharmacists) completed and returned the informed consent along with the questionnaire electronically. More than half of the respondents (58.0%) were willing to receive a COVID-19 vaccine, even if the vaccination is not mandatory for them. On the other hand, 25.7% of respondents were not willing to take COVID-19 vaccine while 16.3 % were undecided. The top three reasons for not willing to be vaccinated were unreliability of COVID-19 vaccine clinical trials (62.0%), fear of the side effects of the vaccine (45.3%), and that COVID-19 vaccine will not give immunity for a long period of time (23.1%). CONCLUSION: Overall, the study revealed suboptimal acceptance of COVID-19 vaccine among the respondents in the EMR. Significant refusal of COVID-19 vaccine among healthcare professionals can reverse hard-won progress in building public trust in vaccination program. The findings suggest the need to develop tailored strategies to address concerns identified in the study in order to ensure optimal vaccine acceptance among healthcare workers in the EMR.

Public Willingness and Hesitancy to Take the COVID-19 Vaccine in Afghanistan

COVID-19 has been causing a global threat to almost all countries for more than one year. Vaccination of the majority of any country's population is considered to be an effective way of controlling the spread and mortality of this infection. Therefore, it is important to assess the public's willingness to be vaccinated against COVID-19. In this study, we evaluated the public willingness and hesitancy to take the vaccine in Afghanistan, during December 2020 and January 2021. Sociodemographic data, awareness on vaccine production, vaccine availability, willingness and hesitancy to take the COVID-19 vaccine were collected. The Statistical Package for Social Studies (SPSS) version 25 was used for data analysis. A total of 806 complete responses were received. Majority of the respondents were ≤ 40 years old (89.8%) and male (72.7%). Less than two-thirds (509; 63%) of the participants reported willingness to take the vaccine when it becomes available, whereas almost one-third (297; 37%) of them were hesitant to take the COVID-19 vaccine. More female than male respondents were willing to take the vaccine (χ2 = 13.176, P value = 0.001). A significant portion of the public were not willing to take the COVID-19 vaccine. In a country like Afghanistan, which already has a low coverage of vaccination, this could pose a challenge for the vaccination program against COVID-19 to be effective. The Ministry of Public Health should work on public trust and change people's mindset about vaccine reality and efficacy to prevent the rejection of this health intervention.

A Survey on the Health and Financial Status of Private Educational Institutions in Afghanistan During COVID-19 Pandemic

Purpose

The worldwide spread of the coronavirus named SARS-CoV-2 has disrupted the world economy and the economy of Afghanistan as part of it. In addition, it has affected health and education in the country. The aim of this study is to highlight the damage the pandemic has done to private educational institutes in Afghanistan, in terms of finances, health and educational aspects. This is to draw attention to the setbacks the COVID-19 pandemic has caused to post-war (ie, post 2001) Afghan private education.

Methods

A cross-sectional study was conducted with the help of Afghanistan’s Educational Centers Association (AECA) members to analyze the impact of the COVID-19-related lockdown. The questionnaire for the survey was distributed through SurveyMonkey to founders of educational institutes. It included basic demographics, perception of and exposure to COVID-19 by the participants and the educational and financial state of their institutions. Data analysis was conducted using SPSS software version 25.

Results

Almost all participants who completed the questionnaire were male; 82% of them were under 35 years old, the others were older. Fifty-one percent obtained their COVID-19-related information through social media. Fifty-six percent confirmed that either they themselves or employees had tested positive with COVID-19. Eighty-seven percent of their educational institutes were not conducting any online classes. Only 2% received continued payment from their students. Five percent did not pay rent for their center’s lease. Regarding the economic damage during the lockdown period (March to July 2020) they encountered, 47% reported a loss of 2000–5000$ with a decreasing amount of participants responding and an ascending amount of financial loss.

Conclusion

COVID-19 pandemic caused a significant financial and educational loss to the private educational institutes in Afghanistan. The lockdown induced by it affected students’ fees transactions, induction of online classes, substantial financial loss, and it elevated the health crisis according to the founders of private educational institutes’ reports.

Tongue ulcer in a patient with COVID-19: a case presentation

BACKGROUND

The emergence of COVID-19 has devastated many parts of the world. From asymptomatic to symptomatic, the virus causes a wide spectrum of presentations. COVID-19 patients may present with oral manifestations. In Afghanistan, where COVID-19 has severely strained the health care system, much of the population lacks proper oral hygiene. This makes the oral cavity a perfect site for SARS-CoV-2 to manifest clinical signs.

CASE PRESENTATION

A 62-year-old male was evaluated in the Dentistry Teaching Clinic of Kabul University of Medical Sciences for a painful erosive lesion on dorsal surface of his tongue. He also complained of fever, cough, and taste alteration. He was referred to Afghan Japan Hospital for COVID-19 testing and tested positive. He was followed on for the treatment of SARS-CoV2. After 2 weeks, the patient tested negative and returned to the dentistry clinic for follow-up. Although there were no other signs of COVID-19, the painful erosive lesion on his tongue persisted. Oral evaluation were performed and the patient was advised to practice good hygiene. After 10 days, we observed an asymptomatic geographic tongue without fever and myalgias and the lesion of dorsal surface of tongue improved from severe condition to moderate.

CONCLUSION

In conclusion, patients with suspected or confirmed SARS-CoV-2 should be screened for symptoms and physical findings in the oral mucosa To prevent such an outcome, awareness programs need to be implemented for the diagnosis and management of clinical symptoms among patients.

Knowledge, Attitudes, and Practices of Medical Students Regarding COVID-19 in Afghanistan: A Cross-Sectional Study

BACKGROUND

The coronavirus pandemic has had devastating effects on many nations, including Afghanistan. Public awareness and following recommendations play an important part in managing such a large-scale crisis, which are affected largely by knowledge, attitudes, and practices (KAP). Medical students can act as reliable sources of information for the public in such a scenario. This study aimed to investigate KAP of medical students regarding COVID-19.

METHODS

A cross-sectional online survey was conducted in October 2020 among medical students in Afghanistan, Kabul University of Medical Sciences. Information on sociodemographics and KAP, was collected using a web-based questionnaire.

RESULTS

A total of 1,169 medical students completed the survey. More than half were female (54.6%), a majority (95%) aged ≥20 years, and more than half (56.2%) lived in the city of Kabul. Overall, students had acceptable KAP regarding COVID-19, except for a few undesirable responses with regard to the risks of close contact with COVID-19 patients, incubation periods, and groups vulnerable to COVID-19.

CONCLUSION

Overall, the students had acceptable KAP regarding COVID-19, except for the few undesired aforementioned responses, which need more focus during awareness campaigns in future.

Prevalence of Symptoms of Anxiety Among Residents of Kabul During Pandemic of COVID-19: A Report from Capital of Afghanistan

PURPOSE

This study was conducted to evaluate the prevalence of symptoms of anxiety among residents of Kabul during the present COVID-19 pandemic.

METHODS

This descriptive cross-sectional, community based survey was conducted in Kabul, Afghanistan, during the COVID-19 pandemic. Data were collected from July 11, 2020, to July 16, 2020. A bilingual (Dari and English) questionnaire was used for data collection. The first section of the questionnaire collected sociodemographic information of the respondents and the second comprised a self-report standardized scale, i.e. Generalized Anxiety Disorder-7 (GAD-7) to assess symptoms of anxiety. The survey form was distributed through online platforms. All residents of Kabul who used social apps such as WhatsApp and Facebook were eligible to participate in the study and participation was voluntary and non-commercial.

RESULTS

Altogether 1135 complete responses were received. The majority of them were males and aged 18-34 years. Almost 18% were healthcare workers. Overall, 28.2% of the respondents reported symptoms of moderate to severe anxiety, 38.8% reported symptoms of mild anxiety, and nearly one third of the respondents reported no symptoms. Female participants reported significantly higher levels of anxiety compared with males (39.7% versus 25.6%; p = 0.0001). No significant association was noted between anxiety levels and age groups, occupations, and healthcare workers versus non-healthcare workers.

CONCLUSION

The findings suggest that a gender-specific psychosocial protocol needs be integrated into the public health emergency plans to fight against the current pandemic.

A Survey of the Healthcare Workers in Afghanistan during the COVID-19 Pandemic

Healthcare workers (HCWs) in Afghanistan faced many challenges during the COVID-19 pandemic. A cross-sectional, online survey was conducted from July 4, 2020 to July 12, 2020 to evaluate the working conditions and health situation of HCWs in Afghanistan during the pandemic. Healthcare workers from 34 provinces, who were actively working in Afghan hospitals, were invited to participate in this study; 925 HCWs completed the survey. The results showed that 85% of the HCWs participated in the study were tested positive for COVID-19. This highlights the critical need of HCWs for personal protective equipment when caring for suspected and/or confirmed cases of the COVID-19.

Expanding the phenotypic spectrum of the Baller-Gerold syndrome

We report on two sisters off-spring of healthy consanguineous parents, where their major clinical features absent thumb, radial aplasia and craniosynostosis led to a diagnosis of Baller-Gerold syndrome BGS (OMIM:218600). Syndromes with associated preaxial reduction defects mainly Fanconi pancytopenia, VATER association, Rothmund-Thompson and Roberts phocomelia syndrome were excluded by proper clinical and cytogenetic studies. In addition to craniosynostosis and radial deficiency, our studied cases had absent or hypoplastic thumbs, postaxial polydactyly in the left foot, genital anomalies and orodental manifestations. Review of the literature depicted phenotypic variability of BGS. The presence of affected sibs the offspring of consanguineous parents confirms autosomal recessive inheritance. The observation of associated postaxial polydactyly, blue sclera, rotatory nystagmus, other skeletal and orodental anomalies broadened the spectrum of phenotypic variability. Awareness of the expanded phenotypic spectrum will improve the diagnosis and genetic counseling of BGS.

[Indication, type of resection and results of surgery in cases of lung tuberculosis. A historical and regional overview]

Pulmonary tuberculosis has become a rare indication for surgical intervention in all industrial nations. Over a period of 10 years we overview 193 patients who were suffering this disease and underwent thoracotomy. Main indication (79.8 %) was pulmonary nodules, of unknown origin. In this cases wedge resection was performed. Expanded resectional techniques were necessary in cases of cavernes, superinfected bronchiectasis, bronchial stenosis, hemoptysis and destroyed lungs due to tuberculosis. Considering the heterogenous groups of patients, the perioperative morbidity (21.8 %) and mortality (0.5 %) has to be regarded in comparison to the data found in the literature.