Locality based Approach for containment of COVID-19 Infections in Pakistan’s High risk Districts-ICT

Background

In May 2020, considering gradual restoration of all economical activities the Government of Pakistan updated containment strategy from locking down the whole country to locking down high-risk areas to mitigate COVID-19 spread. All districts having ≥300 cases/100,000 population. COVID-19 case incidence and test positivity rates by real-time RT-PCR before and after zonal lockdown were compared to assess whether the locality-based lockdowns can be used as an alternative to country lockdown to contain COVID-19 spread.

Methods

Smart lockdowns were implemented in ten localities in the Islamabad Capital Territory (ICT), having a population of 60,000 from 12 May 2020 to June 3, 2020. Movements were restricted. Entry and exit points were guarded by police. Any person with symptoms of fever, cough, or sore throat tested by real-time RT-PCR methods and reported within 24 hours of collection. To compare the rate of active cases and positivity rate by weeks, we performed a z-test for two proportions and set p < 0.05 as the level of significance.

Results

The red zone had 60,000 persons in 2.00 square kilometers. The rate of active COVID-19 cases significantly decreased (p < 0.0001) during intervention from 300/100,000 population pre-containment time to 22/100,000 population after the first three weeks of lockdown. The COVID-19 positivity rate also decreased significantly (p < 0.0001) from 24% (24/78) pre-containment to 5.3% during containment. A total of 3800 people were tested in the following three weeks of intervention and 26 cases were detected.

Conclusions

The smart lockdowns approach reduced COVID-19 transmission in the ICT district. This type of intervention was recommended to reduce the COVID-19 infection spread

Key messages

• Reduced COVID-19 transmission in the ICT district.

• Keeping balance between life and economy.

Assessment of Psychological Impact of Covid Pandemic on Frontline workers at Points of Entry,Pakistan

Background

The unprecedented public health crisis of the COVID-19 pandemic has caused heightened levels of stress and fear among health care workers.With the advent of COVID-19 in Pakistan,frontline workers of POEs have been under physical and psychological pressure including a high risk of infection, abnormal levels of workload, prolonged working hours, lack of personal protective equipment for safety from contagion, isolation, exhaustion, and lack of contact with family.The study aims to assess the impact of Covid-19 on the mental health of frontline healthcare workers.

Methods

A descriptive study was conducted among HCWs across points of entry from 1st October 2020 to 31st December 2020.Data was collected using a structured questionnaire.Depression, anxiety, and stress scale (DASS-21)was used for the assessment of depression, stress, anxiety. Descriptive analysis of socio-demographic and professional factors was done. Multivariable logistic regression analysis (MLRA) was performed using SPSS version 23.0.

Results

A total of 628 participants (586 males and 42 females) completed questionnaire.The mean age of the participants was 42.6 ± 45.9 years. The majority of the respondents were married (94.3%). The frequency of depression, anxiety, and stress in the HCWs was 12.1%, 42.3%, and 22.1 %, respectively. Multivariable logistic regression analysis found that the depression in HCWs was significantly associated with the profession and age (P < 0.001). The anxiety in HCWs was associated with their age and gender (P < 0.005). The stress in HCWs was significantly associated with their age (P < 0.05).

Conclusions

The HCWs at the Points of entry across Pakistan showed mild to moderate symptoms of DAS. The COVID-19 pandemic has caused a heavy psychological impact among the frontline healthcare professionals. Timely psychological counseling and early psychological intervention need to be implemented for HCWs to alleviate their anxiety and stress and improve their general mental health.

Key messages

• The COVID-19 pandemic has caused a heavy psychological impact.

• Timely psychological counseling and early psychological intervention.

Natural Polysaccharides as Preventive and Therapeutic Horizon for Neurodegenerative Diseases

Neurodegenerative diseases are a serious and widespread global public health burden amongst aging populations. The total estimated worldwide global cost of dementia was US$818 billion in 2015 and has been projected to rise to 2 trillion US$ by 2030. While advances have been made to understand different neurodegenerative disease mechanisms, effective therapeutic strategies do not generally exist. Several drugs have been proposed in the last two decades for the treatment of different types of neurodegenerative diseases, with little therapeutic benefit, and often with severe adverse and side effects. Thus, the search for novel drugs with higher efficacy and fewer drawbacks is an ongoing challenge in the treatment of neurodegenerative disease. Several natural compounds including polysaccharides have demonstrated neuroprotective and even therapeutic effects. Natural polysaccharides are widely distributed in plants, animals, algae, bacterial and fungal species, and have received considerable attention for their wide-ranging bioactivity, including their antioxidant, anti-neuroinflammatory, anticholinesterase and anti-amyloidogenic effects. In this review, we summarize different mechanisms involved in neurodegenerative diseases and the neuroprotective effects of natural polysaccharides, highlighting their potential role in the prevention and therapy of neurodegenerative disease.

New insights into the spread of resistance to artemisinin and its analogues

Plasmodium falciparum, the causative agent of malaria, has been developing resistance to several drugs worldwide for more than five decades. Initially, resistance was against drugs such as chloroquine, pyrimethamine, sulfadoxine, mefloquine and quinine. Research studies are now reporting parasites with resistance to the most effective and novel drug used against malaria infection worldwide, namely artemisinin. For this reason, the first-line treatment strategy of artemisinin-based combination therapy is becoming unsuccessful in areas where drug resistance is highly prevalent. The increase in artemisinin-resistant P. falciparum strains has threatened international efforts to eliminate malarial infections and to reduce the disease burden. Detection of several phenotypes that display artemisinin resistance, specification of basic genetic factors, the discovery of molecular pathways, and evaluation of its clinical outcome are possible by the current series of research on genomics and transcriptomic levels in Asia and Africa. In artemisinin resistance, slow parasite clearance among malaria-infected patients and enhanced in vitro survival of parasites occurs at the early ring stage. This resistance is due to single nucleotide polymorphisms within the Kelch 13 gene of the parasite and is related to significantly upregulated resistance signalling pathways; thus, the pro-oxidant action of artemisinins can be antagonised. New strategies are required to halt the spread of artemisinin-resistant malarial parasites.

Antimicrobial resistance surveillance, intensive care units of a tertiary care hospital, Islamabad

Background

Hospital Acquired Infections (HAIs) are the emerging threat in the health care facilities around the globe. Most of Intensive Care Unit(ICU)patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. Objective was to study the occurrence of different types of HAIs in patients admitted to various ICUs of and the AMR pattern of the bacterial pathogens isolated from them.

Methods

It was a retrospective descriptive study based on culture reports of the patients admitted to surgical, Medical ICU of tertiary care hospital during period from March 2019 to October 2019.

Results

Most common culture positive clinical specimen received was tracheal aspirate(35.3%) followed by exudate(22.7%).Pseudomonas from blood specimens were the most common organisms isolated; whereas Escherichia coli was the predominant organism found in urine, exudate and sterile fluid specimens. About 25% infections were HAIs, out of which pneumonia(7.24%)was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli(GNB) was Multi Drug Resistant(MDR) resistant to three or more class of antibiotics such as cephalosporins, aminoglycosides, tetracyclines and fluoroquinolones.

Conclusions

Increasing trend of AMR among hospital acquired pathogens such as MDR-GNBs,MRSA and VRE pose a great threat to critically ill patients of ICUs. Study on AMR surveillance is the need of the hour as it helps the centers to generate local antibiogram which further helps in formulating the national data. Hence, such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial resistance in future

Key messages

Study on AMR surveillance is the need of the hour. such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial resistance in future.

Knowledge about hepatitis B vaccination among women of childbearing age: a cross-sectional study from a rural district of Punjab, Pakistan

Pakistan is considered as an intermediate zone of hepatitis B virus (HBV) infection, with an estimated population prevalence of 2-7%. This study assessed knowledge about HBV and vaccination among women of childbearing age in a rural setting of Punjab province, Pakistan. In 2012 a cross-sectional, community-based survey of 430 women was conducted using a semi-structured questionnaire. Less than half of the women (43%) surveyed had correct knowledge about HBV vaccination, and knowledge was especially poor among the low socioeconomic groups. Age, level of education and obstetric history of the respondents were significantly associated with knowledge about HBV and its vaccination. The main sources of information regarding HBV vaccination were lady health workers (53%) and traditional birth attendants (22%). Health promotion and behaviour change campaigns highlighting the importance of hepatitis B vaccine need to be designed to meet the needs of rural areas where women have little exposure to the mass media.