Explore the vast range of titles available.

Grant administration plays a pivotal role in the success of research and academic endeavors. However, in Pakistan, academic institutions often face challenges in this domain, primarily due to a lack of specialized training and infrastructure. This research paper presents the outcomes of a comprehensive capacity-strengthening workshop, hosted in two cities, aimed at improving grant administration skills in Pakistani academic institutions. A pre and post-survey analysis was conducted to assess participants' knowledge and experience. A pre-survey method was used to develop the learning objectives and content for the workshop, whereas the post-survey tool was used to assess the immediate effect of a two-day capacity-strengthening workshop on participants' knowledge of grants. Response rates for Karachi participants were 86% pre and 87% post, while for Islamabad participants, they were 63% pre and 57% post. Notably, participants in Islamabad, where infrastructure and support services are often less advanced, exhibited significant improvement in their understanding of grant administration processes. Factors contributing to the workshop's success included its dynamic content, interactive learning methods, and an inclusive learning environment. The outcomes of this research provide insights into the effectiveness of tailored capacity-strengthening programs in addressing the unique needs of diverse academic institutions. In addition, it highlights the potential of collaborative learning, where participants from various backgrounds come together to enhance their collective knowledge. This initiative underscores the importance of enhancing grant administration skills to foster a more robust research ecosystem in Pakistan.

Vectorcardiography (VCG) enables measurement of voltages and directions of resultant spatial vectors in the heart that are altered by myocardial ischemia. To validate the ability of VCG to detect electrophysiological effects of regional myocardial ischemia and identify blood vessels that obstruct blood flow significantly, VCG records of 37 patients who presented with unstable symptoms of ischemia requiring coronary angiography (CA) were processed and analyzed. The difference in magnitude and direction of electrical vectors were measured before and after percutaneous coronary intervention (PCI) to study the significance of changes after revascularization. Bio amplifiers recorded 3 simultaneous orthogonal lead ECG signals with low-pass frequency of 150 Hz without electronic filtration. The analogue signals were digitized and recorded for analysis. The numerical output was processed by algorithms to calculate and display the state of vectors. 36 of 37 patients showed congruence between VCG and CA results: 34 of the 36 showed changes in electrical vectors and insufficient blood supply. 2 showed no changes in electrical vectors and non-obstructive arteries on CA. 1 patient had ischemia detected by VCG, but CA was negative. Blood vessels that were opened with PCI corresponded with regions of myocardial ischemia and expected coronary blood supply on VCG interpretation.

Background Non-communicable diseases (NCDs) pose a significant health threat, particularly among adolescents in low- and middle-income countries (LMICs) such as Pakistan. Unhealthy habits, including poor diet, physical inactivity, and substance use, often begin in childhood. These behaviors not only increase the risk of NCDs later in life but can also cause serious health problems during adolescence or early adulthood. This protocol aims to assess the feasibility and potential efficacy of the School eHealth Education Program Pakistan (eSHEPP) in improving the knowledge, attitudes, and practices (KAP) of school students in Karachi regarding NCDs and their risk factors. Methods and analysis A sequential mixed-methods design will be used, combining qualitative and quantitative approaches. In Phase 1, focus group discussions (FGDs) and interviews with stakeholders will identify barriers and facilitators to implementation, as well as gather perspectives on the eHealth application’s design and content. In Phase 2, a pilot cluster randomized controlled trial (cRCT) will assess the program’s feasibility and potential efficacy in improving participants’ KAP regarding NCDs. In Phase 3, FGDs with intervention participants will explore the program’s usability, acceptance, and task–technology fit. Participants The study will engage a diverse group of stakeholders across three phases. Phase 1 will involve four FGDs, two with students and two with teachers (eight participants per FGD), and ten key informant interviews (five with parents and five with school administrators). In Phase 2, 272 secondary and higher secondary school students aged 13–18 years will be recruited from selected schools in Karachi. Phase 3 will include two FGDs with students (eight participants per FGD). Written assents and consents will be obtained from all participants. Intervention The eSHEPP will deliver digital health education via an interactive eHealth application to raise awareness about NCDs and their risk factors among adolescents. Students in the intervention group will attend health-promoting sessions in the classroom for over two months, while the control group will receive no intervention and continue with the routine teaching schedule. Outcomes Phase 1 will identify barriers and facilitators to implementing the eSHEPP in secondary and higher secondary schools and explore stakeholders’ perceptions of its design and content. Phase 2 will assess feasibility, defined as achieving recruitment, retention, and treatment fidelity rates above 70%, and potential efficacy, indicated by a ≥ 25% improvement in KAP after two months. Phase 3 will evaluate the program’s acceptability, perceived usefulness, and task–technology fit to determine how well it meets students’ needs and expectations in the school setting. Ethics and dissemination Ethical approval has been obtained from the Aga Khan University Ethical Review Committee (Ref: 2023-9277-27367) and the National Bioethics Committee Pakistan (Ref: 4–87/NBCR-1089/23/1896). Findings will be disseminated through peer-reviewed journals and national and international conferences. Trial registration number NCT06674798. Strengths and limitations of this study The sequential mixed-methods design will enhance understanding and credibility of the eSHEPP through data triangulation. The pilot cRCT will rigorously evaluate the program while controlling for confounders, strengthening internal validity. Diverse stakeholder perspectives will enrich the data by highlighting barriers, facilitators, and potential efficacy. Findings may not be generalizable to educational settings or cultural contexts beyond Karachi, Pakistan. The small number of clusters ( N  = 4) limits statistical power; therefore, analyses are exploratory, and results should be interpreted with caution.

Background Childhood obesity and hypertension are growing concerns globally, especially in developing countries. This study investigated the association between overall and central obesity at baseline, and prehypertension or hypertension at follow-up among preadolescent school children in urban Karachi, Pakistan. Methods This is a sub study with cohort design embedded within a feasibility trial on School Health Education Program in Pakistan (SHEPP) in preadolescents aged 6–11 years, attending two private schools conducted from 2017 to 2019. Hypertension or prehypertension at follow-up were the outcomes and obesity or central obesity at baseline were the exposure variables. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure ≥ 95th percentile for age, sex, and height. Obesity was defined as body mass index for-age and sex ≥ 95th percentile, whereas central obesity was determined by waist circumference measurements ≥ 85th percentile of age, sex, and height specific cut-offs. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to identify risk factors for hypertension and prehypertension. Results Analysis was conducted for 908 participants, evenly distributed with 454 boys and 454 girls. Hypertension was observed in 19.8% of the preadolescents, with rates of 18.5% in boys and 21.0% in girls. Prehypertension was found in 16.8% of preadolescents, with 18% among boys and 16% among girls. Additionally, 12.8% of preadolescents were classified as obese and 29.8% had central obesity. Obesity at baseline was associated with hypertension at followup (OR 8.7, 95% CI 3.5, 20.4) in the final model after adjusting for age, gender, physical activity, sedentary behavior, fruits, vegetable intake and hypertension at baseline. Central obesity at baseline also yielded high odds, with prehypertension (OR 1.9, 95% CI 1.4, 2.8) and hypertension (OR 2.7, 95% CI 1.9, 3.9) at follow up in the final model. Conclusion This study highlights a concerning prevalence of hypertension and prehypertension among preadolescent school-going children. Obesity and central obesity at baseline emerged as significant predictive factors for hypertension or prehypertension at followup within this cohort. The findings emphasize the urgency of implementing comprehensive school health education programs aimed at early detection and effective management of hypertension during childhood and adolescence in school settings.

Background: Tobacco consumption poses a significant challenge to global health and contributes to the increase in noncommunicable diseases and premature deaths. Aim: To investigate the potential impact of a 70% tobacco tax on consumption and government revenue in Pakistan. Methods: We analysed secondary data from 2011 to 2022 (after imposition of a 70% excise tax) from the Pakistan Bureau of Statistics, Pakistan Social and Living Standard Survey, financial yearbooks and Federal Board of Revenue reports for tobacco consumption and government revenue. Variables included tobacco price inflation, per capita income, cigarette price, federal excise duty, and government revenue. Results: The higher taxes reduced tobacco production by PKR 3.72 billion (≈US$ 13.4 million). Price elasticity analysis indicated an inelastic demand for cigarettes, mostly among the rural populations. Imposition of excise duty of 70% of the retail price caused a decrease in government revenue by PKR 390 million (≈US$ 1.4 million). Conclusion: Implementing 70% taxation on tobacco products is beneficial, however, to fully realize its benefit, there is a need for strict regulation on brand shifting and illegal trade.

ObjectivesData on postdischarge care for stroke and myocardial infarction (MI) patients remain limited. Logistical barriers, including fragmented communication and poor coordination between patients and physicians, contribute to suboptimal outcomes and hinder secondary prevention. Mobile health (mHealth) offers a promising strategy to support continuity of care. We aimed to synthesise existing literature and evaluate mHealth interventions for postdischarge MI and stroke care.DesignThis scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline.Data sourcesPubMed, CINAHIL, Scopus and Cochrane were searched from 26 July 2016 to 5 July 2024.Eligibility criteriaThis scoping review included randomised controlled trials and observational studies published in peer-reviewed journals that evaluated mHealth interventions for postdischarge care in MI and stroke. Studies reporting outcomes such as mortality, functional capacity, readmissions or adverse events were included.Data extraction and synthesisTwo authors independently extracted and summarised the data. Subsequently, methodological quality was independently assessed by two other authors using the Joanna Briggs Institute checklist.ResultsWe identified 31 eligible studies, with 14 631 participants and 59.9 mean years old. Most participants were male. Among these, three (%) originated from low-middle income, seven (%) from upper-middle income and 21 (%) from high-income countries. Overall, we identified 17 studies using mobile apps: eight as a single intervention, and nine combined with remote sensors, seven with SMS, three studies used web-based platforms, two used phone calls, one study combined SMS and phone calls and another used remote sensors only. Multimodal telerehabilitation reported better outcomes compared with single-mode mHealth interventions. Most studies assessed functional capacity (26 studies) and quality of life (21 studies).ConclusionThis review highlighted increased mHealth uptake among postdischarge MI and stroke patients, including significant underrepresentation of female participants, scarce studies from low-middle-income countries or rural areas and limited reporting of hard clinical endpoints. While mHealth showed positive outcomes across most studies, it further highlights contextual factors that account for digital disparity and the need to prioritise inclusive, user-centred designs and integrate objective measurement tools on future trials and policy frameworks.

BackgroundThis review aims to describe existing evidence on the state of hypertension in Pakistan, including the prevalence, associated risk factors, preventive strategies, and challenges in the management of hypertension.MethodsA comprehensive literature search was conducted electronically using PubMed and Google Scholar. Using specific screening methodology, 55 articles were selected to be included.ResultsWe found from this extensive review that several small studies report high prevalence of hypertension but there is a lack of population based prevalence of hypertension in Pakistan. Lifestyle risk factors such as obesity, unhealthy diet, decreased physical activity, low socioeconomic status, and lack of access to care were the main associated factors with hypertension. Lack of blood pressure monitoring practices and medication non-adherence were also linked to uncontrolled hypertension in Pakistan and were more evident in primary care setups. The evidence presented is essential for delineating the burden of the disease, hence allowing for better management of this underserved population.ConclusionThere is a need for updated surveys to depict the true prevalence and management of hypertension in Pakistan. Cost-effective implementation strategies and policies at the national level are needed for both prevention and control of hypertension.

This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44–69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) ( p  < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) ( p  < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period ( p  = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28–34.55, p  < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13–9.05, p  < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38–3.91, p  < 0.001), stroke (aOR 2.40, 95% CI 1.26–4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28–3.35, p  = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95–3.09, p  < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35–0.60, p  < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39–3.56, p  < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37–5.80, p  = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves.

Background Health-related Quality of life (HRQoL) assessment is essential for optimizing patient care, treatment adjustments, and medical decision-making, particularly in post-Myocardial Infarction (MI) patients, but limited data exists on HRQOL post-MI from Pakistan. This study aimed to assess HRQoL and its determinants in the Pakistani population. Methods A single-center cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Patients ≥ 18 years old with a primary diagnosis of acute MI (ICD-9 codes: 410.0-410.9 and ICD-10 codes: 121.0-121.9) discharged from the Cardiology Service from January 2019 to December 2020 who could be contacted and consented to participate were included. Data was collected from electronic records, and patients were interviewed via phone calls using a validated Urdu version of the WHOQOL-BREF questionnaire. Statistical analysis was performed using non-parametric tests via RStudio (Version 1.4.1717). Results The final study cohort was 440 patients with a median age of 63.0 (IQR: 56.0,72.0) years, with a male predominance (68.2%). Physical health was the most affected domain. Females, lower-income individuals, and those with lower levels of education had lower HRQoL scores in all domains. Diabetes and the presence of multiple co-morbidities were associated with lower HRQoL. Marital and socioeconomic status, along with psychosocial factors were significantly associated with HRQoL scores. Notably, 62.0% of post-MI patients rated their overall HRQoL as good (4–5 on a Likert scale of 1–5). Cronbach’s alpha values indicated good internal consistency, with an overall Cronbach’s alpha of 0.902. Conclusion Although a significant proportion of patients in our cohort reported good HRQoL post-MI, several social factors were associated with lower HRQoL. These factors must be investigated further in discharge planning and post-discharge of patients with MI.

Background Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. Objective To estimate the burden of cervical cancer in Pakistan using available data sources. Methods We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. Results A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995–1997 ASIR = 6.81, 1998–2002 ASIR = 7.47, and 2017–2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015–2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. Conclusion The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.